Seniors Housing & Healthcare Trends

NEW YORK: COVID-19 is driving the rapid deployment of self-monitoring apps to allow for care of patients in remote settings.

Kean-Seng Lim is the first to admit that his medical practice has a fairly highly technological setup.

“We do use a lot of remote monitoring tools, including patient self-monitoring tools,” says Dr Lim, a GP based in Western Sydney.

And that’s had an impact on how he’s been looking after COVID-19 patients.

Dr Lim and his colleagues have been referred low-risk patients with mild to moderate coronavirus, which means they can be managed in the community.

They’ve been keeping track of these patients via a mobile app which asks them to self-report their symptoms each day.

Each day, Dr Lim says, the patient would be prompted with a series of questions:

Are you short of breath?
Have you got a cough?
Have you got a fever?
Has there been any reduction in your exercise capacity?

The information feeds into a dashboard monitored by the practice’s nurses, who can see whether individual patients are stable or if their symptoms are getting worse and they need to be contacted.

If a patient’s symptoms are getting worse, the app also advises them to get in touch with their GP.

A video consultation with one of the doctors at the practice is then scheduled.

“That sets in train the process,” Dr Lim says.

“But the nurses would continue to monitor the questionnaires and escalate to doctors should there be any deterioration.”

The app can also collect data from fitness/activity trackers, pulse oximeters, blood pressure machines, scales and so forth, if the patient gives consent.

Crucially, the app allows the practice to pinpoint cases where people report worsening symptoms in the second week of their COVID-19 infection, sometimes described as the “second week crash”.

“Through a remote monitoring tool we were able to identify that very early on,” Dr Lim says.

“That’s the reason why even though someone might be technically low risk and mild, it’s still very important to continue to monitor all the way through until they’re better.”

Giving people some kind of digitised device or self-tracking app to monitor and regulate their chronic health conditions has been around for quite a while, says digital and health sociologist Deborah Lupton of the University of New South Wales Sydney.

So Professor Lupton is not surprised it’s being used in the context of COVID-19.

In her interviews with people who use this kind of self-tracking at home (for chronic health conditions like diabetes or high blood pressure) they often talk about feeling like they have more control over what is often quite a chaotic or unsettling experience.

They don’t have to go and see their doctor so often to get their vital signs and indicators checked.

On the negative side it can also create a lot of invisible work for patients.

“And that can get tiring.”

It can turn your home into a medicalised space as well, she says, because it can feel like you’re never really free of having to think about your chronic health condition.

While people feel optimistic when the metrics they’re monitoring are looking good, Professor Lupton say healthcare professionals need to be aware of what support their patients might need if they struggle to cope when the metrics look bad.

Similar to how we’re all feeling with the daily COVID-19 cases numbers, “you can go a bit up and down with the numbers as well” when you’re self-monitoring.

Based on his experiences, Dr Lim suspects patients self-select and don’t engage with self-tracking if they are worried about their results.

However, he’s also noticed that the apps can be motivating.

“Because patients see it more as a personal challenge, their results tend to improve when using apps in this way,” he says.

It’s been two years since Dr Lim’s practice first started using this technology, initially with patients with chronic health conditions and now with COVID-19 cases.

They used self-tracking for patients with chronic lung disease and asthma during the bushfires last year.

“We were able to … identify when people were deteriorating, provide more proactive outreach care, and achieved a zero hospital admission and zero hospital presentation rate amongst the monitored patients using this application,” Dr Lim says.

He thinks this is the future of medicine.

Once the system is set up a patient downloads the app to their mobile device and then the doctor and nurses at the other end do the monitoring and any interventions that are required.

“We’ve been very fortunate that we’ve had access to good technology before this, and this has really, I think, helped us a lot in this new environment,” Dr Lim says.

Self-monitoring technology also consumes less health resources and takes less time and leads to greater patient engagement, he says.

But while Professor Lupton’s research has shown many people benefit from such technology, she says the overall picture is more complicated than that.

“A lot depends on … where this information that a patient might be generating about themselves and their bodies, where they are going. That is a big question. What third parties have access to them?” she says.

“If healthcare providers are advocating for their patients to use third party apps, they need to … think about how well those data are being protected, because that is part of patient confidentiality and security that I would have thought most doctors are very knowledgeable about that, [but] they’re not in relation to third party app use and they need to be.

“As yet most Australians haven’t actually been negatively affected by any kind of data privacy breach. So they don’t feel as if it’s a problem.”

She says we need to be constantly monitoring developments and risks, and conducting social research on how people are using these apps, and the benefits and barriers they present, rather than just advocating for digital solutions.

Dr Lim agrees technology by itself is never the solution, but at its best it can allow healthcare to be more efficient and effective, and create a more patient-centric partnership between patients and their healthcare team.

All his patients can see who has access to their data in the app and how it is being used, and the practice and the tools they use comply with all the relevant Australian privacy and data safety standards.

“We’re reducing the risk to as low as is reasonably possible,” Dr Lim says.

“The ultimate safety has to be that patients can opt in and opt out of any system.”