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Penn Medicine Study Proves Technology Isn't Always Useful

Analysis  |  By Eric Wicklund  
   April 08, 2022

A remote patient monitoring program launched by Penn Medicine to treat COVID-19 patients at home is working fine and proving its value. Adding technology didn't make it any better.

New technology doesn’t always add value to a good remote patient monitoring program.

That’s the take-away from a study of a COVID-19 RPM program managed by Penn Medicine and recently published in the New England Journal of Medicine. The study of more than 2,000 patients enrolled in the health system’s COVID Watch program in 2020 and 2021 found that patients who used a pulse oximeter at home didn’t have better outcomes than patients who simply contacted their care providers when they had breathing problems.

“Compared to remotely monitoring shortness of breath with simple automated check-ins, we showed that the addition of pulse oximetry did not save more lives or keep more people out of the hospital,” Anna Morgan, MD, medical director of the COVID Watch program, an assistant professor of General Internal Medicine and the study’s co-author, said in a Penn Medicine press release. “And having a pulse oximeter didn’t even make patients feel less anxious.”

To be sure, the program – which has treated more than 28,500 patients - still proves that an RPM platform can be an important tool in monitoring patients outside the hospital, reducing hospital traffic, and improving clinical outcomes.

“The program made it easy to identify the sickest patients who needed the hospital, and keep the others at home safely,” David Asch, MD, executive director of the Center for Health Care Innovation and a professor of Medicine, Medical Ethics and Health Policy, said in the press release. “The program was associated with a 68 percent reduction in mortality, saving a life approximately every three days during peak enrollment early in the pandemic.”

But that doesn’t mean it needs more technology.

Launched in March 2020, the program uses a text messaging platform to keep track of patients diagnosed with COVID-19 who were well enough to stay at home. The automated system sends text messages to those patients twice a day for two weeks, asking how they feel and if they’re having difficulty breathing. If patients indicate they are having problems, a nurse will call them and either suggest continued monitoring, schedule an urgent telemedicine appointment or direct the patient to the hospital’s Emergency Department.

Penn Medicine then decided to see if more technology would make the program better. Acting on research from the Perelman School of Medicine that patients might not notice when their blood oxygen levels are dropping to dangerous levels, the RPM program sent some patients home with a pulse oximeter.

“Several health systems, and even states like Vermont and countries like the United Kingdom, have integrated pulse oximetry into the routine home management of patients with COVID-19, but there’s been scant evidence to show this strategy makes a difference,” M. Kit Delgado, MD, an assistant professor of Emergency Medicine and Epidemiology and the research project’s principal investigator, said in the press release.

With support from the Patient-Centered Outcomes Research Institute (PCORI), Delgado and her colleagues then studied outcomes from roughly 2,000 patients enrolled between March 2020 and February 2021, randomly divided between those using pulse oximeters and those not using the device. And they found no difference in outcomes.

“Overall, these findings suggest that a low-tech approach for remote monitoring systems based on symptoms is just as good as a more expensive one using additional devices,” Krisda Chaiyachati, MD, an assistant professor of Internal Medicine and the research project’s co-principal investigator, said in the press release. “Automated text messaging is a great way for health systems to enable a small team of on-call nurses to manage large populations of patients with COVID-19,”

The study offers a lesson for any health system looking to launch a new technology platform or use an new tool: Don’t just assume it will make things better.

“There are a lot of other medical conditions where the same kind of approach might really help,” he added.

“Compared to remotely monitoring shortness of breath with simple automated check-ins, we showed that the addition of pulse oximetry did not save more lives or keep more people out of the hospital. And having a pulse oximeter didn’t even make patients feel less anxious.”

Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.


KEY TAKEAWAYS

Penn Medicine has treated more than 28,500 patients in its COVID Watch remote patient monitoring program since 2020, improving clinical outcomes and reducing hospital traffic and costs.

When the health system added a pulse oximetry device to the program to enable patients to monitor their blood oxygen levels at home, they found that the added service didn't change outcomes and didn't make patients feel any better at home.

A good program doesn't always need new technology, and in some cases the added tool or service might just make things more costly and complicated.


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