Building a Successful Remote Monitoring Program During COVID-19

^{By Dr. Chris Hobson Chief Medical Officer, Orion Health}

Across the US, health systems face large and unpredictable increases in their work load, resource needs and costs due to caring for COVID-19 patients. These are significant issues for hospitals in particular. In looking for cost-effective options to safely manage COVID-19 patients away from the hospital, organizations are considering significantly increasing their use of remote monitoring tools. 

Virtual care is the new norm

Remote patient monitoring and telemedicine are very attractive alternatives to traditional in-person visits with low cost and high patient satisfaction. In the era of COVID-19, virtual care options also keep highly infectious patients away from health care facilities, helping to reduce the spread of the disease to health care professionals.  

What does a successful remote monitoring solution involve?

Successful remote monitoring solutions need to incorporate several key elements. The basic requirements are capturing data from the patient, delivering that data to providers in easy-to-understand ways and providing targeted advice to patients.   

Solutions need highly configurable alert generation to suit the clinical picture of each individual patient. Alerts must steer a careful path between too many low level alerts that clinicians generally ignore and too few high importance alerts that demand immediate attention. Close clinical oversight is essential in order to ensure the safety and clinical effectiveness of all patient monitoring.  

Integration with the clinical record is important so that clinicians are able to quickly place the patient’s monitored condition in context with the remainder of the patient’s clinical condition. Ideally the clinical record should include care coordination capabilities including access to the patient’s circle of care, long-term care plan and goals of care.

Another important aspect to building a successful remote monitoring solution during COVID-19 is the requirement for rapid deployment and agility. Agile configurations that can rapidly adapt to changing requirements for COVID-19 are critical as we learn and understand more about the disease. 

Remote monitoring options typically come in at least three distinct approaches which we outline next.

Remote patient monitoring options

Telemedicine is the substitution of in-person clinic visits with remote visits facilitated by technology. Commonly used options include phone calls and video sessions facilitated by apps like Skype or Zoom. Telemedicine has been proven to work well, have high patient satisfaction and few downsides.

Remote monitoring of symptoms such as cough and breathlessness plus measurement of vital signs including oxygen saturation is another important approach. Here, patients require a minimum level of training and a mechanism such as a mobile app to capture and transmit data; providers need a dashboard view of their complete population with highlighting of patients whose signs or symptoms are concerning. As well as for COVID-19, this approach has long been used for the management of chronic disease such as congestive heart failure and COPD. Closer more frequent monitoring is especially important for COVID-19 patients in case of rapid deterioration. In many cases, patients have both a chronic disease and COVID-19, and the approach needs to cater for the simultaneous monitoring of more than one condition.  

Remote management of patients offers advanced guidance to the patient directly. Supporting the patient with the use of personalized care plans, regular monitoring of vital signs and the provision of algorithm-generated advice where appropriate can significantly improve the ability to manage patients safely at home.

Conclusion

The COVID-19 pandemic demonstrates that technology can play a major role in facilitating the sustainability of health systems in extraordinary times. It can support both the care needs of individual patients and manage the needs and resources of entire populations — and can safely do so from a distance to limit the spread of the disease.

As the pandemic continues and much of the population is in lockdown at home, we have seen a natural experiment with telemedicine and remote monitoring tools. We have learned that in the right circumstances remote options have both strong patient acceptance and deliver equally good outcomes as traditional face-to-face or in-person clinical encounters. Expect that virtual care approaches will become part of the new normal for health care everywhere.

Dr. Chris Hobson, MD MBA is the Chief Medical Officer with Orion Health. He has 15 years’ experience as a primary care physician and in his role as CMO he is responsible for the clinical strategic direction of all Orion Health products and solutions globally. His major interests are population health, care coordination and ensuring clinical safety and privacy.