Home Monitoring for COVID-19 Now Available Through MyChart

Cleveland Clinic and Epic introduce new functionality

Home monitoring has taken a new turn for patients with COVID-19. In March, Cleveland Clinic introduced an interactive program through Epic’s MyChart app. Patients enter symptoms, temperature and oxygen level once a day. Providers monitor responses and step in if a patient’s condition worsens.

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This unique technology is available to other healthcare systems through Epic’s MyChart Care Companion Home Monitoring Program. The program, itself, isn’t new. (Other practices have used it to manage patients with chronic conditions.) But Cleveland Clinic is the first to customize it for COVID-19.

“Patients with COVID-19 may have only mild symptoms when we first see them,” says Eric Boose, MD, Associate Chief Medical Information Officer at Cleveland Clinic. “But things can deteriorate quickly. Day 7 is often when we start to see pneumonia and shortness of breath. We need to monitor these patients, even if they are low risk or seem to have mild disease.”

At Cleveland Clinic, primary care teams have been checking on patients with COVID-19 individually. Nurses and care coordinators make phone calls every day to high-risk patients and every few days to lower risk patients.

“As more patients get sick, we will need a way to keep up,” says Dr. Boose. “This new automation will supplement the outreach program we already have. Normally it takes three months to design technology like this, but for this critical situation we did it in 10 days.”

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Worsening symptoms trigger provider intervention

Cleveland Clinic offers the program to every patient who tests positive for COVID-19 or is suspected of having it. Patients must agree to be enrolled in the program, which they use via their MyChart account on a mobile app or website.

For 14 days, patients receive daily prompts to report their condition. Patients are asked about shortness of breath, cough, weakness and other symptoms, and if they are better, the same or worse than yesterday. Patients with a thermometer are asked to record their highest temperature since their last entry. Patients with a pulse oximeter are asked to record their lowest oxygen reading since their last entry.

Responses are recorded in each patient’s Epic electronic medical record (EMR). Any abnormal response triggers a real-time message to a pool of nurses that provide 24/7 monitoring. That prompts a phone call to the patient to determine next steps, such as additional care at home, a virtual visit or getting to a hospital.

“This isn’t just a symptom-checking app,” says Dr. Boose. “It’s a connection between patients and providers. And everything goes directly into our EMR. That wouldn’t be the case if we were using other apps or texting patients, for example.”

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Engaging patients in their care

Since March 23, Cleveland Clinic has enrolled 900 patients in the program and is averaging about 35 new patients per day.

“Out of all the patients we’ve recommended for the program, about 40% are actively participating in it,” says Dr. Boose. “That’s a great number for technology uptake. It helps that it’s a platform that’s familiar to our patients and easy to use.”

Ultimately, the program is intended to address emergent symptoms sooner, preventing hospital admissions and an inpatient surge. But it’s also designed to increase patient engagement. In addition to reporting symptoms, patients can use the platform to access education resources about stress and anxiety, protecting your family if you’re sick, and other COVID-centric health topics.

“We want to engage patients in their own care as well as reassure them that someone is keeping an eye on them at this scary time,” says Dr. Boose.