The Unexpected Rise of Telemonitoring During the COVID-19 Pandemic

Monitoring Patients During the Pandemic

During the pandemic, there was a rapid development of telemonitoring, i.e., remote monitoring, whether it was monitoring patients in isolation in healthcare facilities, telemonitoring patients in home treatment, or patients themselves providing data within self-monitoring. In addition to telemonitoring, other related areas of telemedicine also developed, and study results suggest it is the right path to reduce patient morbidity and mortality and improve their quality of life.

Unexpected Development of Telemonitoring

According to recent analysis estimates, regular monitoring of saturation using a pulse oximeter during hospitalization and for a period of 3 weeks after discharge was potentially associated with a mortality rate of 6/1000 patients compared to a mortality rate of 26/1000 patients without monitoring for COVID-19 patients. Based on a hypothetical cohort of 3100 patients, the analysis assumed a reduction in hospitalization by 87% and deaths by 77% (1).

According to preliminary analysis of another study involving 83 patients, pulse oximetry was an effective method to identify patients with a milder course of COVID-19 who required emergency room assessment and those whose condition could be managed via teleconsultation (2).

The development in this direction also seems to contribute to shortening the length of hospital stays. In a study involving 33 patients with severe cases of COVID-19 who were discharged to home treatment with oxygen therapy (<3 l/min), telemonitoring was rated as safe, user-friendly, and cost-effective with an average hospital stay reduction of 6.5 days (standard deviation [SD] 3.4; n=20) for those requiring oxygen therapy and 1.3 days (SD 0.4; n=13) for those without the need for oxygen therapy (3).

Outlook for the Future

In the home environment, besides pulse oximetry, other parameters such as blood pressure, heart rate, ECG curve, or body temperature can be monitored. Data can be monitored by attending physicians in almost real-time using smartphones, secure cloud servers, or web dashboards.

Despite these advances, telemonitoring is still not part of routine clinical practice. Besides the issue of billing this care to health insurers, many other obstacles need to be addressed, such as creating sufficient technological infrastructure and expert teams specializing in telemedicine or protocols that will stratify patient risks and determine for whom home monitoring is suitable.

However, a clear advantage will be that the indication for telemonitoring will not be influenced by the patient's place of residence but by their risk profile, which can help improve the quality of care for patients with poor access to healthcare facilities.

Conclusion

The COVID-19 pandemic contributed to a rather rapid development in the field of telemedicine. One of its domains is so-called telemonitoring, which involves the continuous or variously regular recording and assessment of various biological parameters of patients outside healthcare facilities. During the pandemic, telemonitoring demonstrated benefits in many respects, including reducing patient mortality, and ease of implementation thanks to technological progress. However, it will take some time before telemonitoring can be applied to routine clinical practice.

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Sources:
1. Padula W. V., Miano M. A., Kelley M. A. et al. A cost-utility analysis of remote pulse-oximetry monitoring of patients with COVID-19. Value Health 2022; 25 (6): 890–896, doi: 10.1016/j.jval.2021.09.008.
2. Aalam A. A., Hood C., Donelan C. et al. Remote patient monitoring for ED discharges in the COVID-19 pandemic. Emerg Med J 2021; 38 (3): 229–231, doi: 10.1136/emermed-2020-210022.
3. Grutters L. A., Majoor K. I., Mattern E. S. K. et al. Home telemonitoring makes early hospital discharge of COVID-19 patients possible. J Am Med Inform Assoc 2020; 27 (11): 1825–1827, doi: 10.1093/jamia/ocaa168. 
4. Pronovost P. J., Cole M. D., Hughes R. M. Remote patient monitoring during COVID-19: an unexpected patient safety benefit. JAMA 2022; 327 (12): 1125–1126, doi: 10.1001/jama.2022.2040.