Expanding Telemonitoring in a Virtual World: A Case Study of the Expansion of a Heart Failure Telemonitoring Program During the COVID-19 Pandemic

Abstract

Background To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. Objective At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. Methods A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone’s value-adding approach to enhance the analytic interpretation of the study findings. Results A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program’s ability to provide a more comprehensive picture of the patient’s health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. Conclusions With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being.

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“…Given the disruption of medical care delivery, many surgical procedures were postponed [ 37 , 42 ], and many in-clinic patient care services struggled to maintain contact with their patients [ 87 ]. Clinical appointments were put on hold, and most routine outpatient visits were cancelled [ 11 , 27 , 61 , 83 , 84 ]. The lack of access to health care facilities during lockdown and social distancing became a large obstacle.…”

“…This approach can help with overall health improvement during the current pandemic. Authors in [ 61 ] analysed the role of tele-monitoring patients with heart failure (HF) during the COVID-19 pandemic and found that this technique expanded the access of patients to cardiac care.…”

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“…For instance, electronic stethoscopes could be utilized for contactless auscultation with real-time playback, digital storage of data, and subsequent data transmission for further assessment [ 109 ]. With the reduction of in-person hospital visits, digital technology could facilitate telemonitoring programs to serve as alternative to support patient access to care [ 110 ]. Indeed, a recent bibliometric analysis on digital health papers listed telemedicine and telehealth as two of the most frequently used keywords, indicating their relevance beyond cardiology [ 111 ].…”

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“…Programme evaluation has demonstrated that both patients and clinicians valued care continuity through telemonitoring and the opportunity to foster a meaningful patient-provider relationship. 48 This experience highlighted the importance of RPM being embedded in the context of the interaction with the clinic; patients who understood why they were being enrolled had more positive engagement with the technology than those who had not been introduced to the programme by their usual cardiologist, highlighting the ongoing challenge of building relationships through remote methods. 49…”