Monitoring confirmed or suspected COVID-19 patients at home and remaining in regular contact can be a challenge, but the University of Pennsylvania Health System (UPHS) has come up with an automated text messaging system that has been working effectively.
The COVID Watch app monitors patients with shortness of breath that is worsening or other concerning symptoms. The program combines automated twice-daily, text message check-ins with a dedicated team of telemedicine clinicians who can respond 24/7 to escalations in patient symptoms and is designed to supplement existing lines of care.
Patients also can text “worse” at any time and be immediately routed to a nurse, or end their participation by texting “bye.” Nurses call escalating patients within one hour to assess and address their needs, and may refer them to the emergency department or an on-call team of physicians and advanced practice providers for additional telemedicine assessments. The program continues for 14 days from enrollment, at which point patients may opt for an additional seven days, after which they “graduate,” an NEJM Catalyst report states.
The health system recently reported its initial experience with the first 3,000 invited patients to use the app. About 83% of the patients were managed by the automated program without having to escalate to human care, notes the report.
Referring to their approach as “automated hovering,” UPHS leaders say vigilant evaluation is required at the outset for programs like this — not only for new diseases like COVID-19, but also because initial responses to clinical automation are not always anticipated. They add that the model could be adapted to manage a variety of clinical conditions like hypertension, diabetes or heart failure for which frequent human contact might be supplemented or partially replaced with automation.