Pulse Oximeter Device Research Articles

Hospital Environmental Factors That Influence Peripheral Oxygen Saturation Measurements: A Cross-Sectional Study.

Pulse oximetry is a non-invasive, cost-effective, and generally reliable instrument measuring pulse rate and peripheral oxygen saturation (SpO2). However, these measurements can be affected by the patient's internal or external factors, including the type of pulse oximeter device (POD). (1) This study's objective was to identify potential environmental factors that may impact the measurements taken by three PODs. (2) Methods: A descriptive-analytical cross-sectional study was designed. The patients' SpO2 levels were measured using a standard monitor and two PODs owned by the professionals. The measurements were taken on the patients' fingers. Concurrently, we evaluated the surrounding environmental conditions, encompassing temperature, humidity, illuminance, and noise. (3) Results: This study involved 288 adult participants in the sample. For each 20-decibel increment in noise, there was a reduction in SpO2 by an average of 1%, whereas for every additional degree of ambient temperature, SpO2 decreased by an average of 2% (4) Conclusions: Significant correlations between SpO2 and age, as well as with noise and ambient temperature, were observed. No significant differences between oxygen saturation and lighting or humidity were observed. This study was prospectively registered with the Clinical Research Ethics Committee of Gran Canaria at the Dr. Negrín University Hospital, with protocol code 2019-247-1, and approved on 24 May 2019.

Electronic health record data is unable to effectively characterize measurement error from pulse oximetry: a simulation study.

Large data sets from electronic health records (EHR) have been used in journal articles to demonstrate race-based imprecision in pulse oximetry (SpO2) measurements. These articles do not appear to recognize the impact of the variability of the SpO2 values with respect to time ("deviation time"). This manuscript seeks to demonstrate that due to this variability, EHR data should not be used to quantify SpO2 error.Using the MIMIC-IV Waveform dataset, SpO2 values are sampled from 198 patients admitted to an intensive care unit and used as reference samples. The error derived from the EHR data is simulated using a set of deviation times. The laboratory oxygen saturation measurements are also simulated such that the performance of three simulated pulse oximeter devices will produce an average root mean squared (ARMS) error of 2%. An analysis is then undertaken to reproduce a medical device submission to a regulatory body by quantifying the mean error, the standard deviation of the error, and the ARMS error. Bland-Altman plots were also generated with their Limits of Agreements. Each analysis was repeated to evaluate whether the measurement errors were affected by increasing the deviation time.All error values increased linearly with respect to the logarithm of the time deviation. At 10min, the ARMS error increased from a baseline of 2% to over 4%.EHR data cannot be reliably used to quantify SpO2 error. Caution should be used in interpreting prior manuscripts that rely on EHR data.

Cyber-attacks Risk Analysis of a Connected Pulse Oximeter Device: A Threat Modeling Using STRIDE and DREAD Models

The term "Internet of Things (IoT)" has gained significant traction in recent years due to its wide-ranging applications across various industries, including the healthcare sector. These medical devices, known as connected medical devices, offer immense benefits to patients with chronic diseases and others. However, despite their advantages, regulatory bodies responsible for issuing medical device sales and usage permits currently lack a standardized method for evaluating the security and cybersecurity resilience of these devices before granting approval. The proposed threat modeling approach is an engineering tool that utilizes the STRIDE model to identify and categorize potential threats to connected devices, determine the mitigation techniques employed, and generate a comprehensive report. Additionally, the DREAD model is employed to assess the severity of potential threats throughout the development life cycle of the connected medical device. This paper aims to validate the accuracy and realism of the outcomes derived from this tool and assess the ease of implementation of the proposed methodology by medical device designers and biomedical engineers who lack cybersecurity expertise. The results of applying the proposed threat modeling approach using the STRIDE and DREAD models to an open-source connected pulse oximeter revealed a low average severity score for the connected medical device against potential cyber threats. Our approach was also compared to other threat modeling methods in terms of the number of steps, implementation complexity, and result realism. The findings demonstrat that our threat modeling approach requires the fewest steps, does not necessitate cybersecurity expertise for implementation, and produces more realistic and stable results. Consequently, we propose that the FDA adopt and implement our proposed approach to expedite the approval process for the sale and use of these medical devices, enabling healthcare providers to leverage connected medical devices on a wider scale to combat diseases and epidemics, ultimately delivering higher quality and more effective healthcare.

The effect of the simulated intrauterine sound on behavioral and physiological indices of pain during capillary blood sampling for screening preterm infants: a randomized clinical trial study

IntroductionDue to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants.MethodsA double‑blind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO2) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants’ faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t‑test in SPSS software version 20.0.ResultsEighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30–3.80(, and (1.15 ± 0.84, 95%: 0.95–1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30–5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p < 0.001) and five min after heel lancing (p < 0.001). Mean scores of heart rate in the three phases of before, during, and five min after the intervention were respectively in the intervention group (127.57 ± 4.45, 95% CI:126.27-128.99), (131.07 ± 6.54, 95% CI:129.20-133.22), (128.45 ± 5.15, 95% CI:127.02-130.07) and in the control group (128.67 ± 4.57, 95% CI:127.32-130.07), (136.07 ± 7.24, 95% CI:133.90-138.37), and (132.42 ± 6.47, 95% CI:130.37-134.49). There were significant differences in heart rate between the intervention and the control group during (p = 0.002) and five min after the heel lance (p = 0.003). Mean scores of SPO2 in the three phases of baseline, during, and five min after the intervention were respectively in the intervention group (96.72 ± 0.93, 95% CI:96.42-97.00), (91.47 ± 1.46, 95% CI:91.05–91.92), (94.17 ± 1.03, 95% CI:93.22-94.00) and in the control group (96.6 ± 0.84, 95% CI:96.35–96.85), (91.5 ± 1.24, 95% CI:91.12–91.87), and (93.60 ± 1.27, 95% CI:93.85–94.50).ConclusionThis study showed that the simulated intrauterine sound reduces the behavioral pain and heart rate in the intervention group during and after heel lance. These results suggest using the method during the painful heel lancing to reduce pain parameters in preterm infants.

Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19-Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project.

Wearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. A prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. We used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. In total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. Designing and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period.

Assessment of health technology acceptability for remote monitoring of patients with COVID-19: A measurement model for user perceptions of pulse oximeters.

This study aims to develop a measurement model for health technology acceptability using a theoretical framework and a range of validated instruments to measure user experience, acceptance, usability, health and digital health literacy. A cross-sectional evaluation study using a mixed-methods approach was conducted. An online survey was administered to patients who used a pulse oximeter in a virtual hospital setting during COVID-19. The model development was conducted in three steps: (1) exploratory factor analysis for conceptual model development, (2) measurement model confirmation through confirmatory factor analysis followed by structural equation modelling and (3) test of model external validity on four outcome measures. Finally, the different constructs of the developed model were used to compare two types of pulse oximeters by measuring the standardised scores. Two hundred and two participants were included in the analysis, 37.6% were female and the average age was 53 years (SD:15.38). A four-construct model comprising Task Load, Affective Attitude, Self-Efficacy and Value of Use (0.636-0.857 factor loadings) with 12 items resulted from the exploratory factor analysis and yielded a good fit (RMSEA = .026). Health and digital health literacy did not affect the overall reliability of the model. Frustration, performance, trust and satisfaction were identified as outcomes of the model. No significant differences were observed in the acceptability constructs when comparing the two pulse oximeter devices. This article proposes a model for the measurement of the acceptability of health technologies used by patients in a remote care setting based on the use of a pulse oximeter in COVID-19 remote monitoring.

Passive leg raising test induced changes in plethysmographic variability index to assess fluid responsiveness in critically ill mechanically ventilated patients with acute circulatory failure

BackgroundPassive leg raising (PLR) reliably predicts fluid responsiveness but requires a real-time cardiac index (CI) measurement or the presence of an invasive arterial line to achieve this effect. The plethysmographic variability index (PVI), an automatic measurement of the respiratory variation of the perfusion index, is non-invasive and continuously displayed on the pulse oximeter device. We tested whether PLR-induced changes in PVI (ΔPVIPLR) could accurately predict fluid responsiveness in mechanically ventilated patients with acute circulatory failure. MethodsThis was a secondary analysis of an observational prospective study. We included 29 mechanically ventilated patients with acute circulatory failure in this study. We measured PVI (Radical-7 device; Masimo Corp., Irvine, CA) and CI (Echocardiography) before and during a PLR test and before and after volume expansion of 500 mL of crystalloid solution. A volume expansion-induced increase in CI of >15% defined fluid responsiveness. To investigate whether ΔPVIPLR can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and gray zones for ΔPVIPLR. ResultsOf the 29 patients, 27 (93.1%) received norepinephrine. The median tidal volume was 7.0 [IQR: 6.6–7.6] mL/kg ideal body weight. Nineteen patients (65.5%) were classified as fluid responders (increase in CI > 15% after volume expansion). Relative ΔPVIPLR accurately predicted fluid responsiveness with an AUROC of 0.89 (95%CI: 0.72–0.98, p < 0.001). A decrease in PVI ≤ −24.1% induced by PLR detected fluid responsiveness with a sensitivity of 95% (95%CI: 74–100%) and a specificity of 80% (95%CI: 44–97%). Gray zone was acceptable, including 13.8% of patients. The correlations between the relative ΔPVIPLR and changes in CI induced by PLR and by volume expansion were significant (r = −0.58, p < 0.001, and r = −0.65, p < 0.001; respectively). ConclusionsIn sedated and mechanically ventilated ICU patients with acute circulatory failure, PLR-induced changes in PVI accurately predict fluid responsiveness with an acceptable gray zone. Trial registrationClinicalTrials.govNCT03225378.

Home pulse oximetry monitoring during the COVID-19 pandemic: An assessment of patient engagement and compliance

ObjectivesPatients with suspected COVID-19 remain at risk for clinical deterioration after discharge and may benefit from home oxygen saturation (SpO2) monitoring using portable pulse oximeter devices. Our study aims to evaluate patient engagement and compliance with a home SpO2 monitoring program. MethodsThis is a single center, prospective pilot study of patients being discharged from the ED or urgent care after evaluation of symptoms consistent with COVID-19. Subjects were given a portable pulse oximeter and instructed to obtain measurements at rest and with exertion twice daily for 14 days. Patients were contacted daily to collect recorded data. If attempts to contact the patient were unsuccessful for 3 consecutive days, patients were considered lost to follow up. The primary outcome of interest was patient engagement in the program which was defined as the percentage of patients that completed the 14-day study period, meaning they were not lost to follow up. Secondary outcomes included compliance with performing the SpO2 readings. Patient compliance was calculated as a percentage of completed readings out of the total expected readings. ResultsFifty patients were enrolled - 2 withdrew and 1 was a screen failure. Overall, engagement in the program was 46.8% with no significant difference between those who tested positive for SARS-CoV-2 versus those who tested negative (48.2% vs 45%, p = 0.831). Median compliance overall was 42.9% (IQR 22.22–78.57). Median compliance for the positive group was 50.0% (IQR 20–85.71) and 42.86% (IQR 22.92–76.44) for the negative group (p = 0.838). ConclusionOur study demonstrated that there was acceptable engagement and compliance in a 14-day home SpO2 monitoring program. These results support the use of home pulse oximetry monitoring in a select group of mildly ill patients with suspected COVID-19.

Wearable devices for remote monitoring of hospitalized patients with COVID-19 in Vietnam.

Patients with severe COVID-19 disease require monitoring with pulse oximetry as a minimal requirement. In many low- and middle- income countries, this has been challenging due to lack of staff and equipment. Wearable pulse oximeters potentially offer an attractive means to address this need, due to their low cost, battery operability and capacity for remote monitoring. Between July and October 2021, Ho Chi Minh City experienced its first major wave of SARS-CoV-2 infection, leading to an unprecedented demand for monitoring in hospitalized patients. We assess the feasibility of a continuous remote monitoring system for patients with COVID-19 under these circumstances as we implemented 2 different systems using wearable pulse oximeter devices in a stepwise manner across 4 departments.

Pulse Oximeter And Different Skin Tones In Pakistan.

Madam, A recent retrospective cohort study found that 3069 patients of Asian, Black, and Hispanic racial origin were associated with lower average oxygen delivery rates than white patients using the pulse oximeter in the intensive care unit.[1] It is well known that these readings are affected by skin melanin pigmentation, which affects light absorption and scattering, resulting in unreliable readings in non-white patients.[1] This can increase the risk of hidden hypoxemia, which is established as falsely elevated SpO2 readings, usually 92% or greater when the blood haemoglobin oxygen saturation is &lt; 88%.[2] This, in turn, is associated with higher mortality rates.[2] The Pakistani population has a variety of skin tones making this a concerning matter for people of all age groups. According to data analyzed from 18 different hypoxemic studies over the last three years which included studies analyzing the performance of pulse oximeter brands, employing both transmission and reflectance, with 3 sensor types (reusable finger clip, disposable adhesive finger, disposable adhesive forehead) found a slight positive bias in readings on skin with darker pigmentation.[3] The current ongoing situation with COVID-19 makes it even more important to investigate the matter of the pulse oximeter’s performance. A retrospective study on 117 COVID-19 patients found that those with increased fibrinogen, increased ferritin and decreased lymphocyte count were risk factors for those with significant difference (&gt;4%) in SpO2 and SaO2 suggesting that the pulse oximeter alone isn't enough to accurately and precisely assess COVID-19 patients with those conditions.[4] It is also important to note that the performance of the pulse oximeter devices differ in a clinical vs ideal laboratory setting.[3] During the pandemic in Pakistan, many hospitals and homes have used the pulse oximeter as a reliable portable device without being aware of the discrepancies in the precision of its readings. The Pakistani population should have a pulse oximeter device that works ideally in all settings and on a variety of skin tones to reflect the diversity of its population. The regulatory agencies and leading hospitals in Pakistan should analyse and change their standards for measuring the accuracy and precision of the pulse oximeter on patients with darker pigmentation, especially in low-perfusion and hypoxemic states.[3]

Wearable devices for remote monitoring of hospitalized patients with COVID-19 in Vietnam

Patients with severe COVID-19 disease require monitoring with pulse oximetry as a minimal requirement. In many low- and middle- income countries, this has been challenging due to lack of staff and equipment. Wearable pulse oximeters potentially offer an attractive means to address this need, due to their low cost, battery operability and capacity for remote monitoring. Between July and October 2021, Ho Chi Minh City experienced its first major wave of SARS-CoV-2 infection, leading to an unprecedented demand for monitoring in hospitalized patients. We assess the feasibility of a continuous remote monitoring system for patients with COVID-19 under these circumstances as we implemented 2 different systems using wearable pulse oximeter devices in a stepwise manner across 4 departments.

RACIAL BIAS IN PULSE OXIMETRY IN ACUTE HYPOXEMIC RESPIRATORY FAILURE

RACIAL BIAS IN PULSE OXIMETRY IN ACUTE HYPOXEMIC RESPIRATORY FAILURE

Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course.

Arterial blood oxygen saturation as measured by pulse oximetry (peripheral oxygen saturation (SpO2)) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect the course of coronavirus disease 2019 (COVID-19) treatment. We analyzed pulse oximeter accuracy and its association with COVID-19 treatment outcomes using electronic health record data from Sutter Health, a large, mixed-payer, integrated health-care delivery system in Northern California. We analyzed 2 cohorts: 1) 43,753 non-Hispanic White (NHW) or non-Hispanic Black/African-American (NHB) adults with concurrent arterial blood gas oxygen saturation/SpO2 measurements taken between January 2020 and February 2021; and 2) 8,735 adults who went to a hospital emergency department with COVID-19 between July 2020 and February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (-3.1 percentage points), dexamethasone treatment (-3.1 percentage points), and supplemental oxygen treatment (-4.5 percentage points), as well as increased time to treatment: 37.2 minutes before dexamethasone initiation and278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.

Remote Biometric Monitoring of Patients With COVID-19 With Exertional Hypoxia Treated With Supplemental Oxygen

Remote Biometric Monitoring of Patients With COVID-19 With Exertional Hypoxia Treated With Supplemental Oxygen

Secret Carbon Monoxide Intoxication Assessments of the Patients Who Presented to Emergency

Aim: The primary aim of this study is to evaluate patients who present to the emergency department with atypical symptoms in terms of occult Carbon monoxide (CO) poisoning, and the secondary aim is to compare the invasive and non-invasive values of Carboxyhemglobin (COHb) levels in patients with high CO levels.&#x0D; Material and Method: This prospective and descriptive study was conducted on 2775 adult patients who visited the Emergency Department (ED) between January 1 and March 31, 2015. The COHb levels of the individuals who applied to the emergency department with non-specific complaints were measured with a non-invasive multiwave pulse oximeter device and the date of application, age, gender, complaint, smoking history, pregnancy status, pulse COHb, blood COHb and blood metHb parameters were recorded in the preformed form. Values under 10% in smokers and under 6.6% in non-smokers were recorded as secret COHb intoxication.&#x0D; Results: 52.8% of the patients were male and 34.4% were smokers. The rate of pregnant women among female patients was 13.4%. The first three complaints were shortness of breath, chest pain and stomach ache. It was determined that the mean COHb of the patients was 1.44±1.65 in arterial blood gas and 1.75±1.63 in finger measurement. A highly significant positive correlation was found between the two averages. The COHb value measured by both techniques was higher in male patients and in smokers and non-pregnant patients. The rate of latent COHb intoxication was determined as 1% in smokers and 0.1% in non-smokers.&#x0D; Conclusion: We came to the conclusion that non-invasive COHb measurement can make positive contributions to the diagnosis of secret carbonmonoxyde intoxications.

Evaluation of a New Smartphone Powered Low-cost Pulse Oximeter Device.

Measurement of blood oxygen saturation is a vital part of monitoring coronavirus 2019 (COVID-19) patients. Pulse oximetry is commonly used to measure blood oxygen saturation and pulse rate for appropriate clinical intervention. But the majority of direct-to-consumer grade pulse oximeters did not pass through in-vivo testing, which results in their accuracy being questionable. Besides this, the ongoing COVID-19 pandemic exposed the limitations of the device in resource limited areas since independent monitoring is needed for COVID-19 patients. The purpose of this study was to perform an in-vivo evaluation of a newly developed smartphone powered low-cost pulse oximeter. The new prototype of a smartphone powered pulse oximeter was evaluated against the standard pulse oximeter by taking measurements from fifteen healthy volunteers. The accuracy of measurement was evaluated by calculating the percentage error and standard deviation. A repeatability and reproducibility test were carried out using the ANOVA method. The average accuracy for measuring spot oxygen saturation (SPO2) and pulse rate (PR) was 99.18% with a standard deviation of 0.57 and 98.78% with a standard deviation of 0.61, respectively, when compared with the standard pulse oximeter device. The repeatability and reproducibility of SPO2 measurements were 0.28 and 0.86, respectively, which is in the acceptable range. The new prototype of smartphone powered pulse oximeter demonstrated better performance compared to the existing low-cost fingertip pulse oximeters. The device could be used for independent monitoring of COVID-19 patients at health institutions and also for home care.

Development of Low-Cost and Portable Pulse Oximeter Device with Improved Accuracy and Accessibility

PurposeIn a clinical setting, blood oxygen saturation is one of the most important vital sign indicators. A pulse oximeter is a device that measures the blood oxygen saturation and pulse rate of patients with various disorders. However, due to ethical concerns, commercially available pulse oximeters are limited in terms of calibration on critically sick patients, resulting in a significant error rate for measurement in the critical oxygen saturation range. The device’s accessibility in developing countries’ healthcare settings is also limited due to portability, cost implications, and a lack of recognized need. The purpose of this study was to develop a reliable, low-cost, and portable pulse oximeter device with improved accuracy in the critical oxygen saturation range.MethodsThe proposed device measures oxygen saturation and heart rate using the reflectance approach. The rechargeable battery and power supply from the smartphone were taken into account, and the calibration in critical oxygen saturation values was performed using Prosim 8 vital sign simulator, and by comparing with a standard pulse oximeter device over fifteen iterations.ResultsThe device’s prototype was successfully developed and tested. Oxygen saturation and heart rate readings were both accurate to 97.74% and 97.37%, respectively, compared with the simulator, and an accuracy of 98.54% for the measurement of blood oxygen saturation was obtained compared with the standard device.ConclusionThe accuracy of oxygen measurement attained in this study is significant for measuring oxygen saturation for patients in critical care, anesthesia, pre-operative and post-operative surgery, and COVID-19 patients. The advancements made in this research have the potential to increase the accessibility of pulse oximeter in resource limited areas.

Pulse Oximeter App Privacy Policies During COVID-19: Scoping Assessment

BackgroundPulse oximeter apps became of interest to consumers during the COVID-19 pandemic, particularly when traditional over-the-counter pulse oximeter devices were in short supply. Yet, no study to date has examined or scoped the state of privacy policies and notices for the top-rated and most downloaded pulse oximeter apps during COVID-19.ObjectiveThe aim of this study was to examine, through a high-level qualitative assessment, the state and nature of privacy policies for the downloaded and top-rated pulse oximeter apps during the COVID-19 pandemic to (1) compare findings against comparable research involving other mobile health (mHealth) apps and (2) begin discussions on opportunities for future research or investigation.MethodsDuring August-October 2020, privacy policies were reviewed for pulse oximeter apps that had either at least 500 downloads (Google Play Store apps only) or a three out of five-star rating (Apple Store apps only). In addition to determining if the apps had an accessible privacy policy, other key privacy policy–related details that were extracted included, but were not limited to, app developer location (country); whether the app was free or required paid use/subscription; whether an ads disclosure was provided on the app’s site; the scope of personal data collected; proportionality, fundamental rights, and data protection and privacy issues; and privacy safeguards.ResultsSix pulse oximeter apps met the inclusion criteria and only 33% (n=2) of the six apps had an accessible privacy policy that was specific to the pulse oximeter app feature (vs the app developer’s website or at all). Variation was found in both the regulatory nature and data privacy protections offered by pulse oximeter apps, with notable privacy protection limitations and gaps, although each app provided at least some information about the scope of personal data collected upon installing the app.ConclusionsPulse oximeter app developers should invest in offering stronger privacy protections for their app users, and should provide more accessible and transparent privacy policies. This is a necessary first step to ensure that the data privacy of mHealth consumers is not exploited during public health emergency situations such as the COVID-19 pandemic, where over-the-counter personal health monitoring devices could be in short supply and patients and consumers may, as a result, turn to mHealth apps to fill such supply gaps. Future research considerations and recommendations are also suggested for mHealth technology and privacy researchers who are interested in examining privacy implications associated with the use of pulse oximeter apps during and after the COVID-19 pandemic.

160 Home Pulse Oximetry Monitoring for Patients With Suspected COVID-19: A Pilot Assessment of Patient Engagement and Compliance

Patients infected with SARS-CoV-2 who are evaluated in the emergency department but well enough to go home are still at risk for clinical deterioration. They may benefit from a program to monitor oxygen levels at home using portable pulse oximeter devices. Our study aims to evaluate patient engagement in and compliance with a home pulse oximetry monitoring program. The results of this study will be important to inform development and operationalization of remote patient monitoring programs.

A Novel Large Scale Integrated Telemonitoring Program for COVID-19.

Introduction: Coronavirus disease 2019 (COVID-19) has forced health care systems to rethink the optimal delivery of health care services and has dramatically increased demand for general medicine providers (internal medicine, family medicine, emergency medicine), while simultaneously reducing demand for many subspecialty services. At Kaiser Permanente, we implemented a program wherein health care providers drawn from multiple disciplines perform daily telemedicine check-ins on COVID-19 patients, allowing us to both maintain social distancing and make use of providers in specialties who otherwise may have had lower in-clinic volumes. Methods: Kaiser Permanente patients testing positive for COVID-19 between March and October 2020 were referred to our program. Physicians and nurses (RNs) were invited to participate in our program and were trained using Microsoft Teams™ meetings. Patients receive daily phone calls by a physician or RN. Select patients receive portable pulse oximeter devices based on standardized criteria incorporating age and comorbidities. When patients are determined to be clinically stable, they are discharged back to their primary care physician for ongoing management. Results: Descriptive results for the virtual home care program (VHCP) are reported through October 2020, though these results do not represent a planned statistical analysis. Forty-two percent of the patients were male, 43% were black, and 30% were Hispanic. The most common comorbidities of patients in our program were obesity (body mass index >30 kg/m2; 35%), followed by hypertension (32%) and diabetes mellitus (19%). Then, 8.2% of patients ultimately required hospital admission. Mortality rate for patients in our program was 1.33%. Discussion: Our program was able to provide virtual care for thousands of COVID-19 positive Kaiser members in the Washington, DC, and Baltimore Metro regions. We did so by utilizing physicians and RNs from specialties experiencing a decrease in clinic volume attributable to the COVID-19 pandemic. The experiences of our program may be valuable to clinicians wishing to establish similar programs of their own.