  Current remote patient monitoring (RPM) systems are fully reliant on the
Internet. However, complete reliance on Internet connectivity is impractical in
rural and remote environments where modern infrastructure is often lacking,
power outages are frequent, and/or network connectivity is sparse (e.g. rural
communities, mountainous regions of Appalachia, American Indian reservations,
developing countries, and natural disaster situations). This paper proposes
augmenting intermittent Internet with opportunistic communication to leverage
the social behaviors of patients, caregivers, and community members to
facilitate out-of-range monitoring of patients via Bluetooth 5 during
intermittent network connectivity in rural communities. The architecture is
evaluated for Owingsville, KY using U.S. Census Bureau, the National Cancer
Institute's, and IPUMS-ATUS sample data, and is compared against a delay
tolerant RPM case that is completely disconnected from the Internet. The
findings show that with only 0.30 rural adult population participation, the
architecture can deliver 0.95 of non-emergency medical information with an
average delivery latency of approximately 13 hours.
