By Robert Havasy, MS, Managing Director, Personal Connected Health Alliance, HIMSS
At some point in the past three weeks, nearly every person on the planet has felt an ordinary tickle in the throat, a single dry cough or a flush of warmth and wondered, is this an early symptom of coronavirus?
The normal first step would be to contact your doctor and begin a conversation about how you feel, possibly augmented with a couple of readily measurable vital signs like your body temperature. But the strain on healthcare resources caused by the COVID-19 pandemic has flipped the healthcare paradigm on its head.
Authorities across the world are telling people not to go to a hospital or urgent care center until they need serious help. But as you lay awake at night wondering what to do, how will you know when to make the call or go to the emergency room?
It is possible to monitor physiologic parameters at home and base your decisions on objective evidence. A wide variety of sensors has been available for home use for years — a portable thermometer for healthcare use was introduced in 1867 and has been common in homes since the middle of the 20th century. And most people have a bathroom scale, based on a spring scale invented in 1770 and digitized in the 1980s. But connecting these devices to modern smartphones and allowing them to transmit data to healthcare data systems is a more recent capability, gaining popularity since the mid-2000s.
Using these and other medical devices to track various physiologic measurements is known as remote patient monitoring (RPM).
There are two common devices that can help someone with suspected or confirmed COVID-19 to monitor their condition and to guide decision-making for patients and their families. I keep both of these in my home sickness kit at all times.
Current guidelines from the Centers for Disease Control and Prevention (CDC) say you should seek immediate treatment if you have:
But diagnosing milder COVID-19 symptoms requires the use of a thermometer to check for low-grade fever of between 99 and 101 F, and to monitor higher fevers if they are present. For those recovering from a suspected case, guidelines state that you can leave isolation after, "You have had no fever for at least 72 hours (that is three full days of no fever without the use of medicine that reduces fevers)." Both of these require an accurate thermometer to track.
According to the World Health Organization, COVID-19 progresses to severe pneumonia when the signs of difficult breathing noted above are present and a patient's oxygen saturation, or the amount of oxygen carried by the blood, is equal to or less than 93 percent.
This is a critical measure of illness that is routinely and constantly monitored for patients in the hospital, as anyone who has ever spent time in a hospital bed knows. As soon as you hit the bed, a small clip goes onto your finger and stays there until you are moved again. That same technology is available for home use, and the device that measures your blood oxygen saturation is called a pulse oximeter and the readings are often referred to as "pulse ox."
Normal pulse ox is greater than 95 percent. For a patient worried about difficulty breathing, knowing their blood oxygen levels remain within the normal range can be very reassuring. And stress, anxiety and breathing have an interesting relationship in the body, as shortness of breath (also called dyspnea) can be can be side-effects of anxiety and stress.
Checking pulse ox at home can reassure a patient feeling a tightness in the chest. And knowing that a patient's pulse ox has been steadily declining can help a doctor know when to recommend that a person go to a hospital in this crisis.
In the United States, Chris Cuomo, a television news anchor and brother of the Governor of New York, was recently diagnosed with confirmed COVID-19. During a conversation with Dr. Sanjay Gupta, he sang the praises of having a pulse oximeter to monitor himself at home. See minute 1:52 of this video posted to CNN. He calls the pulse oximeter, "A great gift to people who are fighting COVID-19 because it lets you know that ... your chest situation is still good..."
It is one thing to place a call to your doctor and say, "My condition is getting worse and it's hard to breathe." Decisions can be made much easier if you can say, "My fever continues, breathing is hard, and my pulse ox has been steadily declining and is now 93 percent." There is no guessing in the second case that action is required.
Other health challenges don't disappear just because the coronavirus that causes COVID-19 is circulating. People with diabetes and high blood pressure (hypertension) still need to monitor their conditions, and remote patient monitoring is important for these patients as well. About one third of Americans have hypertension, and half of them do not have their blood pressure under control. And the stress caused by anxiety about COVID-19, changes in diet because of disruptions to normal life and economic uncertainty can create situations that can exacerbate high blood pressure and aggravate diabetes.
For these reasons, it may be beneficial to have a blood pressure monitor at home to track the effects on your overall health. Diabetics who test their blood glucose levels should ensure a sufficient supply of test strips are available for any expected periods of isolation.
Finally, it might be helpful to step on a scale once in a while. Many people have had their daily routines totally disrupted, have had to cut out exercise due to government orders, and are probably eating different food than normal since shopping trips happen less frequently. All of these factors can contribute to weight gain, and if these disruptions last for months, it will be important to manage your weight to maintain health.
Though the idea of people monitoring health at home isn't new, the infrastructure needed to connect all these devices is still being built. The Personal Connected Health Alliance and HIMSS have advocated for interoperability and policies that make data and information easily accessible, transportable and secure.
The industry, by and large, has not seen data as a public good, but rather an important part of business. Widespread adoption of the standards and mechanisms needed to share data has happened very slowly or not at all. But a global pandemic with the effects of COVID-19 may be the kind of once-in-a-generation event that changes this.
People using common tools to keep track of their health data, connected to the public health system, will be an integral part of a robust monitoring system of the future.
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