Cleveland Clinic worked with Epic, its electronic health record vendor, to develop and implement a COVID-19 home monitoring program that is now available for other healthcare organizations across the country to use.
Collaboration among clinicians and analysts helped the Clinic to rapidly design, build and launch the technology in just 10 days. Typically, it would have taken three months to do so, said Dr. Eric Boose, associate chief medical information officer at the Clinic.
Though patients with COVID-19 often experience mild symptoms, monitoring these symptoms is critical because deterioration can be rapid, even in low-risk patients. The new tool automates patient engagement and supplements existing processes to enable the Clinic to extend the reach of clinicians without adding staff members, according to a post on Epic's Health Research Network.
"With so many patients needing to be monitored, this kind of helps the process be a little more automated to really focus on the ones that need the help the most," Boose said.
The Clinic already has more than 1 million patients active on MyChart, its patient portal. Organizations across the country use Epic's MyChart Care Companion, which has been available since 2018, to monitor patients with chronic conditions. The Clinic is the first to customize that technology for COVID-19, creating a tool that surveys enrolled patients on their condition and integrates educational content to further support their recovery at home. New or worsening symptoms trigger an alert to a system monitored by a dedicated group of clinicians.
"Another organization now can basically take that programming right from Epic and install it in their systems and be ready to go," Boose said.
Upon enrollment in home monitoring, which has been implemented for all of the system's confirmed and suspected COVID-19 cases, an initial outreach call gives patients isolation instructions, education and screening for social support and home safety. They are then invited to engage with the tool, which asks them whether symptoms (including cough, shortness of breath, weakness, vomiting, diarrhea and poor appetite) are present and whether they have been getting better or worse, or staying the same. If they are able, patients are also asked to provide oxygen levels and temperature readings.
Patients with new or worsening symptoms are notified their condition will be reviewed by a clinician, who may then escalate the patient to additional care, such as a virtual evaluation, referral to an emergency department, an order for new medications, additional diagnostics or the dispatch of a visiting paramedic or allied health professional. For those who don't desire escalation of care, providers focus on the comfort and management of symptoms. Palliative care may also be activated through a virtual visit, and services are initiated when symptoms worsen, according to the post.
Daily monitoring, which continues for 14 days from the reported onset of symptoms, includes a Care Companion task reminder and telephone outreach to high-risk patients from a registered nurse or allied health professional. Patients enrolled after a hospital stay are monitored for seven days after discharge. Through the EHR, patients' primary care and other providers are kept informed about all encounters.
The information collected through these touchpoints is stored in the EHR, and discrete data collection enables further research and predictive modeling in the ongoing efforts to better understand and treat the novel virus.
So far, more than 1,200 patients with lab-confirmed COVID-19-positive cases have been enrolled in the program, including more than 240 who were discharged from a Clinic hospital after treatment for complications from COVID-19. Engagement has risen from 13% to nearly 20%. About 900 suspected cases have been referred, with most patients being enrolled after the fifth day of symptoms. To date, more than 700 patients have been discharged from the program.
Since the program was implemented, 24 patients have been admitted due to deteriorating symptoms, complications of underlying medical conditions and other reasons.
Though right now the enrolled patients are all suspected or positive COVID-19 cases, Boose said he sees a lot of future applications for this technology, especially in the management of chronic conditions.
"Going forward, when things are settling down and we're opening up to see patients in person, I will see sort of hybrid state that will be permanent where we see some patients face-to-face and other patients virtually for years to come," Boose said.
This story first appeared in our sister publication, Crain's Cleveland Business.