Due to the limitation of interpersonal contact in connection with the pandemic, many healthcare professionals have expanded the organization of treatment monitoring online. Electronic health monitoring has provided improved access to treatment for at-risk patients who may be at risk thanks to frequent doctor visits. Especially in patients with chronic obstructive pulmonary disease, it is important to reduce the risk of contact with the pandemic, while avoiding a worsening of the diagnosis, which requires regular check-ups, by identifying exacerbations.
During the pandemic, in cooperation with a major pharmaceutical company, we implemented a project between patients with chronic obstructive pulmonary disease (COPD) and their attending physicians. The aim of this project was to improve communication between doctor and patient. In addition, the project wanted to draw attention to real-time analysis of the patient’s health status using a technological solution in healthcare.
We have created software that connects doctors and patients through electronic health monitoring. Our system monitors the patient’s condition several times a week and via SMS messages and notifies the attending physician of any deterioration. Read more about how it works, what technologies it is built on and what its future is like.
Starting point
COPD patients are often unaware of their deteriorating health. They only have regular check-ups with the doctor at certain intervals, so it may happen that the doctor adjusts the treatment later than they should.
COPD is a chronic disease that requires regular check-ups by a doctor. With this type of diagnosis, it often happens that the patient underestimates the ongoing control. In addition, the period of the pandemic has made it difficult to see a doctor. As the treatment of COPD is in the hands of pulmonologists, who were severely overwhelmed by patients with COVID during the pandemic period, this is doubly true. We have therefore developed a solution that helps monitor health status digitally and thus partially replaces the absence of physical examinations at the doctor’s.
How did the solution work?
Almost 40 doctors and over 160 patients whose health condition we monitored for at least 4 weeks took part in the project. COPD is most common in elderly patients, aged 50-65 years. Therefore, it was important to make electronic health monitoring and recording of responses as simple and acceptable as possible for patients of all ages, even those who do not have sufficient experience or even equipment to work with modern technologies.
The registered patient was asked about his health condition by SMS messages 3 times a week through three short questions (how they feel, whether they manage to do normal daily activities, …). They could simply reply to these messages using the numbers 1 or 2, with two options to choose from – “I feel good” and “I feel bad”. If the patient felt unwell, the system generated a more extensive questionnaire that the patient could complete on the website. Based on the data from the survey, we identified that in the age group in which most patients with COPD are located, the inexperience of users with smartphones is relatively common. Therefore, we chose a website to fill in the form and not a classic mobile app. Subsequently, the patient was also notified of the completion of the questionnaire by the attending physician, who was able to view their answers in detail within a web interface available only to specialists. The questionnaire examined the patient’s feelings during specific activities that cause the patient difficulties and served to better understand their health condition.
The system also enables the sending of other SMS messages to individual patients – for example, reminders on medicines or notifications about the need for monitoring.
Each patient’s responses were recorded and archived in their attending physician’s web profile. After logging into the system, the doctor could see the development of the health status of the patient identified by a unique anonymized identifier, displayed in a graph and a clear table of responses with the date and time of responses.
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Technological solution
We used the Laravel framework and the MariaDB database for development. These technologies have enabled us to develop a solution that ensures reusability and rapid response to changes that have occurred during the operation of the project.
We used simple, ordinary SMS messages to electronically monitor patients’ health. We had to think about the technological skill of the older target group, which we did not expect to be so flexible and to access the system through a mobile app or a computer. So we wanted to maximize the number of responses by making the whole process comfortable for the patient. That’s why we have integrated an SMS gateway that allows you to send thousands of SMS messages in a short time. Over the course of four weeks, we sent out thousands of SMS messages.
As the questionnaires were multilevel, some answer could be followed by another question. Based on how the client answered, we sent another question using a system for periodic event triggering, the so-called cron job.
The system can also generate interesting analyzes and statistics on the development of the patient’s health, which their attending physician can see visualized in a clear graph and take appropriate steps in the patient’s treatment, e.g., change his treatment.
Project challenges
The average age of the monitored patients was around 60 years, so we tried to make it as easy to answer and log in to the system as possible. The patient received the login details from his doctor, which they entered on the website in case they needed to fill in a questionnaire. The login could be saved, so the username and password were required from patients only once. As many as 88% of sent SMS messages received a response from patients, which documents that the chosen model works. Even less technologically proficient users were not only able to work with the system, but were also willing to provide data on a regular basis. Patients with deteriorating conditions were able to complete the questionnaire several times in a row, which provided valuable data on the subjective development of their health status. We tried to make the questionnaire as simple as possible so that the patient filled it in quickly and was understandable to them, but at the same time so as to provide the doctor with the necessary information.
One of the challenges of this project was the advanced age of the respondents, another was the doctors themselves and their technical capabilities. Not all physicians are digitalized and not all want to address their patients’ health online, despite the undeniable benefits for the patient. The aversion to digital devices in the healthcare industry has therefore prompted us to develop the simplest website possible, in which a doctor would have access to the most important information as soon as they log on.
The present
Electronic health monitoring was successfully completed after the specified period. It was evaluated very positively by the client, as they received valuable data that serves as a basis for decision-making processes. Thanks to this survey, we were able to identify several monitored patients whose health was subjectively deteriorating. As a result, the doctor was informed and was able to make timely decisions. It is therefore a bit of an exaggeration to say that the project was able to prolong the quality of life, as it captured changes in health so quickly that the doctor was able to stabilize the patient by adapting the treatment.
Our solution opens the door to a discussion on the possibility of using digitization in healthcare. The connection of modern technologies with healthcare helps doctors in diagnosing and adjusting treatment. For patients, in turn, such modernization can mean early diagnosis or early treatment change to prevent further complications.
It is high time to consider integrating modern digital tools into healthcare for highly qualified diagnostics and advanced treatment. If you are interested in a similar solution, do not hesitate to contact us.
