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Remote patient monitoring in the era of COVID-19

por Lauren Dubinsky, Senior Reporter | April 20, 2020
Emergency Medicine

“These triage doctors are waiting to take calls with patients who are deteriorating quickly,” said Putrino. “If they Zoom [call] and really don’t like what they see then we quickly arrange for emergency care.”

In one case, a patient reported feeling a little breathless and a small amount of pain while breathing, which wasn’t a major cause for concern. However, the next day she was so breathless that she couldn’t complete a sentence so she was immediately admitted to the emergency department.

In some cases, patients with worsened symptoms can be treated with prescription medications or other interventions that don’t require hospitalization.

The Mount Sinai Precision Recovery team spans five hospitals within the health system and is staffed with 22 coordinators, 12 providers and 10 physicians. As of early April, the team has escalated a handful of patients to the emergency room.

Given the nature of this virus and the accompanied symptoms, Putrino explained that telemedicine approaches that only involve a single urgent care visit are inadequate. This virus requires an approach that checks in with patients on a daily basis to track any changes in symptoms, and follows a clear set of guidelines for when a patient needs to be admitted.

It took Mount Sinai between a year and a year and a half to build the Precision Recovery platform. They spent that time vetting different approaches and determining what works best with a clinical workflow and how to make it work on a practical level.

They decided to run the platform on a secure web application called REDCap, which is used by nearly every large research institute in the country. According to REDCap’s website, this application is already in use at other institutions in response to COVID-19.

The University of Washington’s Institute of Translational Health Services is using REDCap to surveil the community and monitor the virus in pregnant women. Vanderbilt University Medical Center’s Occupational Health group in Nashville, Tennessee is using REDCap surveys to monitor any employees who may have been exposed to the virus.

Mount Sinai launched a website — precisionrecovery.net — to help other hospitals that want to deploy a remote monitoring platform like their own. It provides manuals with basic step-by-step instructions to create this platform and integrate it into their own electronic health record.

“This is all about making these tools available to everybody so we can save as many lives as possible,” said Putrino. “We really hope that other hospitals use these resources, and that it can help them in their own fight against COVID.”

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