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Expanding Telemonitoring in a Virtual World: A Case Study of the Expansion of a Heart Failure Telemonitoring Program During the COVID-19 Pandemic.
Wali, Sahr; Guessi Margarido, Milena; Shah, Amika; Ware, Patrick; McDonald, Michael; O'Sullivan, Mary; Duero Posada, Juan; Ross, Heather; Seto, Emily.
  • Wali S; Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.
  • Guessi Margarido M; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
  • Shah A; Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.
  • Ware P; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
  • McDonald M; Department of Computer Systems, Institute of Mathematics and Computer Science, University of São Paulo, São Paulo, Brazil.
  • O'Sullivan M; Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.
  • Duero Posada J; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
  • Ross H; Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.
  • Seto E; Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
J Med Internet Res ; 23(1): e26165, 2021 01 22.
Article in English | MEDLINE | ID: covidwho-1030360
ABSTRACT

BACKGROUND:

To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand.

OBJECTIVE:

At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic.

METHODS:

A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone's value-adding approach to enhance the analytic interpretation of the study findings.

RESULTS:

A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program's ability to provide a more comprehensive picture of the patient's health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program.

CONCLUSIONS:

With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / COVID-19 / Heart Failure / Monitoring, Physiologic Type of study: Case report / Diagnostic study / Observational study / Prognostic study / Qualitative research Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 26165

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / COVID-19 / Heart Failure / Monitoring, Physiologic Type of study: Case report / Diagnostic study / Observational study / Prognostic study / Qualitative research Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 26165