Telemonitoring for Patients With COVID-19: Recommendations for Design and Implementation

Abstract

Despite significant efforts, the COVID-19 pandemic has put enormous pressure on health care systems around the world, threatening the quality of patient care. Telemonitoring offers the opportunity to carefully monitor patients with a confirmed or suspected case of COVID-19 from home and allows for the timely identification of worsening symptoms. Additionally, it may decrease the number of hospital visits and admissions, thereby reducing the use of scarce resources, optimizing health care capacity, and minimizing the risk of viral transmission. In this paper, we present a COVID-19 telemonitoring care pathway developed at a tertiary care hospital in the Netherlands, which combined the monitoring of vital parameters with video consultations for adequate clinical assessment. Additionally, we report a series of medical, scientific, organizational, and ethical recommendations that may be used as a guide for the design and implementation of telemonitoring pathways for COVID-19 and other diseases worldwide.

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

“…Many patients did not understand the purpose of their enrollment in the program, especially those who were not producing alerts, and they felt that this lack of clarity jeopardized their virtual relationship. Recent studies have attributed similar findings to the widening of the scope of telemonitoring programs to accommodate the limitations posed by the pandemic without considering the impact of the changes on clinical effectiveness or patient satisfaction [ 6 ]. We argue that to sustain telemonitoring adoption, clinicians should begin to clarify the specific objectives of the telemonitoring program to prevent possible misconceptions among patients.…”

“…Virtual care interventions have been implemented to provide solutions to the health delivery challenges posed by the COVID-19 pandemic [ 2 , 6 ]. Despite the push for virtual care and the previous support for its use, few studies have explored the perception of these technologies within the contexts of both before and during the pandemic [ 4 ].…”

“…While the additional nursing staff helped support the patient caseload, the telemonitoring program was operating under a fragmented ecosystem of virtual technologies (ie, the EMR, the Medly system, videoconferencing) that increased the complexity of clinical practices. With these technical challenges, recent research has recommended shifting traditional clinical workflows to a more digitally assisted pathway [ 6 ]. Specifically, to prevent duplicating tasks or spending excessive time navigating different systems, the adoption of dedicated communication channels and tailored workflows across multiple platforms would help to increase clinician collaboration and streamline data access.…”

“…These patients have been reported to face a higher risk of severe illness when infected with COVID-19. Thus, maintaining patient health status in the context of the current health care reconfigurations represents a significant challenge [ 5 , 6 ].…”

“…To ensure access to care in light of restrictions to in-person visits, innovative virtual care models have been used during the pandemic as a necessary alternative [ 4 , 6 ]. The value of virtual care has been demonstrated in a number of studies through its ability to provide timely care that enables patients to maintain physical distancing while also conserving health care resources [ 6 , 7 ]. Among virtual care technologies, telemonitoring is being increasingly promoted as a tool to assist patients who need more frequent care touchpoints [ 7 ].…”