EXECUTIVE SUMMARY

The University of Pennsylvania’s new texting program, called COVID Watch, could play a key role in the future of monitoring COVID-19 patients after discharge.

  • The program sends automated text messages in English and Spanish twice a day for 14 days, asking patients if their symptoms are better, the same, or worse.
  • Case managers and nurses determine who is eligible for COVID Watch, enroll patients, and teach them how to use the program.
  • The program could enhance case management in the future by expanding to monitor patients with chronic illnesses such as diabetes, hypertension, or heart failure.

When the COVID-19 pandemic began, health systems had to come up with new strategies for handling an influx of patients with the disease. One solution is to use technology to extend the reach and monitor discharged COVID-19 patients more efficiently.

The University of Pennsylvania created the COVID Watch text messaging program to follow up with patients on their symptoms, says Austin Kilaru, MD, MSHP, assistant professor of emergency medicine at the University of Pennsylvania.

“Patients receive twice-daily automated text messages, asking them if their symptoms today are the same, improved, or worse,” he explains. “If it’s worse, the technology [sends] separate questions asking for additional details.”

One example of a COVID Watch question is, “Is it harder than usual for you to breathe? Reply Y or N.”1

“COVID Watch [was] developed at the beginning of the pandemic when we realized hospital systems may potentially become overwhelmed with patients, and they needed a triage system,” says Anna U. Morgan, MD, MSc, MSHP, assistant professor of clinical medicine, medical director of COVID Watch, and director of care management and community health at Penn.

In the early days of the pandemic, COVID-19 testing was lagging. The health system often enrolled patients based on clinical suspicion of COVID-19.

“We usually had about 1,000 patients at a time in peak enrollment, and it was managed by six or seven RNs at a time,” Morgan explains. “So far, there have been more than 17,000 patients enrolled in COVID Watch.”

COVID Watch also spawned companion programs, including Pregnancy Watch, which monitors pregnant patients with COVID-19, and COVID Pulse, which enrolls COVID-19 patients from the emergency department (ED) with depressed oxygen saturations and who will need pulse oximeters.

This is how COVID Watch works:

Create texting program. “The program is run through a software platform,” Kilaru says. “We had the existing infrastructure to do it.”

The health system already used technology called Breathe Better Together, which was developed at Penn for patients with COPD. “That was the foundation on which we built this program,” Morgan says.

Breathe Better Together is one of the reasons they built COVID Watch in two weeks.

Screen patients. Case managers or providers offer the program to Penn Medicine patients who have presumed or confirmed COVID-19 infection after they are seen in an outpatient setting or are discharged from the ED or hospital. Patients who can self-monitor from home qualify for COVID Watch.

“They can be enrolled by outpatient providers if they get a positive test after an emergency department discharge,” Morgan adds.

Send automated messages. COVID Watch enrollees receive two text messages a day in English or Spanish for 14 days.

“The messages ask them how their breathing is. If they report any difficulty in breathing, they’re asked if they want to speak with a nurse,” Morgan explains. “If they say yes, then that call is escalated to a nursing team or an advanced practice provider.”

The texting service is available 24/7, and the nursing team calls patients back within one hour. The nurse assesses the patient’s breathing and tells him or her to go to the ED if needed.

“Sometimes, they’ll book them an appointment at the telehealth clinic, or just have them stay home,” Morgan adds. “The patients are enrolled for 14 days, and they have the option to end it early if they’re feeling better, or extend it to 21 days if they like.”

Enhance case management. This type of patient monitoring could be expanded to populations with chronic illnesses, such as diabetes, hypertension, or heart failure, Morgan suggests. The technology could enhance care transitions as patients go from the hospital to home and to primary care providers.

“We want to use these text messaging programs to ease that transition,” Morgan explains. “There could be a lot of future applications.”

One benefit of the technology is that it is simple to use and efficient, she notes. For instance, seven nurses could watch 1,000 patients simultaneously.

“It is an SMS technology, which is really widely used. It doesn’t require an app because it is a text message going back and forth,” Morgan says. “A key reason why it is successful is because the program is pretty easy to use, even if they don’t have smartphones.”

Obtaining patient buy-in is important. “Case managers are instrumental in enrolling patients for this,” Kilaru says. “They figure out who is eligible and who is technologically savvy. They get older patients to learn how to use COVID Watch, or else they enroll them in home health.”

COVID Watch has helped case managers ensure every patient received what they needed. It was part of the discharge planning for COVID-19 patients, he adds.

REFERENCE

  1. Morgan AU, Balachandran M, Do D, et al. Remote monitoring of patients with COVID-19: Design, implementation, and outcomes of the first 3,000 patients in COVID Watch. NEJM Catalyst. July 21, 2020.