11/09/2020

How to Organize Remote Patient Monitoring for COVID-19 Patients at Home with Show2Doc

Steps to organize remote patient monitoring for СOVID-19 patients at home or outpatient treatment:

1. Direction to RPM.
2. Onboarding (creation clinic and doctor accounts with Show2Doc team, creation Subscription for Patients, downloading Patient App and downloading the patient app, activation of Subscription, monitoring devices supply).
3. Training (online videos and support, teaching the patient how to take measurements and make data).
4. Daily monitoring log (prescribing tasks from the doctor, creating of the monitoring or/and treatment plans).
5. Measurements (collection and transmission of health parameters).
6. Online interaction (text messages or video calls).

Direction to RPM

Show2Doc is a doctor-to-patient communication and monitoring platform for remote monitoring and continuous care at home or in ambulatory treatment. It is a cloud-based system that includes a mobile patient app (both iOS & Android), software for doctors and connected medical devices. Show2Doc has established itself as a tool for remote monitoring of patients with COVID-19 symptoms in self isolation or outpatient care.

After examination by the doctor (personally or virtually), patients were referred to remote patient monitoring (PRP).

Individuals are referred by the doctor to the RPM, if they have:

• a positive test for COVID-19, 
• a suspected diagnosis of COVID-19 based on symptoms similar to COVID-19.

Onboarding

Patients are orally instructed by the clinical coordinator how to download the Show2Doc mobile application to their smartphones during check-in. Show2Doc is a mHealth software which includes measurement data entry functions, treatment scheduler and online video platforms.

Patients also receive medical devices to monitor symptoms which may include:

• infrared thermometer
• pulse oximeter
• blood pressure meter, etc.

Patients who are at high risk of rapid respiratory distress, should be provided with a pulse oximeter.  

Criteria indicating a high risk of airway deterioration included the following:

1. persons with a history of severe respiratory or cardiovascular diseases
2. persons discharged from hospital with supplemental oxygen
3. people who were in hospital in difficult conditions, including those who needed mechanical ventilation
4. patients with severe symptoms of COVID-19.

Training

Patients should be provided with a virtual guide describing the procedures for using the software and data entry, and contact information for technical support. After admission, patients are encouraged to complete a questionnaire containing information on their demographic characteristics and test results for COVID-19.

They then need to be instructed on how to log their daily symptoms and physiological data in Show2Doc, and how and when to make video calls with a doctor for symptom review, clinical assessment and risk stratification.

Daily monitoring log

Daily physiological measurements include:

• body temperature (°F / °C) — 3-4 times a day every 4 hours
• oxygen saturation level (%SpO2) — 3 times a day
• systolic and diastolic blood pressure (mm Hg) — 2 times a day
• heart rate (bpm) — 2 times a day

Also, the doctor can prescribe medication with an indication of the time of admission. 

For example: “Take 500 mg of Ascorbic Acid, after meals, the time is 9:00”.  

The patient will make a check mark and the doctor conducting the PRP will see that he is following recommendations for the implementation of the treatment protocol.

Doctor-to-Patient interaction

Video calls are primarily needed for visual clinical assessment of symptoms, as well as teaching patients how to manage symptoms at home. If a clinical deterioration is detected, the patient should immediately make a virtual visit to the doctor via Show2Doc. Clinical indicators for a virtual visit to the doctor, include:

• significant changes in the severity of symptoms
• new chest pain or shortness of breath
• deterioration of physiological indicators, including hypoxemia (oxygen saturation <94%), tachycardia (heart rate >100 beats per minute), tachypia (>20 breaths per minute) 
• or any other clinical picture specified by the doctor conducting the PRP. 

As conclusion

Given the level of anxiety experienced by patients with symptoms of COVID-19, there is a great deal of uncertainty about “how sick a person really is” so that they can seek help in an emergency. In addition, the burden on the medical staff is extremely increasing every day.

The introduction and use of the RPM system like Show2Doc for managing COVID-19 cases is preferable to traditional models of medical care. Because RPM allows for daily symptom monitoring, reduces the use of limited hospital resources, improves access to care and reduces the spread of the virus.