The coronavirus pandemic has led to a rapid scaling up of telehealth services outside of hospital settings and also within its walls. National Health Reporter Erin Billups takes a look at how one hospital system is leveraging technology.
As Angelica Russo, a licensed professional counselor, began developing COVID19-like symptoms, her anxiety started rising. “I had a low-grade temperature, you know 99.5. Fatigue, chills, body aches, some tightness in my chest. And I do suffer from asthma. So all the things that were concerning,”
With hospitals overwhelmed with those severely ill, Russo was unable to get tested. She was stuck nursing her moderate symptoms at home, isolated away from her husband and 18-month-old daughter.
A friend suggested she reach out to a remote monitoring program for COVID-19 patients.
“As with most young, healthy individuals who have never experienced shortness of breath before, initially, it was a very scary experience and you know a feeling for her. And so she didn't quite know whether or not it was appropriate to go to the hospital,” said David Putrino, PhD, Co-Director of the Abilities Research Center at Mount Sinai.
Russo said having someone to check in daily with her, made all the difference. “It gave me peace of mind. Gave my mom peace of mind, to know that I wasn't alone in this.”
Putrino helps lead the tele-monitoring program at Mount Sinai Hospital, called Precision Recovery. It was launched six months prior to the COVID-19 pandemic, originally created for stroke patients.
The team quickly reworked their app to monitor coronavirus symptoms.
“Our main focus has been on respiratory symptoms,” said Putrino. “Is it difficult to take a breath? or do you feel like you're breathing more rapidly than normal? Are you noticing a sort of a bluish tinge around your lips?”
Temperatures, blood pressure and blood oxygen levels are also monitored remotely, patients enter their stats into the app. The team also sends devices like blood pressure cuffs and pulse oximeters to patients who may need them- to get even more accurate readings.
“Our mission is to keep them calm and keep them out of the emergency department,” said Putrino. “It is just so important right now that everybody works together to keep our colleagues in the emergency department working at capacity rather than well beyond capacity.”
Russo, now recovered, was the program’s first patient. Now, doctors are keeping tabs on roughly 500 patients daily. About 900 have been referred to the program, many have been discharged. So far around 15 patients have been sent to the emergency room.
“I think that very, very slowly people are starting to realize that remote patient monitoring is a crucial piece of this fight. What we really need with a condition like this is chronic monitoring on a daily basis so that we can identify problems in the moment, and have a detailed history of what has happened in the past,” said Putrino.
Crises have a way of sparking innovation, it’s been estimated there has been a ten-fold increase in the use of tech to treat patients during the pandemic, including the use of devices to treat COVID-19 more efficiently within hospitals.
“If you're in the emergency department and you need a cardiologist or a psychiatrist or whoever it is to give a consult on a patient, we would enable that virtually,” said Elena Sethi, IT Director, Mount Sinai Health System. ”On the [patient] units, we have set up tele-isolation as well, which allows for a device to be with the patient in the room and another device to be outside the room for the care team, the nurses and providers to be able to communicate with the patient seamlessly without having to go in and out of the room.”
Before the pandemic, Sethi says the hospital was working on using tablets, with less than 10 in rotation. They quickly scaled up in early March and now more than 400 are in use, reducing the need to travel to multiple locations and also helps preserve much needed medical gear.
“We can save a lot of PPE. And in addition, allow the individuals who are being so terribly isolated to reach out virtually and interact with family and friends from the hospital bed, which I think is a really important piece of the overall recovery,” said Putrino.
While a large 13- hospital system like Mount Sinai is able to expand its own HIPAA-compliant video system the federal government has relaxed standards, making it possible for smaller hospitals and private providers to start using video platforms like FaceTime and Skype to connect with patients.
“Since this began, we have had thousands of visits a day. Out of necessity, people will learn of the technology that's there and start to utilize it and see benefits,” said Sethi “I am hoping that that's something we can hold onto and expand our reach and our ability to serve our patients after this is all behind us.”