without the patient’s willingness to be an active participant in their care, rpm implementation will likely fail. cost is also a barrier to its widespread use. there is a lack of reimbursement guidelines for rpm services, which may deter its incorporation into clinical practice. the shift of accountability associated with rpm brings up liability issues. there are no clear guidelines in respect to whether clinicians have to intervene every time they receive an alert regardless of the urgency. the continuous flow of patient data requires a dedicated team of health care providers to handle the information, which may, in fact, increase the workload. although technology is introduced with the intent to increase efficiency, it can become a barrier to some healthcare providers that are not technological. there are common obstacles that health informatics technologies encounter that applies to rpm. depending on the comorbidities monitored, rpm involves a diverse selection of devices in its implementation. standardization is required for data exchange and interoperability among multiple components. furthermore, rpm deployment is highly dependent on an extensive wireless telecommunications infrastructure, which may not be available or feasible in rural areas. since rpm involves transmission of sensitive patient data across telecommunication networks, information security is a concern. debate surrounds the potential cybersecurity issues of rpm, including the likelihood of hacks which could pull personal medical data. additionally, most remote monitoring devices are limited to single-user applications, and could be expanded in the future for better inclusion of multi-user technologies. controversy published by the new england journal of medicine, a randomized controlled trial involving congestive heart failure patients concluded that the use of telemonitoring failed to provide a benefit over usual care. the telemonitoring patient group was instructed to call a designated number daily, and answer a series of questions about their symptoms using a keypad. clearly, the process described by chaudhry et al. (2010) differs from the rpm methodology illustrated in the overview, which involves actual collection and transmission of physiological data through point-of-care devices. with articles from forbes associating rpm with the negative findings by chaudhry et al. (2010), it may be difficult to clear the misconception that telemonitoring is synonymous with remote patient monitoring. researchers at the semnan university of medical science have determined that while remote patient monitoring is a more feasible type of care for elderly people at home, especially during a difficult period like the ongoing covid-19 pandemic, it is difficult for physicians to maintain control over their care while not under their supervision. the lack of standardization of rpm nomenclature and definition makes it difficult to differentiate between different forms of patient monitoring involving technology. different forms of rpm have varying effectiveness, with researchers supporting more resources going towards developing technologies which counter the pitfalls of these methods.