Article originally published in Healthcare IT Today 05-27-2020

A text-based patient monitoring and outreach solution deployed in just 8 days by New York City Health + Hospitals (NYC H+H) at the start of the COVID-19 pandemic continues to benefit patients, staff, and the people of New York City a year later.

Leading Edge of COVID-19

New York City was one of the first cities in the US to be “stressed” by COVID. The first case of COVID-19 was confirmed on March 1st, 2020 and the city (and state) quickly became the epicenter of the pandemic. NYC H+H, the largest public healthcare system in the US, has been at the leading edge of the city’s COVID-19 efforts since the beginning and has carried a heavy burden as a safety-net hospital.

“Our clinicians identified early that there were a lot of patients who were coming into the ED who clearly had COVID symptoms and some even had x-rays that indicated COVID and yet they had normal oxygen saturation levels,” recalled Dr. David Silvestri, Emergency Physician and Senior Director of Care Transitions and Access at NYC H+H, who recently sat down with Healthcare IT Today. “At the time, we were really reticent to discharge these patients to their homes without any way to monitor them or track their progression over the 24-48hrs.”

Unfortunately, there was simply not enough resources available to call every one of those patients to check up on them. Dr. Silvestri and the NYC H+H team recognized they needed an automated solution that could scale to hundreds of patients.

Text-Based Solution

NYC H+H chose to partner with Lumeon, a care journey orchestration platform, to co-create a solution. Given the dire situation, the teams worked closely together and in just 8 days they went from idea to implementation.

The solution was based on simple interactive text messages – no online forms, patient portals or integration with fancy wearables. The solution would simply text questions one by one to patients that NYC H+H wanted to monitor, and the patient would respond via text. If the responses indicated the person was at risk, an escalation would be triggered.

In the first phase of the roll-out, the questions were focused on tracking the breathing status of patients and the escalation was a phone call from a medical provider. In later phases, additional questions about oxygen levels and resting/ambulating heart rates were added. This became practical once the city and state made resources available for pulse oximeters to be distributed to patients who didn’t need to be admitted to the hospital.

The solution was also enhanced to offer patients direct access to the virtual urgent care service, created by NYC H+H, where they could speak to an emergency medicine resource. Through the solution, patients were given the option to connect via a phone line or via video.

Equal Access

“At NYC H+H and any other safety-net hospital, you have the burden and the honor to do more with less,” stated Dr. Silvestri. “Someone that does not have stable internet or even speaks English deserves the same level of care as someone who does. That means we must really think through different operational approaches and technology in order to accomplish that.”

This need to provide broad and inclusive access was the reason NYC H+H opted for a text-based solution and why they incorporated additional languages right from the beginning.

“We were very happy that we could offer our patients a choice of 14 other languages.” Said Dr. Silvestri. “We even had some right-to-left languages available. That helped us cover over 99% of the patients that we serve in our communities.”

Because of this consideration of patients’ needs, the solution was very well received. It provided a tremendous amount of relief and reassurance to those who came in with COVID symptoms, but asked to isolate and monitor at home. Instead of repeated visits to the ED or calls to COVID-19 hotlines, people enrolled with the solution were more at ease because they knew their situation was being monitored by their local healthcare provider.

Solution Expansion

According to Dr. Silvestri, the solution was also well received by the staff at NYC H+H. ED clinicians felt better knowing that their patients were being monitored at home, and it helped reduce the burden on staff who did not have to manually call every patient who came into the ED with symptoms.

As word spread about the successful deployment, other departments at NYC H+H jumped on board. Obstetrics, for example, which was one of the few departments that still operated at full capacity through the early pandemic, quickly adopted the solution to help monitor and care for pregnant mothers who had signs of COVID.

NYC H+H then deployed the solution in their COVID testing centers and any patient that came through for a COVID test was automatically offered enrollment in the monitoring solution. It was a resounding success – so much so, that it caught the eye of city officials and soon the solution was deployed to all of New York’s testing and tracing programs. For anyone that tested positive, the solution was offered to help monitor them.

In addition, the solution was enhanced to provide people with their test results electronically. After visiting a testing center, everyone would be notified via text message when their results were available (within 48hrs). People were offered a choice to see the results in a MyChart portal or via a text message (with consent of course).

This helped to address one of the biggest gaps in COVID testing – getting the results back to the people who had come in. With this solution, hundreds of clinics were saved from having to organize and mobilize staff to call patients with test results. It has saved thousands of man-hours.

Dr. Silvestri estimates that 5million New Yorkers have been notified of their COVID test results via their text solution since it was deployed.

Solution Future

The success of this solution has opened the eyes of many within NYC H+H.

There was some skepticism that a tool like this could be effective at monitoring patients with a potentially deadly condition at home using nothing but text messages. The success of the past year has shown everyone that it not only works, it works AT SCALE.

“It has moved our comfort level with this type of technology forward by YEARS,” said Dr. Silvestri.

The solution co-created with NYC H+H is aligned with Lumeon’s mission to be a leading provider of Care Journey Orchestration (CJO) solutions. The COVID monitoring solution is essentially the first step in a COVID care journey. As a patient sends in their breathing, pulse oximetry and heart rate information, the system was analyzing it to determine what the next, most appropriate step was for that individual. For those in the “red zone” it meant escalating to a NYC H+H provider.

It’s not hard to imagine the solution being modified to accommodate chronic conditions like diabetes, heart disease and COPD – prompting and collecting patient-generated data to assist with care navigation and delivery. Integration with home-devices, wearables, ambient sensors, and EHRs would make the entire experience more seamless.

“The question is, will patients be as engaged with chronic conditions as they are with COVID?” asked Dr. Silvestri. “Everyone is super-motivated right now because the disease is highly contagious, progresses quickly and is potentially deadly.”

Although it is unclear if the same level of success can be achieved, Dr. Silvestri and the team at NYC H+H are making plans to try.

Listen and watch the full interview with Dr. Silvestri here:

A still from the video interview between NYC H+H and Healthcare IT Today