The Value of Remote Monitoring for the COVID-19 Pandemic

COVID-19 is forcing telemedicine to the forefront of national attention, a long-overdue exposure, but it comes during a complicated crisis. Providing care beyond the traditional face-to-face model, telemedicine is a critical component in the ever-changing environment of a spreading epidemic. This leads to the existential question for telemedicine as it is evolved into separate areas: which form of telemedicine is best suited to address the current COVID-19 pandemic?

Telemedicine has rapidly evolved in the past 5 years, especially with the expansion of wireless broadband and expanded capabilities of smartphones. Traditional telemedicine was based on connecting rural clinics and the use of store-and-forward technology for subspecialties. With the evolution of consumer electronics, the telemedicine endpoints are moving toward individuals and into the homes. There is no end to this evolutionary pressure with the meteoric rise of smartphones, bioperipherals, 5G networks, and next-generation telemedicine platforms. COVID-19 has created a fundamental need for telemedicine in a scalable and cost-effective manner.

Telemedicine has evolved into seemingly separate areas. There is now a growing internal separation between three types: (1) traditional rural access, (2) direct to consumer live video, and (3) remote monitoring. With the imminent and mass scale needed for COVID-19 screening, coupled with telemedicine, the subset of remote monitoring appears to be a logical solution to be deployed. This telemedicine type is well positioned to economically and effectively scale.

The Pressing Need for Telemonitoring in COVID-19 Pandemic

The coronavirus, SARS-CoV-2, first appeared in China at the end of 2019, and now has spread worldwide. The virus remains viable in the air up to 3 hours postaerosolization and persists on plastics and steel for 3 days.¹ The mortality ranges between 3% and 5%, higher in countries where mitigation is delayed.² Vaccines are being developed but require more time to reach market. The global impact of COVID-19, from a societal and financial standpoint, is enormous and unprecedented: a “shovel-ready” platform at a commoditized rate is of urgent need.

Screening with traditional health care has two main challenges. First, hospitals and clinics have scheduling logistics, and, more important, could inadvertently serve as disease amplifiers through concentrated contact with sick cohorts. Second, the cost and logistics of coordinating mass face-to-face, unscheduled or rapidly scheduled, visits will challenge the majority of United States delivery systems and information technology systems—especially for travelers or quarantined individuals not native to local electronic health records (EHRs).

To screen for and educate the population about the COVID-19 epidemic require a large scale and asynchronous approach that is not hospital focused. As remote monitoring emerges as the third frontier of telemedicine, it comes with unique and comprehensive features that can serve the immediate COVID-19 need:

• It is asynchronous to enable scale

• Education videos can be pushed and updated immediately

• Patient-reported outcomes come from designed survey questions

• Self-entered data such a blood pressure or temperature are integrated into the workflow

• The monitoring platform is centrally governed and modified in real time to account for new disease information or updated symptom questions

• Live video visits are possible

• Secure bidirectional chat features are included

• A patient can request a call back or in other words call for help.

Operationalizing Remote Monitoring for COVID-19 Pandemic

The asynchronous and bidirectional features enable large cohorts of individuals to interact with the monitoring platform when they are ready and in a longitudinal manner.³ It prevents them from coming to the clinics or hospitals that risk exposure. The data generated by the patients are strategically tagged with meta-data by design and populate a web-based portal for central monitoring and analytics.

The core of remote monitoring is based on pathways that combine all of the mentioned list of features. These pathways are deployed on a population scale with branched-chain logic to react to responses and automatically tailor the interventions. COVID-19 screening can be pushed daily for a week if there is suspected exposure, daily education videos can be updated and sent to concerned citizens about the latest news, and self-entered temperatures can be screened by a monitoring specific or even more generalized contact center. Monitoring can screen the worried well, those who are exposed and not symptomatic, and those with symptoms.

If the screening remains unrevealing or a patient’s answers make them less likely to be at risk for COVID-19, the monitoring platform can slow down the intensity of interactions and focus more on long-term education through the branched-chain logic. This “consumer-friendly” approach that adapts in real-time to answers, self-entered data, and risk, enables population scale and engagement, thus helping to help understand this outbreak.

Live video visits for patients are a key feature and multiple telemedicine platforms. Many institutional portals include video visits with EHRs and patient portals. The challenge is arranging for the vast number of potential live video visits by providers who currently are employed by their practices and have substantial existing work requirements. Demand during a national outbreak will force remote monitoring to become a front-end screening tool to identify individuals at risk and who need video platforms to conduct the video visits or even come to the hospital. Remote monitoring should become a triage engine for health care.

From an operational standpoint, COVID-19 screening needs a low-cost bidirectional solution with commoditized scale. Monitoring platforms have the scalability seen in most telephony-based (synchronous) call centers. With remote monitoring, one staff member can manage hundreds if not thousands of patients’ inbound data based on pathway design. Monitoring is secure, Health Insurance Portability and Accountability Act-compliant, and the bring-your-own-device features leads to rapid economic scale to individual cell phones. Apple Health and the newly emerging CommonHealth represent a powerful modality to gather valuable clinical and other background data to empower both monitoring and video-based visits. Using Apple Health and CommonHealth could provide a more complete picture for telemedicine encounters. Individuals can also acquire their own peripherals to funnel additional data into the monitoring portal. COVID-19 bioperipherals such as a thermometer and potentially a pulse oximeter are most relevant.

Remote monitoring platforms are typically based on durable medical equipment, they routinely manage hardware delivery coupled with pathways and bioperipherals. Monitoring for COVID-19 could return data that automatically generate bioperipherals or test kits shipped to an individual’s house, avoiding human contact and contamination. Monitoring has a unique advantage of experience and integration with durable medical equipment and delivery in its routine workflow.

Tracking COVID-19 Pandemic Data in Real Time with Remote Monitoring

Remote monitoring also has data that immediately go into a secure database with the tagged meta-data and unique identifiers. This type of data aggregation from the home, from the front lines of COVID-19 screening will enable the CDC and other regional agencies to track the outbreak and treatments in near real time. This remote monitoring data set with longitudinal patient-reported outcomes and self-generated data is a natural for machine learning and algorithms to monitor disease progression or future possible vaccine effectiveness. This type of near real-time data would help local and national responses to COVID-19.

COVID-19 is forcing an immediate reconsideration and confrontation with how to handle such outbreaks. Technology and our digital society have fundamentally enabled telemedicine, and now it is show time for such new modalities of “digital health” to perform and succeed.⁴ The traditional belief that a face-to-face visit is necessary for health care has been changed forever and telemedicine is ready. Remote monitoring is one of the three main forms of telemedicine that appears most apt to handle the type of screening and informational challenges that COVID-19 presents.

Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.