Wearable technology: covid-19 and the rise of remote clinical monitoringBMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n413 (Published 18 February 2021) Cite this as: BMJ 2021;372:n413
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Best gives a broad, up-to-date review of the use of remote clinical monitoring and its relevance to the covid-19 pandemic.
They rightly point out some of the potential benefits of this technology including the ability to; spot signs of deterioration early, reduce contact between healthcare workers and covid-19 patients, potentially reduce admissions freeing up beds and provide a broader picture of a patient’s health status by collecting regular data over time.
However, there are considerable limitations and pitfalls associated with the use of technology in this context. Best quotes Mistry, a digital fellow at King’s Fund, in saying that remote monitoring can provide “reassurance” to people, but this is not necessarily the case. At the Care Research & Technology Centre, in the UK Dementia Research Institute(1), we are running a study monitoring the vital signs of 50 people living with dementia, in their own homes. We have found that a large number of ‘false positive’ alerts are generated by erroneous readings – particularly by the pulse oximeters used to measure oxygen saturations. Pulse oximeters are often programmed to produce a low reading (e.g., 70%) if they are unable to pick up an adequate trace, and this will produce an alert that is hard to differentiate from a true desaturation. We have found that patients with dementia frequently produce these error readings, for example, due to having cold hands or a tremor generating movement artefact(2). This then causes anxiety in the patient and their carer and poses a problem for the clinical team monitoring the patient who have to make a decision about what the appropriate response is.
This raises questions about the feasibility of home monitoring of vulnerable patients during the pandemic, with the intention of detecting health deterioration, due to covid-19 and other acute illnesses. Studies such as the NHS England-funded ‘TIHM (Technology Integrated Health Management) Monitoring Service’(3) have been set up to identify signs of ill-health early. The aim of their project is to recruit 1000 elderly people, many of whom will be living with dementia, and offer reassurance about their health and reduce anxiety about covid-19, whilst prompting access to support if needed. If this service is to follow the guidelines of the NHS England ‘Covid Oximetry@home Pathway’(4) for patients with confirmed covid-19, patients will be directed to call 999 for any readings of <93%. We would suggest that this is likely to increase the burden on the health-service and cause more worry, rather than reassurance, for the patients.
Remote monitoring can be done effectively, non-invasively and is likely to be an important part of the health service going forward. But caution must be taken before rolling out large scale services before the issues surrounding false positive readings are solved and the resultant burden on the monitoring service is reduced.
2. Olive S. Using pulse oximetry to assess oxygen levels. Nurs Times 2016;112:12–3.
Competing interests: No competing interests