Remote monitoring program brings peace of mind to COVID patients at home

A remote patient monitoring system for people with COVID-19 has worked so well that the telehealth team at MUSC Health is already thinking about ways to expand the system to cover other conditions. 

“We can basically add a thousand observational beds without laying a brick,” said David Wheeler, telehealth patient and provider experience coordinator at the MUSC Center for Telehealth.

Most importantly, the remote patient monitoring system brings a top-notch health care team straight into the patient’s home, regardless of where in the state the patient lives. That lifeline to medical professionals has so far provided peace of mind to 945 people battling an unpredictable illness that has killed more than 3,400 South Carolinians. Wheeler, who’s been conducting informational interviews with patients to find out what worked well and what didn’t, said their appreciation shines through in their comments to him.

“I was all alone, and then I had people looking out for me. I do not know what I would’ve done without them,” one patient told Wheeler.

When the COVID-19 pandemic arrived in South Carolina in March, MUSC Health leaders sprang into action to provide screening through the existing virtual urgent care platform, followed by testing at an off-site location so that people possibly infected with the coronavirus wouldn’t bring it into clinics or the Emergency Department where they could infect staff or other patients.

But with a disease that was confounding doctors with how quickly things could go downhill, they knew they needed a way to keep track of people who were ill but not sick enough to be admitted to the hospital. Together, Family Medicine, Primary Care, the Biomedical Informatics Center and the Center for Telehealth developed a plan for remote monitoring, said Cheryl Hamill, R.N., telehealth remote patient monitoring coordinator.

“We review every new positive that MUSC tests, anywhere in the state, determine their eligibility and then offer them, if appropriate, monitoring."
Cheryl Hamill, R.N.

The program begins when people get tested for COVID-19 through MUSC Health.

“We review every new positive that MUSC tests, anywhere in the state, determine their eligibility and then offer them, if appropriate, monitoring,” Hamill said. The monitoring is available regardless of whether the patient usually sees MUSC Health doctors.

Patients who agree to participate in the home monitoring program respond to a daily COVID symptom survey that asks questions about things like how easily they feel out of breath and allows them to report vital signs like temperature and oxygen levels. Depending on their answers, nurses determine what next steps to take, including calling the patient or notifying the patient’s primary provider. When necessary, the nurse recommends the patient contact their primary provider or directs the patient about how to safely transfer to the closest emergency room.

Wheeler and Hamill said the contact with nurses helped reassure patients and prevent unnecessary trips to emergency rooms.

“Every patient I’ve talked to, in 101 interviews, said they would have gone to the emergency department at least one time. In several cases they said two or three times,” Wheeler said.

On the other hand, nurses have been able to persuade people to go to emergency rooms when medically necessary.

Just recently, one patient was especially nervous about going. But over the course of two phone calls, the nurses persuaded her that it was necessary. After receiving treatment and rehydration, she returned home feeling better and grateful for the encouragement to seek care, Hamill said.

The Telehealth Center has a handful of other remote monitoring programs in place, but those are all based on apps geared to a single condition, like diabetes. This time, they decided to conduct the monitoring through Epic MyChart, a web- or app-based portal that gives patients, or a proxy, access to all of their MUSC Health test results, appointment schedules and after-visit summaries as well as the ability to message their care providers.

“We're big champions of Epic MyChart because after the COVID experience, then they have all this opportunity to stay connected to their care system that they did not have before. So many times, patients are so frustrated because they think the only way to connect is getting on the phone and sitting there waiting for someone to help them,” Hamill said.

“You think ‘telehealth’ and you think ‘technology’ first, and that is not how we’re thinking of remote monitoring."
Cheryl Hamill, R.N.

Age has not been a barrier to successful use of MyChart.

Hamill said the telehealth nurses help patients or their proxy over the phone to activate their MyChart accounts and learn basic navigation features. It can be empowering for patients to have their own health information at their fingertips, she said.

But, she emphasized, patients who are unwilling or unable to access MyChart are never excluded from participation in the program. In those cases, she said, nurses begin monitoring the patients via telephone.

“You think ‘telehealth’ and you think ‘technology’ first, and that is not how we’re thinking of remote monitoring,” she said.

Wheeler agreed.

“At the end of the day, it does have a human aspect to it. We are human beings taking care of other human beings,” he said.

They’re excited about the possibility of expanding the telehealth remote patient monitoring program to assist patients and providers in addressing other health conditions and have started working with key stakeholders within MUSC Health as well as statewide telehealth alliance partners.

Remote monitoring breaks down barriers for those restricted by distance, money or unease with health facilities, Wheeler said, and instead, exemplifies “boundaryless” access for the underserved.

“To the patient, remote monitoring will feel seamless and will feel powerful, and it will make them feel much more in control of their health care,” Hamill said.