Providence St. Joseph using Twistle remote monitoring technology for 700 COVID patients

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Remote monitoring is necessary to provide more capacity for an already stressed health system, according to healthcare leaders. (Sladic/Getty Images)

Washington-based Providence St. Joseph Health worked with two digital health startups to quickly deploy remote monitoring technology for COVID-19 patients.

The health system is currently among those treating some of the largest numbers of patients who have been diagnosed with or are at risk of contracting the COVID-19 virus, largely because of its significant presence in Seattle, an epicenter of the pandemic.

Providence worked with Xealth, a digital prescribing platform, to roll out startup Twistle's care automation and remote monitoring tools in just four days, the organizations said.

Several health systems are using the Twistle app to check in with patients and look for adverse health trends. At Providence, Xealth is providing the underlying platform for automation and integration into the provider electronic medical record workflow. 

The health system is using the platform to monitor more than 700 positive or presumptive positive COVID-19 patients, which helps keep patients at home and prevents additional stress on hospitals, emergency rooms and front-line healthcare teams.

Patients who are exhibiting symptoms but are well enough are given a thermometer and pulse oximeter and are monitored from home by Providence’s remote patient monitoring team using the Xealth/Twistle technology.

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“In the current environment, we have a large population of patients who are concerned and experiencing symptoms that may or may not be indicative of COVID-19,” said Todd Czartoski,  M.D., Providence's chief medical technology officer. “Incorporating Xealth and Twistle into our clinical operations extends the reach of our front-line caregivers—enabling us to give them leverage to monitor patients effectively and efficiently—while keeping patients safe at home.”

The health system has developed a digital strategy to help address the crisis that includes a COVID-19 Hub microsite to help educate patients, a self-assessment tool called Grace and virtual visits through Providence's Express Care Virtual. 

A proving ground for monitoring technologies

The ongoing health crisis could be the tipping point for remote monitoring technology, healthcare leaders say. 

Boston-based startup Biofourmis plans to use its wearable and artificial intelligence technology to aid with disease surveillance in Hong Kong and help researchers better understand the illness. 

At the University of California, San Francisco, 2,000 front-line healthcare workers have been given Oura smart rings to help with potential early detection of COVID-19 symptoms. And Scripps Research Translational Institute has launched an app-based research study to analyze data from smartwatches or activity trackers to see whether these data can quickly detect the emergence of influenza, coronavirus and other fast-spreading viral illnesses.

Up until now, many health systems have used wearables, connected devices and sensors for smaller pilot projects focused on patients with specific chronic conditions.

"We’re seeing [the use of remote patient monitoring] ramp up pretty quickly. This is driving institutions to quickly scale up these programs and look at how to build a connected health experience for a much broader population," said Arielle Trzcinski, senior analyst, application development and delivery professionals, at Forrester.

Digital health company Validic has worked in this space for 10 years and provides a platform that connects providers with data gathered from smartwatches, devices and wearables. The company connects with more than 450 in-home devices, health apps and wearables.

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"We’re seeing an increased interest for health systems to move quickly to monitor specifically for symptoms of COVID-19 in terms of both monitoring patients and monitoring personnel and front-line staff," said Drew Schiller, CEO of Validic.

To address the demand for this technology, Validic rolled out a COVID-19 rapid deployment remote monitoring tool for employers and healthcare organizations. That solution can be deployed the same day, with no integration required, and can support data entered manually, Schiller said.

The platform tracks a person’s body temperature, difficulty breathing, cough frequency and oxygen saturation.

"The current situation is highlighting that virtual care in general, and remote patient monitoring specifically, are a need-to-have for the future of healthcare," Schiller said.

Remote monitoring is necessary to provide more capacity for an already stressed health system, Trzcinski said. While hospital inpatient teams can focus on COVID patients, health systems can use wearables and connected devices to help monitor and manage patients with chronic conditions safely from home, Trzcinski said.

Telehealth plays a major role at the front end of the COVID response to help screen and triage patients. Patient monitoring technologies are a critical tool at the back end to manage patients outside of the clinical setting, according to Rene Quashie, vice president of digital health at the Consumer Technology Association.

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"What we saw with Italy is that all the care was centralized in the hospitals and then we saw an incredible increase in the infection rate and death rate. Remote patient monitoring can play a great role in leaving the hospital beds for admissions and then use technology to monitor patients who have been discharged," he said.

Expanded reimbursement

The Centers for Medicare & Medicaid Services (CMS) has stepped up to expand reimbursement for the use of wearables and other devices during the ongoing crisis. CMS clarified Monday that clinicians can provide remote patient monitoring services to patients with acute conditions along with chronic disease patients. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.

"We’re also seeing commercial insurers cover payments on the chronic disease side and I expect they would also start to cover patients being monitored on the acute side, given they generally follow what CMS is doing," Schiller said.

Rapid adoption and expanded reimbursement pave the way for wearables and connected devices to become a permanent fixture in how healthcare is delivered in the future, healthcare leaders say.

"This is really the tipping point for all digital health," Quashie said.

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