Pilot Study of Home Vitals and Activity Monitoring for Allogeneic Hematopoietic Cell Transplant Recipients

Abstract

Can leveraging fast growing technology assist with improving patient outcomes and streamline workflows at the same time? We piloted remote monitoring technologies to find out. In partnership with our hospital's Digital Health team, we provided 39 allogeneic blood and marrow transplant (BMT) recipients with a Bluetooth enabled blood pressure, temperature and activity tracking device. After a one-time set up and pairing with the patient's smartphone, the devices automatically transmitted real-time readings into the patient's permanent electronic medical record (EMR). The patient's transplant care team had the ability to view a dashboard with at home readings. Abnormal readings were also delivered directly to their EMR's inbox. Patients were asked to monitor these readings for at least 100 days post BMT, with the option to continue using the remote devices longer, if desired. Approximately 60% of patients had consistent at home BP and temperature readings recorded in their EMR but only 16% had activity tracking data. We observed the following advantages of remote monitoring: (1) Ease of use by BMT team: The transplant nurse coordinators found it relatively simple to view normal and abnormal at home readings from the EMR. (2) Enhanced patient monitoring: Transplant nurse coordinators were able to see trends before the patient's office visits. For one patient, monitoring prompted a cardiology appointment, where they were able to route home readings to the cardiologist through the EMR. (3) Patient experience: Patients who were able to successfully use the devices generally had positive feedback about them. However, some challenges and opportunities for improvement were identified: (1) Need for better hardware: The activity device used in this pilot was a basic device, future efforts may be better focused on other activity devices. The functionality of our platform was not seamless for Android users. (2) False positive readings: False positive temperature and heart rate readings were an issue (e.g., temperature of 105 recorded due to a family member playing with thermometer, recording heart rate from wife's Apple watch . (3) Patient expectations: Despite educating patients to call their care team with abnormal readings, many patients did not and expected an immediate phone call from their nurse coordinator. (4) Patient experience: Some patients stated that the devices were not easy to use and troubleshooting issues was difficult. We found that remote monitoring of vitals and activity in allogeneic transplant recipients is feasible but has opportunities for improvement before it can be more widely adopted. Workflows were not negatively impacted and visualizing the data was easy. We can see the benefit that at home monitoring could bring, but would need to see improvements with integration, software and hardware before it can be used routinely to care for patients.