JMIR Publications

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 to healthcare organizations considering 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 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 three embedded units of analysis. Semi-structured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program, at a Heart Function clinic in Toronto, Canada. Data was 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 virtual healthcare 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 like 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 healthcare system. These include revisiting the scope and expectations for TM 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.