As cases of the novel coronavirus continue to mount, hospitals are shifting their attention to monitoring and treating patients in their own homes—making virtual care an increasingly widespread and critical part of delivering healthcare.
That includes the video visits people often think of when referring to telemedicine, but also programs that help clinicians regularly monitor patients’ vital signs and symptoms from afar. Across the board, demand for virtual care has gone up 20 to 30 times since mid-March, said Gurpreet Singh, health services leader at consulting firm PwC.
For COVID-19 cases, keeping low-acuity patients at home not only cuts down on staff’s risk of exposure to the virus, but also saves hospital beds for the most critical patients.
Preparing for a surge of patients was one of the main reasons University Hospitals in Cleveland decided to try remote monitoring for some patients with COVID-19 symptoms.
“You have unlimited capacity if you can turn your home into something that you can monitor in,” said Dr. Peter Pronovost, the health system’s chief clinical transformation officer.
Before joining University Hospitals in 2018, Pronovost co-founded a remote patient-monitoring platform called Doctella, which was sold to devicemaker Masimo. Pronovost last month decided to reach out to Masimo—he said he does not have a financial stake in the company—to see whether the tool could be repurposed and paired with other devices for COVID-19 monitoring.
It took a few weeks of work, including supporting the company as it sought regulatory clearance for some of its remote monitoring capabilities, but in late March, University Hospitals launched a pilot.
Now, patients in the system’s emergency departments with mild COVID-19 symptoms can be discharged home with the remote monitoring system, which includes an eight-day supply of disposable, single-use pulse oximeter sensors and access to an app that prompts users to input information such as possible fevers or shortness of breath.
It’s for “patients who you might be worried about (and) might admit in normal circumstances,” Pronovost said.
Data from the remote monitoring devices is delivered to a University Hospitals command center staffed by nurses, who monitor vital signs and contact patients if something looks wrong. Those nurses also call patients twice a day to check in, even if their data is normal.
As of mid-April, more than 40 patients have been discharged from a University Hospitals ED with the remote monitoring system. Some of those patients had conditions like pneumonia or chronic obstructive pulmonary disease, but most were given the monitoring tools in response to a suspected or confirmed COVID-19 case, Pronovost said.
University Hospitals isn’t charging patients to participate in the program. Masimo donated the remote monitoring tools to the health system for the pilot. Typically, a kit costs $150, according to the company.
University Hospitals is in good company. NYC Health & Hospitals last week launched a new program to send text messages to patients with COVID-19 symptoms who don’t require hospital admission, so that the New York City-based system can keep tabs on patients’ symptoms from home. And OSF HealthCare in Illinois has stood up two home-based monitoring programs in response to the COVID-19 outbreak.
Reducing the need to hospitalize patients has been a core driver of systems across the U.S. implementing remote monitoring in recent weeks, with many hospitals concerned that COVID-19 will “eclipse” their ability to treat patients as beds become limited, said Jeff Becker, a senior analyst at market research firm Forrester.
By monitoring patients at home, “you’re adding capacity back to that health system. You’re giving beds back to the hospital,” Becker said.
OSF in early April began dropping off packages with tablets, thermometers, hand sanitizer and other supplies to the homes of possible COVID-19 patients. Patients enter their symptoms into apps pre-downloaded onto the tablet, and if those symptoms get worse, they’re enrolled into a separate program called AcuteCOVID@Home. That involves another package, this time with remote monitoring devices like blood pressure cuffs and pulse oximeters.
“We’re really thinking about the patient journey, trying to keep our patients in their homes and save our hospitals for the most critical,” said Jennifer Junis, senior vice president at OSF St. Gabriel Digital Health, which oversees the system’s digital health services.
