March 2021 marked a grim milestone: the one-year anniversary of the COVID-19 pandemic.

Even as the total number of U.S. COVID-19 deaths nears 570,000 according to the Centers for Disease Control and Prevention, overall case numbers and mortality rates are expected to continue to decline. To help keep these favorable trends going, the Military Health System must continue to ensure COVID-19 and other high-risk patients get the care they need while protecting them from potential exposure to the coronavirus, hospital-acquired infections, and other potential health threats.

Virtual health and other digital health technologies are an essential part of care delivery going forward for all patients, and especially the most vulnerable. These technologies have come into their own during the pandemic by enabling continuity of care anytime, anywhere while keeping beneficiaries and clinicians safely separated. One especially important area of development has been remote patient monitoring – also known as remote health monitoring – which uses digital health technology to track patient symptoms outside medical facilities.

As the MHS plans for care delivery for the rest of the pandemic and life thereafter, it is reviewing lessons learned from the many innovative technology systems it has launched. One such system is the MHS COVID-19 Remote Patient Monitoring pilot, which has the potential to help transform how the MHS delivers inpatient and outpatient care to beneficiaries and help them more safely and effectively manage COVID-19 and other chronic diseases outside health care facilities.

Program Basics

For more than 30 years, the MHS has used various technologies to offer RPM capabilities to augment care for diabetes and other chronic health conditions. When the pandemic hit, the Defense Health Agency therefore turned to RPM to accomplish two important goals:

1. Keep providers and patients safe by decreasing their exposure to COVID-19 and other infections.
2. Get the most out of limited staff and other resources by decreasing the volume and length of inpatient facility and emergency room admissions.

Launched in September and fielded in December 2020, the CRPM program is a one-year pilot effort that the DHA Virtual Medical Center and Brooke Army Medical Center in San Antonio, Texas spearheaded in conjunction with representatives from all three military services. The program provides 24/7/365 remote patient monitoring of patients enrolled to the pilot, from 10 designated military medical treatment facilities across the country, to support COVID-19 and other high-risk patients 21 years and older who don't need skilled nursing care.

Participating patients receive in-person or virtual training, a tablet, and easy-to-use wearable health sensors. For patients without robust internet connectivity at home, the program provides a Wi-Fi data hub. The FDA-approved equipment provides continuous, near real-time monitoring of blood oxygenation, heart rate, temperature, respiration rate, and movement (step-count), and intermittent monitoring of blood pressure and lung function. More information about the CRPM pilot is available in this health.mil article.

Impressive Results

As of February 2021, the CRPM program had served 98 patients at seven facilities. The program's results so far have supported the DHA's priorities of:

• Better Outcomes: Participating providers estimate that 61 patients (62 percent) decreased their number of bed days and the program eliminated 180 patient bed days overall. In addition to lowering hospital-based infection risks, the program also saved an estimated $908,000 through reduced overhead costs during the first 11 weeks.
• A Ready Medical Force: Keeping low-acuity cases in facilities decreases readiness, so enabling more patients to stay at home frees providers to focus on high-acuity cases that need skilled nursing care.
• Satisfied Beneficiaries: The pandemic has greatly expanded patients' understanding of the value of RPM, virtual health, and digital health technology – factors that made the CRPM program popular with clinicians and patients alike. Of the 98 patients, 26 were referred back to a military medical treatment facility or ER for higher levels of care. Of those 26, 19 (73 percent) requested to be re-enrolled in the pilot after their readmission discharge from the hospital.
• Fulfilled Staff: Having fewer patients in inpatient care improved providers' ability to deliver care and feelings of safety while doing it. Round-the-clock remote care enables providers to feel more comfortable in sending patients home while increasing bed capacity for patients that needs skill nursing care support.

The CRPM program was also able to continue monitoring patients even during the February 2020 blizzards that paralyzed much of the country and especially Texas, home of the VMC. Fortunately, the extreme cold only minimally impacted CRPM's effectiveness because the home kits can access cellular networks. The program's resilience demonstrates its ability to ensure continuity of care in many large-scale emergencies, not just the COVID-19 crisis.

Vision for the Future

The CRPM program will continue to offer high-fidelity monitoring to COVID-19 and other high-risk patients at home through September 2021. Looking ahead, the program has the potential to expand its capabilities beyond the COVID-19 pandemic to help patients with conditions that often require frequent admissions, such as chronic obstructive pulmonary disease and congestive heart failure; deployed service members; and pediatric patients.

The CRPM program is just one small example of the massive success that RPM, virtual health, and digital health technology in general have had during the COVID-19 pandemic. These capabilities – and RPM in particular – have proven they should become part of the standard of care, not the exception.

For that to happen, the DHA must collaborate with the MHS clinical communities to translate functional requirements into technical requirements that inform acquisitions of enterprise RPM capabilities tailored to clinical community needs. The DHA and clinical communities must also develop enterprise-wide RPM clinical protocols and workflows for COVID-19 pandemic response that can also apply to a wide range of infectious diseases and high-risk patients in the future.

These efforts are challenging but are worth doing for the sake of all MHS beneficiaries. Accomplishing them will enable the MHS to do an even better job caring for patients and monitoring population health and demonstrate DHA as a good steward of taxpayers' money and well-being.