JMIR Publications

ABSTRACT

Background:

Telemonitoring can enhance the efficiency of healthcare delivery by enabling risk stratification, thereby allowing healthcare professionals to focus on high-risk patients who need it the most. Additionally, it reduces the need for physical care. In contrast, telemonitoring programs require a significant time investment for implementation and alerts processing. A structured method to improve efficient care delivery in telemonitoring programs is lacking.

Objective:

We propose a framework for optimizing efficient care delivery in telemonitoring programs based on alert data- and scenario analysis of a telemonitoring program for hypertension combined with a literature review on methods to improve efficient telemonitoring care delivery.

Methods:

We extracted 1-year alert processing data from the telemonitoring platform and electronic health records (June 2022-June 2023) for all patients in the hypertension telemonitoring program. We analyzed the alert burden and alert processing data. Additionally, a scenario analysis with different threshold values was conducted for existing blood pressure alerts to assess the impact of threshold adjustments on the overall alert burden and processing. We searched for English language academic research papers and conference abstracts reporting clinical alert or workflow optimization in telemonitoring programs on the 24th of May 2024 in Embase, Medline, Cochrane, Web of Science and Google Scholar.

Results:

174 patients were included and analyzed. On average, each patient was active in the telemonitoring program for 207 days and a total of 30184 measurements were performed. These triggered 17293 alerts: 13647 were processed automatically by the telemonitoring platform and 3646 were processed manually by the telemonitoring center, equivalent to 21 manually processed alerts per patient. Additional analysis of the manually processed alerts revealed that 25 (15%) patients triggered more than 50% of these specific alerts. Review of this subgroup provided opportunities in 3 patients to make individual adjustments to these thresholds based on medical decisions. Furthermore, scenario analysis of the thresholds revealed that a small increase in threshold values for the diastolic and systolic blood pressure alerts would reduce the number of alerts in both cases by about 50%, with only minor changes in alert processing. Literature search yielded 251 articles of which 7 studies reported methods to improve efficient care delivery in telemonitoring programs: including the introduction of complex alerts and clinical algorithms to triage alerts, scenario analysis with alert threshold adjustments and a qualitative analysis to create an alert triage algorithm.

Conclusions:

Based on the data-analysis and literature review a four-step framework was developed to optimize efficient care delivery in telemonitoring programs. The four steps include ensuring accurate measurements, telemonitoring algorithm and alert optimization, focusing on individual patient and patient group’s needs, and improving telemonitoring process efficiency. This framework can be an important first step to improve efficient care delivery in 21st century telemonitoring programs. Clinical Trial: Not applicable