Tiered Service Architecture for Remote Patient Monitoring

We develop a remote patient monitoring (RPM) service architecture, which has two tiers of monitoring: ordinary and intensive. The patient's health state improves or worsens in each time period according to certain probabilities, which depend on the monitoring tier. The patient incurs a "loss of quality of life" cost or an "invasiveness" cost, which is higher under intensive monitoring than under ordinary. On the other hand, their health improves faster under intensive monitoring than under ordinary. In each period, the service decides which monitoring tier to use, based on the health of the patient. We investigate the optimal policy for making that choice by formulating the problem using dynamic programming. We first provide analytic conditions for selecting ordinary vs intensive monitoring in the asymptotic regime where the number of health states is large. In the general case, we investigate the optimal policy numerically. We observe a threshold behavior, that is, when the patient's health drops below a certain threshold the service switches them to intensive monitoring, while ordinary monitoring is used during adequately good health states of the patient. The modeling and analysis provides a general framework for managing RPM services for various health conditions with medically/clinically defined system parameters.