AI remote patient monitoring for chronic care

We added an AI layer to PDC's existing remote patient monitoring platform, cutting clinical decision-making time by 20% and helping the platform reach 150+ patients in 12 weeks.

See all work

This project

Result 01

reduction in clinical decision-making time

20%

Result 02

compliance with HIPAA regulations

100%
4.9 / 5 on ClutchSee all work
Platform
Web App
Duration
12 weeks
Industry
Healthcare
Read time
5 min
PDC logo

The short answer

RaftLabs integrated an AI layer into PDC's remote patient monitoring platform, cutting clinical decision-making time by 20% and helping the platform reach 150+ chronic care patients and 80+ clinics within 12 weeks. The AI runs on AWS Bedrock with Anthropic Claude 3 Sonnet, analyzing readings from CGM and BPM wearable devices to automatically prioritize patients, flag abnormal readings, and generate end-of-month summaries for insurance compliance. The platform is fully HIPAA-compliant, with all patient data anonymized before reaching the AI model.

PDC already had a working remote patient monitoring platform. Clinics used it to track patients with chronic conditions, including hypertension, heart failure, and diabetes, through CGM and blood pressure wearables. The data was flowing in. The problem was what happened next.

Providers had to manually review readings for every patient to decide who needed attention. With a growing patient list, that review process was eating hours of clinical time daily. They were not missing patients, but they were spending far too long to find the ones who actually needed a call.

The client wanted to add AI to solve that problem. Not replace clinical judgment, but do the triage work so providers could focus on the patients who genuinely needed them.

We integrated an AI layer into the existing platform in 12 weeks. The AI analyzes device readings against each patient's historical baseline, ranks patients by risk level, flags abnormal readings in real time, and generates monthly summaries ready to submit to insurers. Clinical decision-making time dropped by 20%. Within three months, 80 clinics had signed on.

AI remote patient monitoring app for chronic care

before & after

What changed

Before
  • Providers manually reviewed all patient readings to decide who needed attention
  • No way to prioritize: a routine reading and a concerning one sat in the same queue
  • Abnormal wearable readings had no automatic alert; providers only saw them when they logged in
  • End-of-month compliance reports for insurers had to be written manually from patient data
  • The platform lacked AI features, making it harder to attract clinics looking for modern RPM tools
  • Billing compliance tracking required manual checking of each patient's monitoring activity
After
  • AI ranks every patient by risk level so providers see who needs attention first
  • Real-time alerts fire when a wearable reading crosses a threshold based on that patient's history
  • Automated abnormality detection flags potential health risks as they happen
  • End-of-month AI summaries are generated automatically and ready to submit to insurers
  • Risk stratification groups patients into care tiers, supporting proactive rather than reactive management
  • Billing compliance prediction flags patients at risk of missing RPM requirements before the month ends

What we had to solve

  • 01

    Running AI on patient data under HIPAA

    Patient health information has strict legal protections. You cannot simply send it to a standard cloud AI service. We had to build the AI layer using AWS Bedrock, a HIPAA-eligible service that signs a Business Associate Agreement, and put data anonymization in place before any patient data reached the model. Standard AI APIs were off the table for this project. Every part of the pipeline had to meet HIPAA requirements before we could run a single test.

  • 02

    Making AI recommendations clinicians would trust

    If the AI flags the wrong patients as high-risk, providers stop trusting it and start ignoring the alerts. We had to build the model with confidence scoring, clear explanations for every alert, and a feedback loop so clinicians could correct the system when it was wrong. Getting the risk stratification thresholds right required iteration with the clinical team, not just the engineering team.

outcomes

What we achieved

20%
reduction in clinical decision-making time
Previously

Providers manually reviewed all patient readings to decide who needed attention. With a growing patient list, this was taking hours of clinical time every day.

100%
HIPAA compliance maintained
Previously

Integrating AI into a healthcare platform meant navigating strict HIPAA rules with no established compliance playbook for AI-in-healthcare at this level.

150+
patients enrolled in 12 weeks
Previously

The platform lacked AI features, limiting its ability to attract clinics looking for advanced chronic care monitoring tools.

What clients say

Don't take our word for it.

Three-year average engagement. Founders and operators describing the work in their own words. No marketing varnish.

D
Dr. Smith
USA
Primary Care Physician

PDC has been a great addition to our clinic. It's easy to navigate, and as a remote patient monitoring app, it helps us stay connected with senior patients who can't visit regularly.

Your clinical data is there. Turning it into real-time decisions is the problem?

the build

What we built

The AI layer sits on top of the existing data flows from CGM and BPM wearable devices. It does not replace the clinical workflow; it prepares the clinical workflow.

01

Providers open their dashboard and see who needs attention first: triage happened before they logged in

When a wearable sends a reading, the AI compares it against that patient's historical baseline and the clinical norms for their condition. Patients are ranked by risk level so providers open their dashboard and see who needs attention first, not a flat list of everyone. The triage that used to take hours happens before the provider logs in.

Automated patient analysis
02

Alerts arrive with context and a suggested next step: providers act without pulling the full patient record

When a reading crosses a threshold that the AI identifies as abnormal for that specific patient, the provider receives an alert with the reading, the patient's recent trend, and a suggested next step. Alerts come with context, not just a number, so providers can act quickly without pulling up the full patient record first.

AI abnormality detection
03

High-risk patients surface at the top: providers see what they need without searching for it

The dashboard shows every patient ranked by current risk level, with trend data, recent readings, and AI-generated insights visible at a glance. High-risk patients surface at the top. Stable patients stay lower in the list. Providers see what they need to see without searching for it.

Provider dashboard
04

Insurer-ready summaries generated automatically, hours of per-patient compilation eliminated

At the end of each month, the AI generates a concise clinical summary for each patient based on their monitoring data. The summary is formatted for insurer submission and billing compliance. What used to take a staff member hours to compile per patient is now generated automatically and ready to review.

End-of-month summaries

Engagement

How we worked together

  1. 01Weeks 1–2

    Discovery and scoping

    We map the problem before writing code. Two weeks of technical audit, stakeholder interviews, and prototype — so both teams align on scope and risk before sprint one.
  2. 02Ongoing

    Two-week Agile sprints

    Each sprint ends with working software, not a status update. You review a real build, request changes, and approve before we move forward. No surprises at handover.
  3. 03Ongoing

    Daily async updates

    Slack for daily progress, Asana for task visibility, weekly video calls for decisions. You have full visibility without needing to attend every meeting.
  4. 04Final

    Handover and warranty

    Full code handover with deployment runbooks and documentation. Thirty-day warranty period for production issues at no extra cost.

Still curious?

Remote patient monitoring (RPM) is a healthcare model where patients use wearable devices at home, such as glucose monitors, blood pressure cuffs, and pulse oximeters, that continuously send health data to their provider. Providers can track patients between visits and intervene early when readings change, without requiring an in-person appointment.

All patient data is anonymized before it reaches the AI model. We run the AI on AWS Bedrock, which is a HIPAA-eligible service that signs a Business Associate Agreement. This is a legal requirement for any AI system that processes protected health information. Standard AI APIs like OpenAI's direct service were not used for this project.

The platform currently supports continuous glucose monitors (CGM) for patients managing diabetes and blood pressure monitors (BPM) for patients with hypertension or heart conditions. Additional device types can be added as the platform expands.

The AI compares each patient's current reading against two things: their personal historical baseline and the clinical norms for their condition. A reading that is within normal ranges for the general population but unusual for a specific patient can still trigger an alert. The risk ranking is personalized, not based on a single universal threshold.

Standard RPM collects wearable data and shows it in a portal. A provider still has to review every patient's data manually to spot problems. With AI, the platform does the triage work automatically. Providers see who needs attention when they log in, receive real-time alerts when readings change significantly, and get monthly summaries generated for them. The same clinical team can manage a larger patient panel without losing quality of care.

Next step

Recognise this problem in your business?

Tell us what's broken. We'll diagnose it and show you where the leverage is before you commit to anything.

  • Scope and cost agreed before work starts. No surprises. No obligation.
  • Working prototype within 3 weeks of kickoff.
  • Pay by milestone. You see progress before each invoice.
  • 60-day post-launch warranty. Bug fixes, UI tweaks, and deployment support. No retainer.
  • All conversations are NDA-protected.

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