Remote Monitoring of COVID-19 Patients

CLINICAL PRIORITY

This large health system was the first to encounter the COVID-19 pandemic’s expansion to the United States. They quickly recognized the need to prepare for a surge, and an important part of their plan was to keep hospital beds open for patients with severe viral illness.

The organization’s leadership sought to develop a patient self-monitoring program for COVID-19 patients who are well enough to recover at home, while maintaining open communication with the care team. They attempted to use their EMR-integrated patient portal to gather self-reported assessments from patients but only achieved 5 percent engagement. A pure texting solution achieved a 30 percent adoption rate. The Telehealth Team needed a more effective, scalable patient engagement tool.

APPROACH

The organization collaborated with Twistle by Health Catalyst to build and deploy clinical communication pathways to address a variety of COVID-19 patient education and monitoring needs including:

• Preventive measure prompts
• Symptomatic self-monitoring
• Monitoring of positive or presumptive positive cases

In addition to the need for much higher patient engagement, the team focused on delivering alerts that could be finely tuned to reduce fatigue, and population health dashboards to allow the nursing team to efficiently track and manage a large patient volume. The health system continues to evolve their COVID-19 communication program; for example, they added a pathway to monitor patients at home after receiving antibody and antiviral medications administered in their temporary infusion tents.

“This program is successful because it’s so accessible to all of our patients. Twistle is an equalizer in our quest to deliver equitable care, delivering tools and technologies to benefit all patients.”

MD, Medical Director of Telehealth Acute Care

IMPLEMENTATION APPROACH

At the start of the project the health system and Twistle worked together to build, iterate, test, train, and go-live with a COVID-19 monitoring pathway in just five days; two days later the pathways were integrated with their Epic EMR. Shortly thereafter, the system supported patient communication in both English and Spanish.

Patients are given a thermometer and pulse oximeter, and the EMR triggers an automatic invitation to the COVID-19 care plan as part of an order set. The program was deployed across 80+ hospitals, urgent care and ambulatory settings located in multiple states.

“This solution dramatically improved the effectiveness of our nurses. While starting at a 1:25 ratio of patients to nurses before Twistle, a week after deploying, the organization reached a 1:50 ratio. We then iterated pathways and streamlined internal processes to reach a safe and effective ratio of 1:85.”

Executive Director of Telehealth Clinical Operations

RESULTS

• Nurse care coordinator productivity increased from a 1:25 ratio of nurses to patients, to 1:85 since implementing Twistle.
• The organization has been able to safely monitor nearly 16,000 with remote patient monitoring technology.
• The organization is seeing an 87 percent engagement rate, due in part because patients do not have to download an app or login to a portal.
• Patients find the technology easy to use, providing a Net Promoter Score of 70, which is unprecedented in healthcare technology and patient communication solutions.