Mobile app-based Remote Patient Monitoring in Acute Medical Conditions: A Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload during the COVID Crisis
BACKGROUND: Digital remote patient monitoring (RPM) can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Healthcare providers are overwhelmed resulting in clinical teams spread more thinly. We aim to assess the impact of the introduction of an app-based RPM (Huma Therapeutics) on a clinician's workload in the context of a COVID-19 specific virtual ward. OBJECTIVE: This prospective feasibility study aims to evaluate the health economic effect (in terms of clinical workload) a mobile app has on a telephone based virtual ward in the monitoring of COVID-19 patients clinically ready for discharge from hospital. METHODS: A prospective feasibility study was carried out over one month where clinician workload was monitored, and full time equivalents (FTE) savings equated. An NHS hospital repurposed a telephone-based respiratory virtual ward for COVID-19. Amber status (NHS definition) COVID-19 patients were monitored for 14 days post-discharge to help identify deteriorating patients earlier. A smartphone-based app was introduced to monitor data points submitted by the patients with telephone calls used for communication. A comparison of clinical workload between those monitored by telephone only (Cohort 1) with those monitored via mobile app and telephone (Cohort 2) was undertaken. RESULTS: 56 patients were enrolled in the app-based virtual ward (Cohort 2). Digital RPM reduced the number of phone calls from a mean total of 9 to 4 over monitoring period. There was no change in the mean duration of phone calls (8.5minutes), and no reports of readmissions or mortality. This equates to a mean saving of 47.60 working hours. This translates to 3.30 fewer FTEs (raw phone call data), resulting in 1.1 fewer FTEs required to monitor 100 patients when adjusted for time spent reviewing app data. Individual clinicians were averaging 10.9 minutes per day. CONCLUSIONS: Smartphone-based RPM technologies may offer tangible reductions in clinician workload at a time of severe service strain. In this small pilot, we demonstrate the economic and operational impact digital RPM technology can have in improving working efficiency and reducing operational costs. Whilst this particular RPM solution was deployed for the COVID-19 pandemic, it may set a precedent for wider utilisation of digital RPM solutions in other clinical scenarios where increased care delivery efficiency is sought.