Remote Patient Monitoring

The opportunity to support healthcare without limits in time and location

We are finalizing a smart remote patient monitoring solution for hospitals and clinics, applicable for remote monitoring of patients in an unrivalled way. Our solution has already been used in several clinics, including the Klinikum rechts der Isar (Technical University of Munich, TUM), to monitor COVID-19 patients in home isolation as part of a study. The cosinuss° remote monitoring system is also currently being used in several research projects. We aim to medically certify this field-tested system and scale it up into hospitals and clinics as an easy-to-use, cost-effective remote patient monitoring solution, for broader application.

Vital signs of a patient located in the inner city of Munich is being monitored remotely with an in-ear sensor

The Challenges

High risk of infections in medical facilities

In hospitals there is an increased risk of nosocomial infections with several diseases. In Germany, for example, there are approximately 400.000 to 600.000 nosocomial infections with up to 20.000 deaths per year1 – often caused by
multi-resistant germs. According to a study almost every tenth patient brings dangerous multi-resistant germs into the clinic.2 This is a potential danger not only for patients, but also for the medical staff.

Limitations due to time-consuming health assessment

In hospitals and medical centers patients can only be treated one after the other due to the limited capacities and available medical staff. For this purpose, a doctor has an average of eight minutes per patient during which, among other measures, he must record the relevant vital parameters and decide on the appropriate next steps. This leads to considerable delays and limitations in treatment of patients.3

Current telemedicine solutions only provide subjective data

Currently available telemedicine solutions for the actual relief of problems such as risk of nosocomial infections and time-consuming health assessment are limited to subjective, manually entered patient data and video consultation, lacking the essential, objective vital signs data from the patients.

The Solution

Remote Patient Monitoring with highly accurate In-Ear Sensors

To address these challenges we are currently developing the cosinuss° RPM (Remote Patient Monitoring) solution, consisting of an in-ear wearable sensor, a gateway (cosinuss° LabApp or Gateway) and a server database (cosinuss° Server), all developed in-house.

The in-ear wearable is a first-in-class vital signs sensor that monitors all the key physiological vital parameters and other key health indicators continuously, non-invasively and in a mobile way. The vital parameters can be monitored with high accuracy in a single in-ear device in everyday life, without restricting movement. The in-ear-sensor is not only robust but also small, light-weight, non-invasive and convenient to use, even for elderly people. In-ear buds are widely accepted and comfortable to wear – even during the night. Most importantly, in addition to its superior medical-grade accuracy compared to other wearable vital signs monitors such as wrist devices or skin patches, the in-ear sensor provides highly reliable data collections.

Furthermore, cosinuss° RPM not only will provide the wearable in-ear sensor, but also a whole end-to-end solution directly connecting numerous patients with a healthcare professional. Aligning the monitored patients on the dashboard according to their Deviation Scores thus will allow the clinical staff to take care of the patients in need first.

Measuring the relevant vital signs

Our cosinuss° RPM system is going to continuously evaluate:

  • Core body temperature

  • Heart rate

  • Blood oxygen saturation

  • Respiration rate

Caring for the patients who are in need first

The cosinuss° RPM will include advanced algorithms to automatically calculate the key physiological vital parameters of a patient, based on continuous measurements. It is going to assist the medical staff in decision-making also by calculating a Deviation Score per patient, indicating a level of deviation from medically accepted normal ranges. The medical staff will oversee the health states of numerous patients in real-time on a dashboard, provided by the cosinuss° Health Platform, and decide whether and for which patient urgent action is necessary (e.g. hospitalization). The cosinuss° RPM could be used as a standalone solution or be seamlessly integrated with existing telemedicine solutions worldwide.

Visualization of cosinss° Remote Patient Monitoring

Fig. 1: Visualization of the cosinuss° Remote Patient Monitoring system (under development)

Addressing the current situation: Remote Patient Vital Signs Monitoring for COVID-19

Remote patient monitoring has become even more relevant during the current COVID-19 pandemic. COVID-19-patients are required to stay in home isolation unless their health status is deteriorating. These patients could be equipped with a cosinuss° in-ear wearable sensor. The measurements will be received via Bluetooth by the data-gateway, which can be a mobile app (cosinuss° LabApp) or a stand-alone device (cosinuss° Gateway) that is capturing and storing the transferred data. Most of the key vital parameters are going to be processed on the wearable itself. The pre-processed data will then be streamed to the cosinuss° Server.

The medical staff will be able to remotely monitor the health status of each patient via the cosinuss° Health Platform and take early action in case of clinical worsening, while preventing unnecessary patients’ hospital visits. In this way a potential collapse of the healthcare system could be prevented as many people going to an emergency room or seeking doctors could be monitored or treated at home. Therefore, the cosinuss° RPM solution aims to enable an optimally working healthcare system, by reducing the number and length of hospitalizations. Exposure to the disease and the risk of infection for the medical staff can be minimized. It enhances financial viability and provides objective data for medical research. With our solution, patients will be assigned a more active role in their own treatment: They will learn more about their condition and improve their self-care skills.

The Conclusion

Supporting the healthcare system

Our solution, with the rapid advancement in telemedicine, will create an opportunity that makes healthcare more available and not only the COVID-19 pandemic more manageable by:

  • Eliminating unneeded hospitalization

  • Minimizing infection risk for healthcare professionals and patients

  • Improving risk assessment for patients

  • Enabling timely intervention

  • Continuous patient monitoring in home isolation

Stage of Development: Field tested

The cosinuss° remote patient monitoring solution has already been successfully tested and deployed in several studies, including at the University Hospital rechts der Isar, Munich (Telecovid), at the Großhadern Hospital of the LMU Munich (Digital Monitoring COVID-19) and at several other university hospitals in Europe. The focus was on monitoring COVID-19 patients in home isolation as well as during hospitalization. Thanks to the feedback received, we have already been able to optimize our RPM solution and now have a ready-to-use system. Further improvements in usability and algorithms are being implemented on an ongoing basis.

Selected references: Use of the cosinuss° RPM solution

A Closer Look

Frequently Asked Questions about Remote Patient Monitoring

To get a better understanding of remote patient monitoring it is useful to define the terms of “telehealth” and “telemedicine” first.

Telehealth is defined as the provision and facilitation of health and health-related services including provider and patient education, health information services, medical care, and self-care via telecommunications and digital communication technologies. Remote patient monitoring (RPM) is an example of a technology used in telehealth.4

Telemedicine involves the remote diagnosis and treatment of patients using telecommunications technology. This includes the use of technology and telecommunications systems to provide health care to patients who are geographically separated from healthcare professionals. While telemedicine specifically refers to the practice of medicine using remote technology, telehealth includes all components and activities of healthcare and the healthcare system that are performed using telecommunications technology. Health education, portable devices that record and transmit vital signs and remote communication from provider to provider are examples of telemedical activities and applications that go beyond clinical care.5

Remote patient monitoring (RPM) or telemonitoring belongs to the subcategory of telemedicine. It enables the use of mobile medical devices and technology to gather patient-generated or automatically measured health data which is sent to healthcare professionals (e.g. medical practices, clinics). Telemonitoring includes the measurement of physiological parameters (e.g. heart rate, temperature), non-physiological data (e.g. GPS position, outside temperature) and subjective patient information (e.g. reporting of feeling, daily mood). RPM helps medical professionals to monitor and treat patients who for example require chronic, post-discharge or senior care. RPM solutions can notify healthcare institutions of potential health issues or keep track of patient data between doctors visits.6 7

Depending on the use case (i.e. medical condition being monitored) and the devices being used the available RPM systems can work slightly differently, but most of them use similar components: Thus many solutions provide the patient with a wearable sensor that can measure specific physiological parameters. Some of these sensors are able to connect to additional sensors or devices, all collecting data, which then typically is sent to a (smartphone) application, gateway device or directly to the healthcare provider database. (Smartphone) applications mostly provide patients with an interface that allows tracking and/or analyzing the data. Some apps also include treatment recommendations. The collected data is then sent to the medical institution, where the staff can monitor, evaluate and overlook the health states of their patients, often via a digital dashboard. If needed, they can get in touch with the patient to discuss the current status and to plan further steps, such as treatment or medication.8

Remote patient monitoring solutions have a wide variety of benefits – not only for the patient but also for medical professionals and health institutions. As patients are able to play a significant role in managing and understanding their own health, patient engagement and compliance grow while using RPM solutions. With RPM devices and applications patients get the opportunity of gaining a lot of feedback and information about their personal health condition, which can lead to higher levels of health literacy. Besides that, the continuous monitoring of the health status via remote technology gives patients a certain peace of mind that any potential issues will be identified by a health professional in a timely manner.
Remote patient monitoring solutions provide patients and healthcare professionals with more relevant patient data than before. This leads to an increased overall quality in healthcare. RPM solutions enable better and more efficient access to healthcare: Patients can complete basic health testing such as measuring oxygen saturation on their own while healthcare professionals are able to treat more patients in a certain amount of time. Furthermore many hospitalizations and resubmissions can be avoided since many issues can be managed remotely via telephone, video call, email or messaging services.9 10

There are different RPM devices being used today. A basic distinguishing criterion is whether the device is invasive or non-invasive. Invasive and/or minimally invasive devices are defined as devices, which, in whole or in part, penetrate inside the body (through a body orifice or through the surface of the body), such as insulin pumps. Besides this category there are also surgically invasive devices and implantable devices available, such as pacemakers.11 In the category of noninvasive monitoring devices and technology there is a great diversity available, such as smartphone apps, wearable devices, computerized systems, biosensor devices. Often a combination of two or more of these technology categories are being used at the same time, whereas they require a different amount of activity from the patient. For example, a wearable in-ear sensor can be automated to capture and transmit health data without any action from the patient. With other technologies, the patient needs to submit his/her own health data manually through a smartphone or website.12 13

Whether or not telemedicine is reimbursed and how it is structured varies greatly from country to country. In addition, many processes are currently under development and still changing, accelerated by the corona pandemic, among other things. Here are a few examples:
In Germany since October 2020 it has been possible to have special apps and digital technologies (DiGA) prescribed by doctors and reimbursed by health insurance companies. Video consultation hours are also possible and reimbursable under certain conditions.
In Denmark, theoretically nothing stands in the way of the legislation from exclusively treating and diagnosing patients via telemedicine services, but the conditions for billing insurance companies are not yet regulated.
In France, the law allows patients to be diagnosed and treated via telemedical services. Since 2018, this service is also legally billable. However, there is as yet no legal regulation on how to finance such services.
The Swedish government finances its e-health authority through a separate budget. In general, digital services are reimbursed by insurers in the same way as conventional services. In the Stockholm region, doctors can charge the same amount for a teleconsultation via video chat as for a visit to a doctor’s office. Patients also pay the same practice fee for both variants.14

More information on this topic and examples of more countries can be found here:

Rapidly developing information technologies – and currently the COVID-19 pandemic – accelerate the adoption of remote patient management and monitoring in Europe. There is an increasing demand for telemonitoring solutions in healthcare, which has a real potential to deliver efficient and preventive patient care in a cost-effective way. Connected medical wearable sensors are part of the infrastructure that can enable objective data based on telemonitoring solutions.
The telemedicine market size worldwide stood at USD 34.28 billion in 2018 and is projected to reach USD 185.66 billion by 2026, exhibiting a CAGR of 23.5% in the forecast period. In Europe, the telemedicine market currently stands at USD 9.93 billion and is expected to grow to USD 19.2 billion by 2024 – that’s 14.1% per year. The worldwide size of the remote patient monitoring market is amounded to USD 4046 million in 2019 and is expected to be USD 7700 million by 2024, implying a CAGR of 13.7%. In Europe, the remote patient monitoring market stood at USD 1046 million in 2019 and is forecast to grow to USD 1972 million by 2024 (CAGR 13,52%). The global market revenue from wearable devices and services is also rapidly growing: over the last five years from EUR 13 billion to EUR 23.1 billion and is expected to increase by an additional EUR 9 billion by 2020.15 16 17 18 19 20 21

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Quellen / References

  1. Neue Schätzung zur Krankheitslast durch Krankenhaus-Infektionen (Pressemitteilung des Robert Koch-Institus, 2019) (Abruf: 26.10.2020)
  2. Fast zehn Prozent der Klinikpatienten bringen multiresistente Keime mit (Ärzteblatt, 15.8.2016) (Abruf: 26.10.2020)
  3. Irving G, Neves AL, Dambha-Miller H, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open 2017;7:e017902. doi: 10.1136/bmjopen-2017-017902
  4. What Is Telehealth?, By NEJM Catalyst, (Abruf: 3.11.2020)
  5. What Is Telehealth?, By NEJM Catalyst, (Abruf: 3.11.2020)
  6. remote patient monitoring (RPM), (Abruf: 3.11.2020)
  7. Weiterentwicklung der eHealth Strategie, Studie im Auftrag des Bundesministeriums für Gesundheit (2016), PwC.
  8. remote patient monitoring (RPM), (Abruf: 3.11.2020)
  9. Remote patient monitoring (RPM), (Abruf: 3.11.2020)
  10. Hennick, Calvin: How Remote Patient Monitoring Programs Are Beneficial, Health Tech Magazine, (Abruf: 3.11.2020)
  11. Principles of Medical Devices Classification, Study Group 1 Final Document GHTF/SG1/N77:2012, (Abruf: 3.11.2020)
  12. Vegesna A, Tran M, Angelaccio M, Arcona S. Remote Patient Monitoring via Non-Invasive Digital Technologies: A Systematic Review. Telemed J E Health. 2017;23(1):3-17. doi:10.1089/tmj.2016.0051, (Abruf: 3.11.2020)
  13. Shelagh, Dolan: The technology, devices, and benefits of remote patient monitoring in the healthcare industry, Business Insider, Abruf(3.11.2020)
  14. Thiel, Rainer & Deimel, Lucas: Einsatz und Nutzung von Telemedizin – Länderüberblick, Juni 2020, (Abruf: 3.11.2020)
  15. Fortune Business Insights (2019). Telemedicine Market to Reach USD 185.66 Billion by 2026 | Global Report Size, Share, Growth, Analysis, Forecast [2019-2026]. URL: (02.10.2020)
  16. Market Data Forecast. (2020). Europe Telemedicine Market Analysis| 2020 to 2025. URL: (05.10.2020)
  17. Topol, E. (2020). Telemedicine is essential amid the covid-19 crisis and after it. URL: (22.09.2020)
  18. Market Data Forecast. (2020). Global Remote Patient Monitoring Market Analysis (2019-2024). URL: (02.10.2020)
  19. Krüger-Brand, H. (2018). Fernbehandlung: Weg frei für die Telemedizin. Dtsch Arztebl 2018; 115(20-21). URL: (01.10.2020)
  20. Judd E. Hollander, M.D., and Brendan G. Carr, M.D. (2020). Virtually Perfect? Telemedicine for COVID-19. N Engl J Med 2020; 382:1679-1681. doi: 10.1056/NEJMp2003539. URL: (30.09.2020)
  21. European Commission. (2018). Market study on telemedicine. URL: (30.09.2020)