Article

Why Start a Remote Patient Monitoring Program?

6 min read

Accessing a patient’s key health metrics remotely was something few healthcare providers could envision just a few decades ago. Today, this technology is readily available, with medical-grade health devices collecting and securely transmitting patient health data directly to physicians. Remote patient monitoring (RPM) programs offer many benefits for both patients and healthcare providers. Let’s explore how this technology can provide higher-quality care for patients while improving the profitability and sustainability of medical practices. We’ll also share a quick checklist you can use to decide if starting a remote patient monitoring program is the right choice for your patients and practice.

How a Remote Patient Monitoring Program Benefits Patients

Connected health devices can be used to monitor important health stats like blood pressure, heart rate, weight, sleep patterns, and more. Many patients get a lot out of participating in a remote patient monitoring program, including those who are managing chronic conditions (i.e. diabetes, hypertension), going through post-op recovery, or who live in a rural community or lack access to reliable transportation. Here are six specific ways RPM programs benefit patients.

Higher levels of patient engagement

One of the most important factors in improving patient health outcomes is engagement. Patients who are actively engaged in their own care are more likely to proactively engage with their healthcare providers and take charge of adjusting lifestyle factors that may be impacting their overall health. Remote patient monitoring technology puts actionable health information within easy reach, allowing patients and their care providers to view both current health metrics as well as trends over time.

Greater patient ownership of health outcomes

Remote patient monitoring connects patients with their own health metrics, allowing them to play a greater role in monitoring their health. Health data is displayed on an intuitive app that allows patients to track progress over time. Easy access to health data empowers patients to see how they can improve their health by adjusting lifestyle factors within their control.

Improved access to care

Patients may face many barriers when it comes to accessing medical care. Long commutes, work and childcare obligations, and a lack of reliable transportation are just a few of the roadblocks to overcome. And in rural communities, the closest provider may be hundreds of miles away. Remote patient monitoring technologies can be used as part of a holistic health program to offer more convenient care when and where patients need it.

Additional data to better inform treatment and early detection of health conditions

In-person visits provide just a snapshot in time of key health metrics like weight, heart rate, and blood pressure, and because these measurements are taken infrequently and in an abnormal environment, these measurements may paint an inaccurate picture of a patient’s health. Remote patient monitoring devices, in contrast, can collect readings much more frequently and can be set to alert providers when numbers indicate the presence of health issues that require urgent attention.

Reduced patient cost for monitoring chronic health conditions

Actively monitoring chronic health conditions can place a significant logistical and financial burden on patients who must make frequent visits to their healthcare providers, since these visits require time off of work as well as transportation-related expenses. Participating in a remote patient monitoring program enables physicians to collect key health data remotely, potentially reducing the number of required in-person visits.

Improved quality of care

Remote patient monitoring can result in significant improvements in the quality of care that patients receive. As noted above, it provides a valuable source of additional health data for providers, leading to more informed care. More frequent readings can enable earlier detection of critical health issues that require timely intervention, and can help physicians catch deteriorating conditions before they become problematic. They also provide a more holistic view of a patient’s health. Additionally, when patients have immediate access to their own health data they can be more motivated to make important lifestyle changes and take a more active role in their health outcomes.

How a Remote Patient Monitoring Program Benefits Primary Care Practices

Launching a remote patient monitoring program can unlock a host of benefits for primary medical practices. For providers seeking to improve the quality of patient care, boost revenue, and remain competitive, offering remote patient monitoring can help accomplish these goals.

Improved quality of care and patient oversight

Remote patient monitoring technologies measure health metrics with much greater frequency than in-office visits and allow healthcare professionals the ability to spot sudden changes that may require time-sensitive intervention. For example, with an RPM program, physicians can track weight as part of fluid management in patients with CHF.

Longitudinal care

Tracking patient health trends over time provides physicians and other healthcare professionals with valuable trend data that can be used to better manage patient care. For example, providers can more easily see how a chronic illness has progressed over time with a quick glance at a data chart.

Opportunities to expand the patient base

Now that remote patient monitoring technologies have matured, patients are starting to recognize the value and convenience of enrolling in one of these programs. The proliferation of wearable technology, such as the ScanWatch, has contributed. Establishing a robust remote patient monitoring program in your practice can attract new patients eager for the advantages it can provide.

Increased patient satisfaction

Remote patient monitoring programs result in happier patients. That’s no surprise. This technology enables patients to avoid unnecessary office visits, spend more time at work or home, and access their own health data with a few clicks of a mobile app. Research backs up this assertion. A 2021 study found that 91% of post-discharge COVID-19 patients monitored remotely using a pulse oximeter would recommend it to others.

Improved profitability for the practice

Remote patient monitoring can result in more efficient workflows, boosting the productivity of office staff and healthcare providers and enabling more patients access to care. RPM programs include several billable services reimbursable by Medicare and private insurers.

Checklist to Identify if an RPM Program Is Right for Your Practice

Although remote patient monitoring programs have a lot to offer, some patients and medical practices will benefit from them more than others. Here are a few important questions to ask when deciding if launching a remote patient monitoring program is the right move for your practice.

  • Would your current patients benefit from this technology?
  • Do a significant number of your patients have chronic health conditions such as hypertension, heart failure, COPD, or diabetes?
  • Do a significant number of your patients have health conditions requiring short-term monitoring such as those recovering from an acute condition like severe illness, injury, or a recent hospitalization?
  • Do some of your patients struggle to keep frequent in-person visits due to living in remote locations, lack of transportation, or schedule conflicts due to work or primary caregiver obligations?
  • Is your practice eager to expand billable services and take on additional patients?
  • Do you have adequate buy-in from office staff and physicians?

Withings Health Solutions Makes Starting an RPM Program Simple

Starting a remote patient monitoring program from scratch can feel like a daunting task. That’s why partnering with the right remote patient monitoring provider is so important. Every healthcare provider has been through the pain of technical integrations that take far more time and money than planned. Withings Health Solutions understands the challenges, and we know that everyone has different needs and processes. This is why we offer carefully designed data connection solutions for devices and RPM. During program setup, Withings Health Solutions handles all the onboarding and manages support, freeing your team to focus on patients, not managing tech.

With over a decade of industry experience, Withings Health Solutions offers medical-grade devices that feature intuitive designs that encourage high user adoption and retention rates, including a sleep tracking mat, remote blood pressure cuff, and smart scale. Our patient-facing Health Mate mobile app puts health data within easy reach, displaying it in a way that’s personalized and easy to understand. Our physician data dashboard offers intuitive, continuous access to all your patients’ critical health data in near-real time so you can provide better care to your patients. When you’re ready to launch your remote patient monitoring program, we’re ready to help.

Learn more about Withings Health Solutions for remote patient monitoring.

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This article is based on our November 1, 2024 interview with Dr. Solomon Tesfaye.

 

When Solomon Tesfaye was a 16-year-old boy in Addis Ababa, Ethiopia, a military regime closed his school and forced the students into national service. Tesfaye, who had by then developed a true passion for learning, desperately hoped to continue his intellectual development and academic journey.


On the urging of his brother, he took a chance and applied for an international scholarship to the prestigious Sevenoaks School in Kent, England. Sevenoaks, a storied boarding school founded in 1432, may have seemed like an unlikely next home for Tesfaye. But they also decided to take a chance on him. Those bets ultimately paid off.

 

Dr. Solomon Tesfaye

Dr. Tesfaye is now a globally recognized diabetes expert at the University of Sheffield whose research has played a significant role in understanding diabetic nerve damage, how to identify it earlier, and how to potentially treat it before the complications become debilitating. In September, Dr. Tesfaye was honored with a Lifetime Achievement Award at the 34th NeuroDiab annual meeting in recognition of his pioneering research in the field. Tesfaye credits his experience at Sevenoaks School as having kindled his interest in science and his enduring passion for grappling with difficult problems, like diabetic peripheral neuropathies (DPN).

 

Fast forward to today and Dr. Tesfaye is leading some of the most exciting work on early diagnosis of DPN and clinical strategies for altering its relentless progression. His team at University of Sheffield recently presented findings at The American Diabetes Association Scientific Sessions that found the use of point-of-care testing devices by clinicians (Withings’ Sudoscan in combination with DPNCheck) could significantly improve the detection of DPN over current standard of care methods and provide a rapid, reproducible, and quantitative assessment for busy clinicians.

 

“For diabetic retinopathy, we’ve been successful using technology to improve diagnosis and care,” said Tesfaye. “But for neuropathy, we're using these Stone Age implements. With a monofilament, even the best doctors cannot diagnose neuropathy the same two days in a row. Meanwhile, fifty percent (of patients) die within 5 years, it costs more than breast or colon cancer, and is devastating because it's so painful patients can't sleep. Sadly, advanced neuropathy is the strongest risk factor for diabetic foot ulceration that results in fifty percent mortality within 5 years, and costs more than breast, colon and prostate cancers, combined. Neuropathy also is devastating as it can also cause distressing foot and leg pain that interferes with sleep.”

 

Tesfaye is now immersed in a major new study with 160 participants – called OCEANIC – that seeks to determine whether early diagnosis, coupled with robust, early intervention can alter the course of DPN for the better. OCEANIC is using Withings Body Pro 2 smart scales with Electrochemical Skin Conductance (ESC) technology, wearable sensors, and activity trackers, to monitor and share patient progress on metrics including body fat, muscle mass, and ESC score, with the aim of reinforcing lifestyle changes. The study group will receive personalized diabetes education and exercise programs, and weight loss interventions including GLP-1s, to significantly reduce HbA1C. 

 

“Our goal is to explore whether these intensive strategies to manage risk factors can halt or even reverse diabetes-related nerve damage when it is identified at an early stage,” said Dr. Tesfaye. “We want to do for neuropathy what early and routine screening has done for retinopathy – bringing better outcomes to millions of people with diabetes.”

 

If Solomon Tesfaye’s history is any guide, achieving clear answers to the big questions in the OCEANIC study will be but a waypoint on his journey. He credits a mentor, the late Professor John Ward, with encouraging him to tackle the most meaningful problems. “He told me not to worry about publishing too many studies, but rather focus on a few big questions that will fundamentally change people’s lives.”

Interested in partnering with us?

Contact Us [post_title] => Turning Challenges into Opportunities: Dr. Solomon Tesfaye and His Quest to Eradicate Preventable Amputations [post_excerpt] => Dr. Solomon Tesfaye is one of the world’s leading researchers in the field of diabetic peripheral neuropathies (DPN). His life has been a story of overcoming challenges with a mission to tackle one of the biggest problems facing people with diabetes - preventable amputations. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => turning-challenges-into-opportunities-dr-solomon-tesfaye-and-his-quest-to-eradicate-preventable-amputations [to_ping] => [pinged] => [post_modified] => 2024-12-09 16:45:25 [post_modified_gmt] => 2024-12-09 16:45:25 [post_content_filtered] => [post_parent] => 0 [guid] => https://withingshealthsolutions.com/?p=1724 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 1727 [post_author] => 11 [post_date] => 2024-12-09 16:36:58 [post_date_gmt] => 2024-12-09 16:36:58 [post_content] =>

Withings products not only help individuals and their clinicians better monitor and understand health, but they are contributing to a wide body of research. Withings is honored that researchers are increasingly turning to our products across an impressive number of therapeutic areas. Among them are diabetic neuropathy, retinopathy, sudomotor function, hypertension, sleep quality, sleep apnea, dementia, ECG intervals in children, arrhythmias, cardiovascular autonomic neuropathy (CAN), public health monitoring, and health technology adoption.

Here’s just a sampling of the diversity and reach of Withings products in medical research this year.

An October 2024 article in Frontiers in Neuroanatomy looks at the history and technical development of electrochemical skin conductance (ESC), as measured by Withings’ Sudoscan, and compares it to other measures of skin conductance such as galvanic skin response (GSR) and electrodermal activity (EDA). ESC was developed specifically to diagnose sudomotor function as opposed to GSR/EDA which is a continuous monitoring tool. EDA is increasingly incorporated into wearable technology. While both use skin/sweat conductance, it is important to differentiate EDA which can be used for physiological and psychological measures of stress from ESC which is used to evaluate sudomotor function and diagnose neuropathy. Withings has incorporated ESC in its smart scales which show a near perfect correlation with the Sudoscan clinical device. The Withings smart scales allow for easier and more frequent individual time series data as well as large scale data collection. 

Public health surveillance has largely relied on self-reported surveys. This study applied mobile and wearable technologies to collect objective, real-time, continuous health data. Data from a variety of Withings products (Withings Sleep, Withings BPM Connect, Withings Thermo, and Withings Body+), were used to predict stress. Findings showed that a system, such as the Mobile Health Platform used here, could complement self-reported health data to better monitor and predict stress in a population.

This study compared the 1-lead ECG intervals available via the Withings ScanWatch with the standard 12-lead ECGs in children and adolescents. Smart watch intervals have previously been shown to be accurate for adults. The heart rate measure was found to be reliable for children, The automated QTc interval was less reliable but can be improved with manual measurements. It is worth noting that the study used pediatric subjects rather than adapting adult research, as is often the case.

This study of 67,254 adults showed that 30% of adults do not get the recommended 7-9 hours of sleep per night, and that even those who did average 7-9 hours, 40% of the nights fell outside the range. Only 15% of participants slept 7-9 hours for at least 5 nights per week. In addition to the findings of irregular sleep, the study highlights the usefulness of the at home Withings Sleep for large-scale and/or longitudinal sleep studies. 

As we close out a year of significant knowledge advancements, we look forward to seeing what the global healthcare research community has in store for 2025. 

If you are conducting research that might benefit from Withings technology, please contact us at contact-pro@withings.com.

Interested in partnering with us?

Contact Us [post_title] => Withings 2024 Year in Review: Research Highlights [post_excerpt] => 2024 was an exciting year for Withings. We’re honored that the global research community is increasingly turning to our solutions for studies across an impressive number of therapeutic areas. Among them are diabetic neuropathy, retinopathy, sudomotor function, hypertension, sleep quality, sleep apnea, dementia, ECG intervals in children, arrhythmias, cardiovascular autonomic neuropathy (CAN), public health monitoring, and health technology adoption. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => researchers-have-used-our-solutions-for-studies-across-an-impressive-number-of-therapeutic-areas-among-them-are-diabetic-neuropathy-retinopathy-sudomotor-function-hypertension-sleep-quality-slee [to_ping] => [pinged] => [post_modified] => 2024-12-24 10:42:37 [post_modified_gmt] => 2024-12-24 10:42:37 [post_content_filtered] => [post_parent] => 0 [guid] => https://withingshealthsolutions.com/?p=1727 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 1729 [post_author] => 11 [post_date] => 2024-12-09 16:36:44 [post_date_gmt] => 2024-12-09 16:36:44 [post_content] =>

Several new, large-scale studies1, 2, 3, 4 from the Flinders Medical Research Institute (FHMRI) in Australia found studying sleep in real-world settings over multiple nights can greatly reduce the high 30% error rate of sleep apnea diagnosis from polysomnography (PSG), the traditional, single night, in hospital gold standard technique. Using Withings Sleep Analyzer, researchers were able to easily track multiple biomarkers for participants over time revealing large variability in sleep indicators from night to night.

 

Withings under-the-mattress sleep trackers have enabled researchers to study large groups over time. The FHMRI studies tracked 67,278 and 12,287 participants respectively over a total of 11 million nights, a feat not feasible with traditional polysomnography.

 

A key finding from the study of 12,000 users is the variability in the severity of Obstructive Sleep Apnea (OSA) from night to night. The variability of OSA, independent of severity, is associated with uncontrolled hypertension which is the leading cardiovascular risk factor. Sleep Analyzer also reveals other risks associated with hypertension, such as snoring, irregular waking and sleep hours, and duration of sleep.

 

Using the same hardware technology as Withings Sleep Analyzer, Sleep Rx is a noninvasive, at home device that users place under their mattresses to gather biomarkers such as heart rate, respiratory rate, snoring, sleep cycles, and the Withings Sleep Index, a measure of breathing events per hour, which can aid in the diagnosis of sleep apnea. Using this simple device for at least 14 nights gives a much clearer picture of sleep quality.

 

The multi-night Sleep Rx data can be used to predict the right patients at the right time for in hospital PSG. Better identification of patients who most need PSG will reduce overall spending on the costly tests and ease scheduling difficulties.

 

Sleep Rx offers an inexpensive, easy to use method to better target high risk cardiovascular patients, reduce the high error rate of sleep apnea diagnosis, and efficiently gather longitudinal, large-scale sleep data for a variety of chronic diseases. For more information about the Withings Sleep Rx, click here.

References

1 Lechat, Bastien et al. “Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea.” American journal of respiratory and critical care medicine vol. 205,5 (2022): 563-569. doi:10.1164/rccm.202107-1761OC


2 Lechat, Bastien et al. “High night-to-night variability in sleep apnea severity is associated with uncontrolled hypertension.” NPJ digital medicine vol. 6,1 57. 30 Mar. 2023, doi:10.1038/s41746-023-00801-2

3 Lechat, Bastien et al. “Regular snoring is associated with uncontrolled hypertension.” NPJ digital medicine vol. 7,1 38. 17 Feb. 2024, doi:10.1038/s41746-024-01026-7

4 Scott, Hannah et al. “Sleep Irregularity Is Associated With Hypertension: Findings From Over 2 Million Nights With a Large Global Population Sample.” Hypertension (Dallas, Tex. : 1979) vol. 80,5 (2023): 1117-1126. doi:10.1161/HYPERTENSIONAHA.122.20513

Interested in partnering with us?

Contact Us [post_title] => Sleep Apnea Data from Multiple Nights is Key to Predicting Hypertension and Cardiovascular Risk [post_excerpt] => New large-scale, longitudinal studies show that monitoring sleep for at least 14 nights at home with a connected sleep tracking mat, can reduce the 30% high error rate of sleep apnea diagnosis from the usual single-night, in hospital polysomnography (PSG) technique. This technology can identify which patients most need expensive, intrusive, and difficult to access PSG. Longitudinal data also detects variability of Obstructive Sleep Apnea from night to night which is associated with hypertension [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => sleep-apnea-data-from-multiple-nights-is-key-to-predicting-hypertension-and-cardiovascular-risk [to_ping] => [pinged] => [post_modified] => 2024-12-10 18:14:34 [post_modified_gmt] => 2024-12-10 18:14:34 [post_content_filtered] => [post_parent] => 0 [guid] => https://withingshealthsolutions.com/?p=1729 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 3 [current_post] => -1 [before_loop] => 1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 1724 [post_author] => 11 [post_date] => 2024-12-09 16:37:06 [post_date_gmt] => 2024-12-09 16:37:06 [post_content] =>

This article is based on our November 1, 2024 interview with Dr. Solomon Tesfaye.

 

When Solomon Tesfaye was a 16-year-old boy in Addis Ababa, Ethiopia, a military regime closed his school and forced the students into national service. Tesfaye, who had by then developed a true passion for learning, desperately hoped to continue his intellectual development and academic journey.


On the urging of his brother, he took a chance and applied for an international scholarship to the prestigious Sevenoaks School in Kent, England. Sevenoaks, a storied boarding school founded in 1432, may have seemed like an unlikely next home for Tesfaye. But they also decided to take a chance on him. Those bets ultimately paid off.

 

Dr. Solomon Tesfaye

Dr. Tesfaye is now a globally recognized diabetes expert at the University of Sheffield whose research has played a significant role in understanding diabetic nerve damage, how to identify it earlier, and how to potentially treat it before the complications become debilitating. In September, Dr. Tesfaye was honored with a Lifetime Achievement Award at the 34th NeuroDiab annual meeting in recognition of his pioneering research in the field. Tesfaye credits his experience at Sevenoaks School as having kindled his interest in science and his enduring passion for grappling with difficult problems, like diabetic peripheral neuropathies (DPN).

 

Fast forward to today and Dr. Tesfaye is leading some of the most exciting work on early diagnosis of DPN and clinical strategies for altering its relentless progression. His team at University of Sheffield recently presented findings at The American Diabetes Association Scientific Sessions that found the use of point-of-care testing devices by clinicians (Withings’ Sudoscan in combination with DPNCheck) could significantly improve the detection of DPN over current standard of care methods and provide a rapid, reproducible, and quantitative assessment for busy clinicians.

 

“For diabetic retinopathy, we’ve been successful using technology to improve diagnosis and care,” said Tesfaye. “But for neuropathy, we're using these Stone Age implements. With a monofilament, even the best doctors cannot diagnose neuropathy the same two days in a row. Meanwhile, fifty percent (of patients) die within 5 years, it costs more than breast or colon cancer, and is devastating because it's so painful patients can't sleep. Sadly, advanced neuropathy is the strongest risk factor for diabetic foot ulceration that results in fifty percent mortality within 5 years, and costs more than breast, colon and prostate cancers, combined. Neuropathy also is devastating as it can also cause distressing foot and leg pain that interferes with sleep.”

 

Tesfaye is now immersed in a major new study with 160 participants – called OCEANIC – that seeks to determine whether early diagnosis, coupled with robust, early intervention can alter the course of DPN for the better. OCEANIC is using Withings Body Pro 2 smart scales with Electrochemical Skin Conductance (ESC) technology, wearable sensors, and activity trackers, to monitor and share patient progress on metrics including body fat, muscle mass, and ESC score, with the aim of reinforcing lifestyle changes. The study group will receive personalized diabetes education and exercise programs, and weight loss interventions including GLP-1s, to significantly reduce HbA1C. 

 

“Our goal is to explore whether these intensive strategies to manage risk factors can halt or even reverse diabetes-related nerve damage when it is identified at an early stage,” said Dr. Tesfaye. “We want to do for neuropathy what early and routine screening has done for retinopathy – bringing better outcomes to millions of people with diabetes.”

 

If Solomon Tesfaye’s history is any guide, achieving clear answers to the big questions in the OCEANIC study will be but a waypoint on his journey. He credits a mentor, the late Professor John Ward, with encouraging him to tackle the most meaningful problems. “He told me not to worry about publishing too many studies, but rather focus on a few big questions that will fundamentally change people’s lives.”

Interested in partnering with us?

Contact Us [post_title] => Turning Challenges into Opportunities: Dr. Solomon Tesfaye and His Quest to Eradicate Preventable Amputations [post_excerpt] => Dr. Solomon Tesfaye is one of the world’s leading researchers in the field of diabetic peripheral neuropathies (DPN). His life has been a story of overcoming challenges with a mission to tackle one of the biggest problems facing people with diabetes - preventable amputations. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => turning-challenges-into-opportunities-dr-solomon-tesfaye-and-his-quest-to-eradicate-preventable-amputations [to_ping] => [pinged] => [post_modified] => 2024-12-09 16:45:25 [post_modified_gmt] => 2024-12-09 16:45:25 [post_content_filtered] => [post_parent] => 0 [guid] => https://withingshealthsolutions.com/?p=1724 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 34 [max_num_pages] => 12 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => 1 [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => 1 [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => [is_privacy_policy] => [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_favicon] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 105fc667f4d08f564af148470782ed1f [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [allow_query_attachment_by_filename:protected] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )
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