Remote Patient Monitoring Applications in Healthcare: Lessons from COVID-19 and Beyond

Abstract

The COVID-19 pandemic catalyzed the rapid adoption of remote patient monitoring (RPM) technologies such as telemedicine and wearable devices (WDs), significantly transforming healthcare delivery. Telemedicine made virtual consultations possible, reducing in-person visits and infection risks, particularly for the management of chronic diseases. Wearable devices enabled the real-time continuous monitoring of health that assisted in condition prediction and management, such as for COVID-19. This narrative review addresses these transformations by uniquely synthesizing findings from 13 diverse studies (sourced from PubMed and Google Scholar, 2020–2024) to analyze the parallel evolution of telemedicine and WDs as interconnected RPM components. It highlights the pandemic’s dual impact, as follows: accelerating RPM innovation and adoption while simultaneously unmasking systemic challenges such as inequities in access and a need for robust integration approaches; while telemedicine usage soared during the pandemic, consumption post-pandemic, as indicated by the reviewed studies, suggests continued barriers to adoption among older adults. Likewise, wearable devices demonstrated significant potential in early disease detection and long-term health management, with promising applications extending beyond COVID-19, including long COVID conditions. Addressing the identified challenges is crucial for healthcare providers and systems to fully embrace these technologies and this would improve efficiency and patient outcomes.

1. Introduction

The 2019 coronavirus disease (COVID-19) challenged healthcare systems worldwide by straining staff capacity, increasing infection risks, and overwhelming hospital resources. In response to the early outbreak of the pandemic, remote patient monitoring (RPM) quickly became a crucial solution that allowed healthcare workers to remotely care for patients with mild symptoms. This relieved healthcare centers and allowed them to prioritize patients with severe conditions. Telemedicine reduced the burden on physical health facilities by using video calls, phone consultations, and sharing patient data between institutions. Wearable devices (WD) had a significant impact in the early detection and management of COVID-19 by allowing healthcare professionals to access real-time physiological data from patients. Resources, such as the COVID-19 Data Archive (COVID-ARC) [1], gave researchers access to multimodal and longitudinal datasets, enhancing healthcare quality and patient empowerment.

Prior to the COVID-19 outbreak, healthcare systems around the globe were already experiencing severe structural challenges, including increasing healthcare costs and diminishing access, especially in rural and underserved communities [2,3]. Over time, these issues resulted in overburdened facilities and strained healthcare workers, limiting the ability of these systems to respond effectively to all patient needs. As global populations continue to age and chronic conditions become more prevalent, traditional healthcare models are seen as unsustainable, whereas telemedicine is predicted to be a useful healthcare modality, specifically feasible and acceptable among older adults [4]. The pandemic underscored these challenges, enhancing the gaps in healthcare solution advancements and making it apparent that digital health solutions, like RPM, could play a pivotal role in solving accessibility issues and managing chronic care outside of traditional healthcare systems.

In order to obtain a deeper understanding of the process of RPM adoption, this review uses concepts of the Diffusion of Innovation (DOI) theory. DOI provides a framework for analyzing the adoption and transmission of new technology in a social system. Certain factors are considered such as relative advantages, compatibility, and observability. These can be utilized to understand the barriers and facilitators that influenced the adoption of RPM during the pandemic.

Beginning with an overview of RPM, this paper reviews the evolution of RPM technologies in healthcare during and after the pandemic. By highlighting the existing literature, this article suggests future uses of telemedicine and WD that may also be helpful if healthcare providers fully adopt them. This paper reviews the existing literature on RPM in healthcare during and after the pandemic (see

Table 1. Summary of remote patient monitoring methods that are commonly used in patient care.

RPM	Specific Types	Studies
Telemedicine	Video conferences, Telephone calls	[5,6,7,8,9,10,11,12]
Wearable Devices	Invasive sensors, Non-invasive sensors	[13,14,15,16,17]

for a review).

The accelerated adoption and evolution of RPM during the COVID-19 pandemic created a unique natural experiment, generating an immense amount of data and experiences at a completely unprecedented scale. This period highlighted the transformative potential of RPM technologies and its inherent challenges in widespread implementation. Although several reviews have explored aspects of RPM in this context, there remains a distinct gap in synthesizing the concurrent lessons from major RPM modalities—telemedicine and diverse wearable device applications. Many existing reviews address these components in isolation or cover different scopes. For instance, some provide broad overviews of telemedicine, including its historical trajectory and future strategies [18,19], and others narrowly focus on specific practices like gastroenterology and hepatology [20]. However much of the existing knowledge on telemedicine and WD usage in relation to the pandemic remains relatively fragmented. Therefore, this narrative review aims to synthesize the lessons learned during the pandemic and evidence of RPM usage post COVID-19, to provide a holistic perspective on how RPM applications evolved during the pandemic and beyond. This is also crucial because the real-world application of these technologies offers scalable lessons for the integration of RPM into routine post COVID-19 healthcare and in preparation for future public health crises.

To guide this narrative synthesis, this paper addresses the following research question: How did the COVID-19 pandemic accelerate the adoption and application of key RPM technologies (specifically telemedicine and wearable devices) and what systemic benefits, barriers, and lessons for future integration persist in the post-pandemic landscape?

2. Methodology

A structured literature search and narrative review process was performed to identify relevant studies discussing the application and impacts of RPM technologies, specifically telemedicine and WDs, during and after the COVID-19 pandemic. In this review, telemedicine is defined as either synchronous or asynchronous virtual consultation between healthcare providers and patients. Similarly, WDs include consumer-grade and medical-grade sensors that are capable of continuously or intermittently collecting physiological data.

The literature search was performed using PubMed and Google Scholar databases. The PubMed search was as follows: ((“covid-19”[MeSH Terms] OR “post covid-19”[All Fields] “SARS-CoV-2”[MeSH Terms] OR “SARS-CoV-2”[All Fields])) AND ((“remote patient monitoring”[All Fields] OR “telemedicine”[MeSH Terms] OR “telemedicine”[All Fields] OR “wearable devices”[All Fields])). For Google Scholar a combination of keywords including the following were used: “COVID-19", “post COVID-19", “SARS-CoV-2", “Remote Patient Monitoring", “Telemedicine", and “Wearable Devices”. The search was set to retrieve articles with publication dates ranging from 2020 to 2025 and to identify texts in the English Language. In PubMed, article types were initially filtered to include clinical trials, meta-analysis, randomized controlled trials, reviews, and systematic reviews to capture a broad range of evidence.

Studies were selected based on predefined criteria. To be included, an article had to fulfill the following: (1) address the utilization of telemedicine and/or WDs within a healthcare setting; (2) directly relate to the COVID-19 pandemic or discuss implications for the post-pandemic period; and (3) provide original data, substantive case studies, or in-depth analyses. The exclusion criteria included the following: (1) articles not published in English; (2) duplicate publications; and (3) opinion pieces.

The selection process was carried out in two steps. First, titles and abstracts of the retrieved articles were screened by the author (A.K.) to identify relevant studies. Next, the full text of these studies was thoroughly assessed against the criteria to determine final eligibility. After this evaluation, 13 studies were chosen for an in-depth review. These 13 studies were chosen based on their direct relevance to our review’s objectives and their collective ability to shed light on the adoption trends, impacts, and challenges of RPM integration. For each of the studies chosen, key information, including study design, cohort size (if applicable), major findings related to RPM, and reported limitations, was extracted and synthesized.

Although this review does not adhere to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines [21] that are generally used for systematic reviews and meta-analyses, it follows a narrative review process. This approach was explicitly chosen because the 13 selected studies are highly heterogeneous, including quantitative analyses, qualitative studies, and program reports. This makes a statistical meta-analysis unfit for this review. The primary objective is therefore a thematic synthesis which is used to integrate and interpret diverse evidence on the co-evolution of two distinct technologies, a goal for which a narrative approach is better suited. Furthermore, this approach allows for the inclusion of varied studies that offer rich insights into adoption patterns, challenges, and real-world impacts.

This review has several methodological limitations. The search was restricted to articles written in English, which omits several relevant insights from non-Western healthcare systems. Furthermore, the focus on 13 core studies means this review is not exhaustive.

3. Results

This section synthesizes the findings of the 13 selected studies to examine the multifaceted impacts and evolution of Remote Monitoring of Patients (RPM) on healthcare during and after the COVID-19 pandemic, as summarized in

Table 2. Comprehensive summary of core studies included in the review.

Study	Study Focus	Study Design	Population Size	Key Findings
[5]	Telemedicine	Time-series analysis	41 million outpatient visits from 94 Epic Cosmos contributors	Telehealth usage surged from <1% to 13% during the pandemic, later stabilizing at 8%. Young patients were the primary users of telemedicine.
[6]	Telemedicine	Retrospective analysis at NYU Langone Health	115,789 patients, 2656 providers	A 683% increase in urgent care telemedicine visits. Daily urgent care visits grew from 102.4 to 801.6. Telemedicine use was highest among patients aged from 20 to 44. Daily non-urgent video visits increased from <50 to 7000+.
[7]	Telemedicine	Retrospective cohort study at Duke University Health	22,156 outpatient cardiology encounters in 2020	About 9.3% of scheduled visits in 2020 were telemedicine visits. In 2020, telehealth users were generally younger and had fewer comorbidities than in-person attendees.
[8]	Telemedicine	Mixed-methods physician study in Lebanon	140 physicians in Lebanon	Showed a significant positive shift in physicians’ perceptions and engagement with telemedicine. Clinical interactions via internet/phone increased during the pandemic.
[9]	Telemedicine	Qualitative interview study in Spain	53 healthcare professionals in Spain	A total of 96.2% professionals considered video consultations satisfactory, especially for chronic patients; 90.6% considered it necessary to train and educate professionals in this modality.
[10]	Telemedicine	Qualitative interview study in Southern California	15 primary care physicians	Physicians could observe patients’ home environments, assessing safety and support systems. Absence of in-person exams reduced diagnostic confidence. Managing telemedicine with regular duties raised concerns about provider burnout.
[11]	Telemedicine	Retrospective patient and physician survey	93 patients, 33 physicians	High patient satisfaction (77%); physicians were comfortable diagnosing via telemedicine. 46.7% of patients encountered technological issues. Physicians’ primary limitations was the inability to perform physical examination.
[12]	Telemedicine	Cross-sectional U.S. household survey	3454 US households	About 86% of users reported positive experiences; use was higher in urban, higher-income households.
[13]	Wearable Devices	Prospective cohort study of post-discharge RPM	225 enrolled patients	An RPM program using patient-entered data was associated with minimized readmission rates.
[14]	Wearable Devices	Systematic review of wearables for COVID-19	9 studies, 10,558 participants	Consumer wearables measuring HRV demonstrated potential in detecting and predicting COVID-19.
[15]	Wearable Devices	Prospective validation of wearable alerting algorithm	470 healthcare workers	Achieved 90% detection rate for PCR-confirmed COVID-19.
[16]	Wearable Devices	Narrative review of wearables for long COVID	N/A	Suggested that wearables can help better control and manage long COVID in a personalized way.
[17]	Wearable Devices	Scoping review of wearables for long COVID	11 studies reviewed	Wearables are feasible for monitoring long COVID symptoms. Identified 10 different devices. Concluded more robust, controlled trials are needed to establish clinical guidelines.

. The discussion is structured to first provide a general overview of RPM, its core components, and its pivotal role (Section 3.1). This is followed by more specialized analyses of the transformations observed in Telemedicine (Section 3.2) and Wearable Devices (WDs) (Section 3.3). In these two subsections, we also highlight key adoption patterns, distinctive contributions, and reported benefits and challenges identified in the reviewed literature to identify overarching themes and insights.

3.1. Remote Monitoring of Patients (RPM)

RPM is a state-of-the-art solution designed to improve patient care by leveraging the digital transmission of health data. Although RPM initially relied on traditional telephone lines for RPM, technology has significantly improved its functionality. The latest technological developments and sensor networks now allow the healthcare providers to monitor their patients more effectively and efficiently and ensure better care [22]. The architecture of RPM comprises three fundamental components, shown in Figure 1. First is the data acquisition layer, where invasive and non-invasive methods are used to collect vital physiological measurements [23]. Invasive methods, while less common in the studies reviewed here targeting pandemic scalability, may use implantable glucose monitors, while non-invasive methods common in the studies reviewed here include pulse oximeters and wearables that collect data such as heart rate and activity levels. Other types of devices record environmental data, such as room temperature, that provide valuable context to the patient’s condition. Once data have been collected, they are transmitted via telephone lines, the Internet, or videoconferencing, and they are secured in cloud-based storage infrastructure to be processed and analyzed. The final layer consists of back-end systems where data are analyzed and used by health providers to facilitate the correct diagnosis and treatment of patients. Several of the 13 reviewed studies underscored how this fundamental RPM architecture was rapidly adapted and scaled during the pandemic to meet surging demands. Some key RPM tools used during and after the pandemic are summarized in Figure 2.

A systematic review of 272 studies [24], 47.8% of which reported on cardiovascular disease, concluded that RPM significantly improves patient care and treatment outcomes. It enables early disease detection and patient education, decreasing mortality and readmission to hospital. Furthermore, 75.7% of the 272 studies found that wireless devices and smartphone applications were the most common form of RPM, with only 15.1% utilizing implantable devices. This result directly corresponds to the growing trend in wireless devices and smartphone applications over the past few years. Aside from cardiovascular ailments, RPM has been shown to be effective in managing other chronic diseases as well. In a randomized controlled study of 100 subjects with diabetes [25], RPM produced clinical results equivalent to those provided by traditional medical center-based interventions. Through many years, RPM has been extremely successful and beneficial to patients and healthcare providers alike; however, it has yet to be widely used within the healthcare system.

A phenomenal increase in the use of RPM was facilitated by the COVID-19 pandemic. Patients who would otherwise require in-person visits were all advised to make a transition to telemedicine care, with COVID-19 patients discharged from the hospital being enrolled into RPM programs to provide ongoing monitoring following hospital discharge [13]. It was also found that the use of RPM among post-discharge COVID-19 patients minimized readmission into emergency rooms or hospitals. RPM predominately comprises the following two prominent modalities: telemedicine, which facilitates virtual consultations between healthcare providers and patients, and wearable devices, which track and transmit real-time health data. RPM has played a critical role in maintaining patient care throughout the pandemic, relieving the workload from healthcare facilities.

3.2. Telemedicine

Telemedicine is a valuable resource for healthcare providers to remotely communicate with patients and reduce the risk of infection transmission. Before the COVID-19 pandemic, although telemedicine was ready to be implemented within healthcare systems, it was not extensively used due to several barriers that hindered patients’ access to their physicians. A 2015 survey revealed that reimbursement was the biggest barrier to adoption, with 90% of 1557 physicians reporting that they would use telemedicine if properly reimbursed [26]. Despite these setbacks, during the pandemic, telemedicine usage surged, beginning with rapid expansions in video consultations, with countries like the United States [27,28], the United Kingdom [29], China [30], and Australia [31] leading the way. This growth was described as a fundamental “telehealth transformation", representing a new model of healthcare delivery even in the early stages of the pandemic [32]. It was estimated by healthcare providers that telemedicine usage would increase by tenfold compared to pre-pandemic levels [33].

In a study of 41 million outpatient visits, recorded by 94 Epic Cosmos contributors between 1 March 2019 and 31 August 2021, Ref. [5] reported a staggering outpatient telehealth usage increase from less than 1% pre-pandemic to 13% during the first 6 months of the pandemic. Although this eventually decreased to 8% in August 2021, it was nonetheless extremely high when compared to pre-pandemic levels. Non-elderly patients, including children, were similarly reported to have higher rates of telehealth adoption and retention than older patients. Supporting this statistic of a significant spike, Ref. [6] documented a 683% increase in urgent care telemedicine visits at NYU Langone Health (NYULH), with 8077 healthcare professionals serving 7,545,427 active patients between 2 March 2020 and 14 April 2020. In addition, Ref. [7] reported, in an analytical analysis of 22,156 outpatient cardiology care visits within the Duke University Health System (DUHS), that telehealth visits (telephone and video consultations) represented 9.3% of all scheduled visits during 2020. Ref. [7] also determined that healthier and younger patients were utilizing telemedicine services more in comparison to patients visiting in person. Similarly, older patients were less likely to utilize telemedicine services even during the period of high infection transmission risks.

The seismic shift towards telemedicine had far-reaching effects on healthcare providers. This brought into view both widespread acceptance and challenges encountered during the utilization of telemedicine services. Most of the reviewed studies reported a general increase in healthcare provider engagement with and willingness to use telemedicine. For instance, in a exploratory sequential mixed methods study involving 140 physicians in Lebanon (93 male, 47 female), aged between 25 and 66+, Ref. [8] administered a questionnaire online and found that physicians now engaged more in telemedicine activities and there was a significant shift in the physicians’ perceptions about telemedicine services. More respondents were open and willing to adopt these services; however, there is significant skepticism concerning its efficiency, safety, and existing regulations. Similarly, in a observational study, Ref. [9] collected the testimonies of 53 healthcare professionals in Spain to examine their perceptions about the implementation of video consultation, a form of telemedicine. About 96.2% of the healthcare professionals considered video consultations a satisfactory method for providing healthcare, with chronic patients benefiting the most, and 90% of participants highly recommend the establishment of training and educational programs for telemedicine. Furthermore, while a significant portion of the studies on adoption rates originates from large U.S. healthcare systems, studies like [8,9] suggest that although this rapid integration of telemedicine was a global trend, specific provider concerns and perceived benefits varied by regional and health system context.

Beyond infection control, Ref. [10] found a novel advantage identified through semi-structured interviews of 15 primary care physicians based in Southern California. The physicians noted the convenience of observing patients’ home environments, which was useful in the assessment of potential safety hazards and in-home support systems. Ref. [11] conducted a survey of 93 patients and 33 neurosurgery physicians regarding their telemedicine consultation experiences during and after the pandemic. About 60% of physicians were comfortable with providing diagnosis via telemedicine. However, a consistent challenge reported in both of these studies [10,11] was physicians not being able to physically examine patients during telemedicine consultations.

Patient experience and satisfaction with telemedicine during the pandemic were generally positive, based on two of the reviewed studies. High levels of satisfaction were a common theme. Ref. [11] found that 77% of 93 patients were extremely satisfied with their telemedicine experiences, with the majority largely valuing convenience and avoidance of travel. A significant finding was that there were no reported cases of incorrect medication or diagnostic mismanagement as a result of telemedicine services. Regarding perceptions of privacy, 84% of the patients perceived telemedicine to be as safe as in-person visits. However, one of the primary concerns was that 46.7% of the patients encountered technological issues in accessing telemedicine services. Similarly, a survey of 3454 US households [12] reported that 86% of the consumers had positive experiences.

Regardless of the general acceptance and overall satisfaction with telemedicine services, some of the reviewed studies indicated significant inequalities with access to services among different groups of patients. Ref. [12] found that urban households (53% of 3454) and those with higher income and access to high-speed Internet used telemedicine services more than rural and lower-income households. Reviewed studies [5,6,7] also reported a trend of younger patients using telemedicine services significantly more often than elderly patients. Ref. [6] concluded that telemedicine services were used the most among patients with ages between 20 and 44. Ref. [10] found that even physicians expressed concerns about elderly patients having difficulty accessing telemedicine consultations.

3.3. Wearable Devices (WD)

Wearable devices (WDs) allow the continuous monitoring of vital signs in humans during daily life or in clinical settings while minimizing discomfort and disturbance to normal routines [34]. These devices are part of personal health systems, a concept introduced in the late 1990s to promote patient empowerment, enabling individuals to manage their health and interact with healthcare providers [35]. This concept aimed to raise people’s interest in their health status, implement new technologies in the healthcare sector, and improve quality of care. Furthermore, WDs have evolved to become an important component of fitness markets with widely available devices, including accelerometer-based activity monitors and photoplethysmography-based heart monitors [36]. A study by Ref. [37] evaluated the accuracy of several commercial devices with 44 subjects. The six WDs were the Apple Watch 2 (Apple Inc., Cupertino, CA, USA), Samsung Gear S3 (Samsung Inc., Seoul, Korea), Jawbone Up3 (Jawbone Inc, San Francisco, CA, USA), Fitbit Surge (Fitbit Inc., San Francisco, CA, USA), Huawei Talk Band B3 (HUAWEI, Shenzhen, China), and Xiaomi Mi Band 2 (Xiaomi Inc., Beijing, China). The evaluation also included two smartphone applications: Dongdong (9.4.1) and Ledongli (10.80). These devices were used to measure five main health indicators: heart rate, step count, distance, sleep duration, and energy consumption. WDs were found to achieve high measurement precision, with a mean absolute percentage error of approximately 0.10 and the performance of fitness tracking devices varying according to brand and indicator measurement. These findings emphasize that WDs show great potential in being used as effective health evaluation indicators for the early detection of diseases and the continuous monitoring of health conditions.

WDs can be broadly classified into five categories [38]. Wrist-worn devices like smartwatches are the most common, used for monitoring heart rate and activity. Head-mounted devices, such as smart glasses, can assist in remote surgical consultations. E-textiles, or smart clothing, integrate sensors to monitor respiratory effort or muscle activity continuously. E-patches are adhesive sensors applied on the skin for tracking parameters like heart rate, temperature, or hydration. Finally, smart jewelry, such as rings, offers a discreet way to measure sleep patterns and heart rate variability. Among these, smartwatches have emerged as the most prevalent and technologically advanced due to its high computational, storage, and monitoring abilities [39,40].

In a national survey of 4551 respondents, Ref. [14] found that approximately 30% U.S. adults use a WD, with most users being younger, healthier, wealthier, more educated, and technology-educated adults. Notably, the potential of WD is under-realized, with less than one-third of U.S. adults actively using these devices. Hence, more effort is needed by healthcare providers and policymakers to bridge the gap and expand WD adoption across broader populations. The COVID-19 pandemic, however, amplified the interest and application of WDs in healthcare contexts.

Using a RPM program to monitor patients with COVID-19 after hospital discharge, Ref. [13] reported findings from monitoring a total of 225 enrolled patients in Mass General Brigham, a large healthcare system in Boston, Massachusetts. After participants answered questions about their symptoms and self-entered their device data (oxygen saturation and temperature) each morning on the MyChart Care Companion software, a message would be sent to a designated inbox if any answers were above the normal threshold; otherwise, no action would be taken. Ref. [13] found that the implementation of this program was associated with minimized readmission rates to emergency departments or hospitals. This study highlights the practical application of wearable-derived data for managing patients effectively in their homes.

During the COVID-19 pandemic, healthcare providers saw the increased usage of WDs. The utility of WDs in the pandemic context was highlighted in a few of the reviewed studies. For instance, Ref. [15], reporting on a meta-analysis (one of the 13 reviewed studies) covering 9 external studies and 10,558 participants, found that consumer wearable like smartwatches and rings measuring heart rate variability (HRV), demonstrated potential in detecting and predicting COVID-19. HRV measurements are very important, to COVID-19, as induced inflammation might affect the parasympathetic nervous system. Ref. [15] also suggested that while the link between HRV and inflammation was significant for the detection of COVID-19, this aspect could be utilized for the early detection of other diseases, creating a long lasting advantage after the pandemic. Similar to HRV measurements, if these devices are permanently adapted, other physiological measurements could help healthcare providers care for patients with chronic diseases and detect the early onset of serious illnesses.

Further supporting the role of WDs in identifying respiratory infections during the pandemic, Ref. [16] evaluated the performance of a WD-based real-time alerting system developed to predict the presence of COVID-19 or other upper respiratory infections. 470 participants from Northwell Health in New York, between 6 January 2022 and 20 July 2022, participated in this 16 week long study by wearing a smartwatch. Once respiratory rate, resting heart rate, and heart rate variability were measured on the smartwatch, the data were processed through an ‘alerting’ algorithm which would indicate the day on which the participant contracted COVID-19 [16]. This study found the system achieved a 90% detection rate for laboratory-confirmed (PCR) COVID-19 cases and a 94% detection rate for all laboratory-confirmed respiratory viruses. This also demonstrated the reliability of WD-based disease detection systems, with impressively low false-positive rates (2% per day) in respiratory viral infection detection. It was also discussed that similar systems, utilizing data from widely available WDs, have immense potential for early illness detection. It could also be valuable for continuous health monitoring during high infection prevalence.

In addition to the health issues of infected patients, survivors of COVID-19 are experiencing the long-term effects of COVID-19 (long COVID). There are various effects, such as complications in the hematologic system, gastrointestinal disorders, neurological disorders, lower immune system, etc., that are being treated in many patients after COVID-19 [17], and WDs can help better control these effects in a personalized way. Further supporting this conclusion, Ref. [41] analyzed 11 studies and found that WDs can be used to monitor persistent symptoms. The studies identified 10 different consumer-grade WDs, including Apple Watch, Fitbit, and WHOOP ring, that were used to track key physiological parameters. Although these devices were helpful in assisting healthcare providers and patients with long COVID-related conditions, such as postural orthostatic tachycardia syndrome, the reviewers emphasized a need for more robust, controlled clinical trials to establish definitive guidelines for the use of WDs.

4. Discussion

The COVID-19 pandemic served as a profound inflection point for RPM, driving extensive adoption and revealing the weaknesses of both telemedicine and WDs. This review contributes to the existing body of knowledge by synthesizing findings from 13 reviewed studies. Key findings reveal that a dramatic, crisis-driven surge in telemedicine utilization established a new higher baseline of use. Furthermore, in general, patients and healthcare providers are highly satisfied with remote services, although there are various concerns regarding RPM like remote physical examinations. Despite limited publications on WDs in relation to COVID-19, the potential of WDs for early disease detection and long-term health management is clear, including long COVID conditions [41]. Another critical insight is the significant disparities in RPM access and utilization across different groups of patients. Overall, a key contribution of this review is the integration of these multifaceted findings across recent, diverse research. This creates a deep understanding of how the pandemic accelerated RPM innovation and adoption while highlighting systemic challenges. This perspective, examining telemedicine and wearable devices in parallel, reveals insights distinct from those in previous reviews about individual RPM technologies or more general, less context-specific analyses of telehealth evolution.

4.1. Telemedicine Adoption Patterns and Implications

Our synthesis of the reviewed studies indicate that while the peak crisis-driven utilization of telemedicine has stabilized from the highest levels, its role in healthcare has been altered. It has also established a new, more prominent baseline for telemedicine service utilization. This aligns with early, influential perspectives from the pandemic which framed this change as a “telehealth transformation" rather than temporary growth [32].

As found in the reviewed studies, there are many concerns regarding the challenges for the post COVID-19 period. One key concern is transitioning from emergency adoption to sustainable, strategically integrated telemedicine services. Technical accessibility and limited access to physical examinations are also significant concerns for both patients and healthcare providers. However, soaring patient satisfaction rates and the recognized potential to relieve workforce shortages, especially in underserved rural areas, provide strong motivation.

For the future, the reviewed studies implicitly and explicitly suggest that permanent integration of telemedicine services requires addressing the technical and clinical barriers and establishing more defined reimbursement programs than the temporary pandemic measures. Furthermore, action needs to be taken towards bridging the digital divide to ensure the benefits of telemedicine are equitably distributed among all groups of patients and healthcare providers. Furthermore, the lessons learned during the pandemic about physicians’ evolving perceptions and the need for specific training are critical for ensuring future telemedicine encounters are positive experiences.

4.2. Wearable Device Adoption and Clinical Applications

The pandemic similarly accelerated the adoption and highlighted the clinical potential of wearable devices. This is shown by the reviewed studies focusing on WD usage for COVID-19 detection, monitoring, and for managing long-term post-COVID conditions. The ability of consumer-grade wearables to measure physiological parameters like HRV to detect early viral illnesses [15], points to a future where WDs play a crucial role in public health surveillance and individual health management. The applications of WDs for managing long COVID [17,41] by enabling continuous and personalized monitoring further supports this shift. This moves WDs beyond from only fitness tracking towards becoming integral tools for chronic disease management and post-acute care monitoring, a potential that is underscored by the Northwell health study’s [16] demonstration of reliable WD-based respiratory infection detection.

However, the clinical integration of WDs must be approached with caution. While WDs in the current market are powerful for continuous monitoring, their varying sensitivity for certain conditions limits them to be used as a complementary tool rather than a standalone diagnostic. Moreover, as our synthesis of the reviewed studies suggest, the path to widespread clinical integration of WDs in the post COVID-19 period requires addressing data reliability and security. There should also be data standardization, seamless technical integration, and clinical training in interpreting WD-generated data.

4.3. Technical Adaptations for COVID-19 Monitoring

The COVID-19 pandemic drove specific and necessary adaptation in RPM and the Internet of Things (IoT) systems. Pre-pandemic existing platforms were often designed for chronic disease management. This included intermittent data uploads to track patterns over a time frame. Whereas, for COVID-19, acute monitoring needs such as the continuous tracking of respiratory rate, HRV, and blood oxygen saturation (SpO₂) demanded higher frequency data transmission and lower data latency to enable timely intervention. This change led to various technical enhancements. Scalable cloud architectures were needed for data ingestion and processing of continuous data streams by a large user base. The systems use a microservices-based architecture [42], in which different functions like data ingestion and processing are allocated into separate services. Additionally, to support increased data throughput over home networks, the utilization of lightweight data compression algorithms became necessary to support less latency. Consumer wearables had to be optimized for reliable SpO₂ measurement, which requires more sophisticated on-device signal processing algorithms to ensure clinical relevance [43]. This drove a critical trade-off between sensing frequency and device battery longevity, and further exploration into edge computing models, in which data is partially processed on the device to minimize power-intensive data transmission.

4.4. RPM in the ERA of Long COVID and Future Preparedness

Among the most important challenges in the post COVID-19 period is the management of long COVID, a condition with diverse and often prolonged symptoms. As discussed in Refs. [17,41], RPM through wearable devices is a promising path for the continuous monitoring and personalized management of patients with long COVID. This allows for tracking symptoms and physiological changes over time in their home environments. In addition, telemedicine consultations can also support these patients by providing accessible healthcare provide care and follow-up remote consultations without the inconvenience of frequent travels. Other key lessons learned from the pandemic underscore the significant role of a robust RPM ecosystem, a combination of both telemedicine and WDs. That would make healthcare systems better prepared to address any future public health emergency. The scalability of remote consultations and monitoring is a significant strength for maintaining essential services and managing large populations in such emergencies.

4.5. Ethical, Privacy, and Regulatory Challenges

As the adoption of RPM technologies increases, there will be significant ethical and regulatory challenges following it. For instance, compliance with the Health Insurance Portability and Accountability Act (HIPAA) in the United States requires robust security measures for the transmission and storage of sensitive patient data. There are also a few key concerns such as data ownership and the potential for data breaches. Therefore, when data are collected from personal devices or home environments, clear protocols are needed to prevent misuse and maintain patient trust. This is foundational to the sustainable adoption of RPM.

4.6. Future Implications and Healthcare System Integration

The results from this review indicate that the combination of telemedicine and WD technologies has the potential to innovate healthcare systems. This involves developing systems to be more accessible and data-driven. However, realizing this potential in the post COVID-19 period requires strategic planning.

Future work must focus on building a resilient and equitable digital health ecosystem. One key direction is the clinical validation of remote monitoring technologies through large-scale, controlled trials that assess long-term effectiveness and cost-efficiency across a range of chronic conditions, including long COVID. In parallel, there is a need to integrate RPM tools into clinical workflows, and population health programs, enabling their use in proactive risk management and chronic disease support. Advances in artificial intelligence and on-device data processing offer promising pathways to convert continuous sensor data into real-time, personalized insights while protecting patient privacy. Finally, to ensure equitable impact, future research should prioritize the design and evaluation of RPM systems that are accessible and engaging across diverse populations, particularly for older adults and historically underserved groups.

Our review provides some key areas for future research and considerations for healthcare organizations and policymakers, outlined as follows:

• Infrastructure and Interoperability: Investment in modern digital infrastructure with the ability to seamlessly integrate data from RPM sources.
• Training and Workforce Development: Comprehensive training programs for healthcare providers are needed for data interpretation skills and effective virtual communication skills.
• Reimbursement: Clear guidelines on data privacy and reimbursement programs to encourage RPM use beyond post COVID-19.
• Addressing the Digital Divide: Reducing the digital divide is essential in fostering equal access across all groups of patients.
• Standardized Protocols: Developing and implementing standardized protocols for incorporating RPM data into chronic disease management and preventive care.

This study has several limitations. First, while this is a narrative review initially focused on studies published between 2020 and 2024 to capture the core pandemic period, we have expanded our scope to include relevant 2025 publications to ensure currency. However, there may be rapidly evolving new developments in RPM emerging even after our updated search. Furthermore, the limited number of selected studies used limits the depth of the conclusions, especially since only a few studies present evidence of RPM technology usage post COVID-19. Second, while this review is aimed for a holistic perspective by including both telemedicine and wearable devices, its scope did not allow for an in-depth analysis of all sub-types of these technologies in all regional variations and medical specialties.

5. Conclusions

The COVID-19 pandemic served as a catalyst, accelerating the adoption of RPM technologies, particularly in the surge of telemedicine and the emerging applications of WDs, as synthesized from 13 reviewed studies. Telemedicine was mostly used for continuous care and WDs for health monitoring. While peak crisis-driven telemedicine use has stabilized, this review of 13 recent studies indicate a new baseline of engagement. This is supported by high user satisfaction rates despite challenges in accessing remote care. Our synthesis underscores the pandemic’s dual role, outlined as follows: propelling RPM innovation and revealing systematic barriers. To translate the lessons of the pandemic into lasting transformation, policymakers must prioritize actionable steps. Conducting studies to evaluate the cost-effectiveness of RPM technologies in Low and Middle-Income Countries (LMICs) will ensure implementation challenges are discovered. Establishing reimbursement models for providers and funding digital literacy programs will bridge the access gap for rural and elderly populations. Developing standardized data protocols for wearable devices will ensure their reliable integration into clinical workflows.