As the COVID-19 cases rise, healthcare systems and practices across the country are innovating care models to provide best management for COVID patients without putting other patients and healthcare staff at risk. With a remote monitoring system, a clinical practice can leverage their existing healthcare resources to triage patients without further spreading the disease, prioritize treatment of highest at-risk patients, and protect their healthcare staff from infection.
In order to best allocate resources as COVID cases increase, practices will need to be able to effectively screen, triage, and monitor their patients at a population health level. Using optimize.health as a use case example, a clinic is able to deploy a screening questionnaire to their patients via text message. Rather than having clinic staff individually call patients, this secure survey will allow for collection of symptom, travel, and other risk factor data across hundreds to thousands of patients simultaneously. Using a dashboard, providers will be able to screen through their population of patients to identify clinically who would benefit from escalation of care whether it’s ordering a COVID test, further evaluating over phone or video, or monitor through further surveillance. In addition to screening patients at home, virtual management of patient care also protects patients from infection and transmission. Patients save a trip to the clinic limiting possible exposure in transit especially those patients that rely on public transit or rideshare or at the clinic site itself e.g. waiting rooms. In addition, triaging patients safely, this system will also set up practices to more effectively monitor patients at home.
Using the COVID surveillance program, clinics will be able to automate checking in with their patient population and focus on those that require the most attention. The range of presentation for COVID based on the data from China varies widely from mild (81%) to severe (14%) to critical (5%)[1]. Of these patients, the overall mortality is 2.3% with no deaths in the noncritical populations. Therefore, clinics are faced with the task of taking care of their patient populations across all levels of severity, but ensuring to not miss those developing a severe or critical presentation. In the COVID surveillance program, patients will receive daily texts with access to a secure survey of their symptoms such as shortness of breath. Furthermore, patients enrolled into a reimbursable remote monitoring program (RPM) will be supplied with a device to monitor their heart rate and blood oxygen saturation providing critical information for the providers if a patient is trending towards respiratory failure.
With a dashboard of collected symptoms and vital signs, providers will be able to more easily identify candidates for a more in-depth evaluation and potential escalation of care such as a hospital admission while reducing the backend administrative burden of phone calls. Given the increasing burden of COVID cases across the country, it will be imperative to be able to scale beyond individual patient visits to manage from a population level. Examples of deploying remote monitoring range from healthcare systems such as Providence St. Joseph Health and University Hospitals to larger regions such as Hong Kong.
In addition to optimizing COVID care for patients, remote monitoring also provides critical protection for our frontline healthcare staff. More than 3,300 health care workers in China[2] and 4,800 in Italy[3] (or 1 in 10) have been infected by COVID. Moreover, in the US a shortage of PPE further jeopardizes adequate protection of the frontline leading to higher risk in managing COVID patients. With 30% of physicians over 60 and the average age of physicians above 50, remote monitoring provides opportunities to enable this workforce without exposing them to an infection where they are at a higher risk. However, an investment in redesigning workflows for a virtual triage and remote monitoring experience can safeguard healthcare staff while ensuring the delivery of care.
[1] "Characteristics of and Important Lessons From the ...." 24 Feb. 2020, https://jamanetwork.com/journals/jama/fullarticle/2762130. Accessed 30 Mar. 2020.
[2] "COVID-19: protecting health-care workers - The Lancet." 21 Mar. 2020, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30644-9/fulltext. Accessed 30 Mar. 2020.
[3] "Nearly 1 in 10 of Italy's infected are health care workers." 22 Mar. 2020, https://edition.cnn.com/world/live-news/coronavirus-outbreak-03-22-20/h_e27a10efe9dfe61900b2ae6583e13189. Accessed 30 Mar. 2020.