Although telemedicine has been widely available for several years, it was not until the SARS-CoV-2 (COVID-19) pandemic that the potential of this approach to medical treatment was truly harnessed.
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This increased dependency on telemedicine was largely fueled by the widespread interest in reducing the exposure of both healthcare workers and patients to COVID-19.
As telemedicine became implemented on this wide scale, healthcare workers began using these communication platforms to protect patients from nonurgent visits to healthcare facilities and approach more urgent situations in a more careful manner. For example, at Baylor Scott & White All Saints Medical Center in Fort Worth, Texas, the emergency department began using telemedicine communication devices to remotely monitor patients who had tested positive for COVID-19 without requiring the physician to enter the patient’s room.
Clinicians have also utilized telemedicine to remotely monitor patients admitted to the intensive care unit, thus allowing hospitals to conserve personal protective equipment (PPE) during global shortages.
In addition to offering protection for both healthcare workers and patients, telemedicine has also allowed medical treatments to become more readily available for both high-risk patients and those residing in rural populations.
Monitoring COVID-19 Patients in Isolation
When an individual first tests positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus responsible for COVID-19, they are often recommended to remain in domestic isolation to prevent spreading the virus to others. Unfortunately, a considerable number of these patients, particularly those with certain comorbidities like cardiovascular, pulmonary, or metabolic diseases, will experience a severe form of COVID-19 that requires immediate admission to the hospital.
Some of the different ways that the progression of COVID-19 in patients who are in domestic isolation has been monitored is through measuring their temperature two to three times a day and self-documentation of symptoms.
However, some of the more critical parameters, such as heart rate, respiratory rate, and oxygen saturation levels, all of which are used in the clinical setting to reduce mortality, are not typically monitored in these patients who are self-isolating.
The lack of monitoring of these parameters can lead to delayed hospital admission for severe cases of COVID-19, which can inevitably increase the patient’s risk of death.
To improve the overall prognosis of COVID-19 patients and allow for high-risk patients to be quickly identified, researchers have discussed the potential utility of remote monitoring systems for these populations.
Some of the non-invasive devices that have been studied for this purpose include a wide range of commercially available wearable devices like smartwatches and skin-attachable electronics, many of which are based on photoplethysmographic (PPG) signals.
A Novel In-Ear Monitoring Device
Another recent approach included using an in-ear monitoring device that also uses PPG to acquire information on the patient’s body temperature, heart rate, respiration rate, and oxygen saturation in 15-minute intervals.
As compared to other wearable devices, this in-ear device is placed within the external ear canal, thus allowing for its protection against disturbing stray lights and unwanted movement that could affect signal transduction. Furthermore, this location is ideal for acquiring accurate readings on body temperature.
This in-ear monitoring device is equipped with two sensors, including a photodiode that reads the PPG signal with red and infrared light-emitting diodes (LEDs) that have a combined sampling frequency of 200 Hz and a sampling depth of 19 bits. Comparatively, the second sensor is a thermometer that measures the patient’s body temperature at a frequency of 1 Hz and an accuracy of 0.3 °.
Bluetooth connects the wearable device to a monitoring system that allows for all data to be easily and safely stored and transmitted over the internet.
To evaluate the feasibility of this device in a clinical setting, a total of 153 patients residing in Bavaria with a median age of 59 were included in a recent study. These patients were monitored for a mean of 9 days, with an average daily monitoring time of 13.3 hours each day.
Of the 153 patients included in this study, 20 were referred to the hospital by a telemedicine team called Telecovid. On average, the time between a positive SARS-CoV-2 polymerase chain reaction (PCR) test and hospital admission was six days. Of the 20 hospitalized patients, seven required ICU admission, three were temporarily placed on invasive ventilation, and one died after 25 days of invasive ventilation.
Notably, none of the other 133 patients who were not admitted to the hospital experienced an unforeseen complication of COVID-19.
Overall, the in-ear monitoring device used in this study was found to provide a sufficient method of remotely monitoring COVID-19 patients over extended periods of time. Since all patients referred to the hospital by the Telecovid team were subsequently admitted for further treatment, the initial decision to bring them to the hospital was justified.
This confirms that not only did this device accurately efficiently detect serious cases of COVID-19, but it also allowed for patients who remained in isolation to be well cared for without unnecessary contact with a healthcare worker. By allowing these patients to be monitored remotely, resources were preserved while also reducing the risk of infection for both medical and nursing staff.
Future Directions
The in-ear sensing device discussed here is one example of many different technologies that are currently being assessed for their feasibility in remotely monitoring patients. Some examples of these sensors include bed occupancy sensors, toilet sensors, and call-for-help pushbuttons, all of which can immediately provide important information on a patient’s health status to their healthcare providers.
Not only are many of these novel sensing devices unobtrusive, but they also provide patients with privacy and comfort while they are cared for in their homes.
Continue reading: The Use of Pressure Sensors in Sleep Apnea Devices.
References and Further Reading
Seivert, S., & Badowski, M. E. (2021). The Rise of Telemedicine: Lessons from a Global Pandemic. EMJ Innovations. Available at: www.emjreviews.com/innovations/article/the-rise-of-telemedicine-lessons-from-a-global-pandemic/
Wurzer, D., Spielhagen, P., Siegmann, A., et al. (2021). Remote monitoring of COVID-19 positive high-risk patients in domestic isolation: A feasibility study. PLOS One. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257095
Telehealth Sensors (2022) Telehealth Sensors [Online]. Available from: https://www.telehealthsensors.com
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