Remote patient monitoring (RPM) devices feed data into FHIR-based EHRs via specific integration patterns. Understanding the flow prevents integration surprises.
RPM device categories
1. Vital signs monitors. Blood pressure, weight, glucose, SpO2. Data as Observation resources. 2. Wearable devices. Steps, heart rate, sleep. High-volume Observations. 3. Specialty devices. Continuous glucose monitors, holter monitors, spirometers. Complex Observation profiles. 4. Patient-reported symptom trackers. SDC Questionnaires → QuestionnaireResponse.
Integration flow
1. Device generates data → sent to vendor cloud. 2. Vendor cloud POSTs to healthcare integration platform. 3. Platform converts to FHIR resources. 4. FHIR resources land in EHR's FHIR store. 5. Clinical dashboards read via FHIR REST.
Volume expectations
| Device type | Data volume per patient/day |
|---|---|
| Blood pressure monitor | 2-4 Observations |
| Continuous glucose monitor | 288 Observations |
| Wearable step counter | 1-2 aggregated |
| Heart rate monitor | 1-10 Observations |
Common integration challenges
1. High-volume Observations. CGM generates 288/day; batching required. 2. Terminology binding. Different devices use different codes; standardize. 3. Reference to Patient. Device data must resolve to Patient identity. 4. Time-series semantics. Observations at high frequency need careful indexing. 5. Alert thresholds. Vital sign anomalies trigger clinical alerts.
Storage optimization
1. Batch write via Bundle transactions. 2. Aggregate low-priority Observations (daily average vs. minute-by-minute). 3. Time-series index optimization in Postgres. 4. Consider dedicated time-series store for very high volumes.
Vendor state (mid-2026)
| Integration platform | RPM support | Volume |
|---|---|---|
| Redox | Full | Moderate |
| Xealth | Full | Moderate |
| Vivify Health | Native | High |
| Custom on Aidbox | Full | High |
Regulatory considerations
1. Device data compliance (FDA SaMD). 2. Patient consent for continuous monitoring. 3. HIPAA compliance for device vendor. 4. Reimbursement codes (CPT 99453-99458 for RPM).
FHIR RPM integration is a growing pattern in 2026. The flow works; volume and quality management is where the engineering effort concentrates.