09/16/20

Keeping abreast of emerging technologies can be challenging and complex for many health systems, especially during a crisis. Organizations must evaluate the safety and effectiveness of new technology in order to harness it for better care and lower costs. They must also determine whether the new solution offers greater clinical benefit than their existing technology provides. As COVID-19 continues to surge across parts of the country, time is of the essence for implementing technologies that can improve patient care and outcomes, but informed decision-making is as important as ever.

Vizient TechFlash reports are used by members to help identify and make acquisition decisions on innovative new technologies. Each report provides an overview of the technology and its significance, current practice and alternatives, financial considerations, patient selection criteria, future developments and conclusions/recommendations.

“The technology assessments we provide are a form of applied evidence-based medicine, based primarily on the latest clinical literature,” says Joe Cummings, PhD, Vizient technology program director. High-impact technologies are selected for assessment based on member input, horizon scanning and federal regulatory actions surrounding the technologies; the latter especially important in the case of COVID-19.

In response to the COVID-19 pandemic, Vizient recently published two new TechFlash reports. The first looks at at-home remote monitoring (RM) trends for COVID-19 patients and the second highlights some innovative medical devices that could help facilitate weaning of COVID patients from mechanical ventilators.

At-home monitoring of COVID-19 patients

The use of virtual visits through video, phone and text messaging has exploded during the pandemic. RM, which uses at-home medical devices to collect information on specific physiologic parameters, can add significant value to virtual visits by including another layer of information beyond symptoms. These at-home devices include thermometers, pulse oximeters and wearable technology.

Vizient’s TechFlash: At-home remote monitoring of COVID-19 patients examines how many hospitals are using RM to ease surge-related bed capacity issues and resource shortages and to minimize virus exposure and risk.

Cummings says that while hospitals with existing RM infrastructure in place prior to the pandemic were able to respond to COVID quickly, effective remote monitoring can be implemented simply and inexpensively at virtually any organization.

“Remote monitoring can be as simple as providing patients with a $5 thermometer and a $20 pulse oximeter and having a nurse check in with the patient to collect their vital signs and monitor trends over time,” says Cummings. “A more sophisticated monitoring program might go more high-tech and collect continuous patient data from a Fitbit, Apple watch or other wearable technology.”

The TechFlash highlights several health systems that implemented RM in response to the pandemic. For example, Atrium Health in Charlotte, North Carolina rolled out Atrium Health at Home, a program that monitors eligible patients who test positive for COVID-19 from their own homes. Each enrolled patient receives a blood pressure cuff, pulse oximeter and thermometer. The service combines education resources and monitoring tools, phone calls and in-person visits. A 24/7 phone line enables patients to reach nurses.

The University of Minnesota Fairview Health used an RM system with 2,255 COVID-19 patients in March and April by modifying software developed for enhanced recovery after surgery remote patient management. Their program rollout reportedly took about two weeks and when complete included daily check-in questions regarding symptoms, care escalation protocols and an upgrade to include an assessment of at-home pulse oximetry data. In one month, the program resulted in 13 hospital admissions and 91 ED visits. Study authors concluded the system was safe and effective for at-home management of COVID-19 patients with 74% of 300 survey respondents reporting high satisfaction.

Potential advantages of RM for COVID-19 patients outlined in the report include rapid patient isolation, reduced potential for disease transmission, increased hospital bed capacity with reduced PPE consumption, and better patient contact, communication and education. The report also details financial considerations of RM, including device, hospital infrastructure and labor costs, as well as reimbursement updates and potential return-on-investment.

Cummings adds that remote monitoring isn’t a magic bullet; oversight from skilled clinicians is critical. “There are so many varied symptoms with COVID-19 – some have respiratory symptoms while others have gastrointestinal symptoms. A lot of this comes down to a well-trained clinician asking about symptoms while also looking at RM physiologic trends over time,” he says.

Supporting ventilator weaning in COVID-19 patients

The second recently published TechFlash report investigates emerging medical devices intended to facilitate ventilator weaning. Seriously ill COVID-19 patients often require mechanical ventilation for long periods of time and that can create challenges when weaning them off of ventilation.

“After prolonged time on a ventilator, patients can develop ventilator-induced diaphragmatic dysfunction,” says Cummings. “Each of the devices reviewed in the TechFlash work in different ways, but all three are essentially applying physical therapy to help strengthen the respiratory muscles.”

This spring, the Food and Drug Administration (FDA) granted emergency use authorization (EUA) for three devices. While these devices serve a similar purpose, there are some unique differences among them regarding procedure invasiveness, stimulation target and usage parameters. Though they were not yet FDA approved for marketing, all three were in various stages of the regulatory process and met criteria for EUA during the pandemic for use in COVID-19 patients.

One of the devices uses electrodes placed directly into the diaphragm, while another is completely non-invasive, using electrode patches to stimulate the abdominal muscles. TechFlash: Devices to assist ventilator weaning in COVID-19 patients shares details on these innovative technologies and reviews the conventional alternatives for weaning patients from mechanical ventilation.

At this time, limited clinical evidence exists for these technologies to assist ventilator weaning in COVID-19 patients, but the report highlights published studies with prior use of the technologies in non-COVID patients.

“We hope people will use the report to evaluate these technologies. It may be reasonable to consider them for COVID-19 patients on mechanical ventilation determined to be at high risk of weaning failure,” says Cummings. “We are dealing with a lot of ambiguity during this pandemic, but I believe that some of these new technologies are going to be part of the solution for caring for these patients.”

A comprehensive evaluation is always important before bringing a new device or procedure into the clinic. As information surrounding the treatment of COVID-19 evolves rapidly, rely on evidence-based evaluations of new technologies. Your assessment should also include a review of recently published research data, as new data is continually emerging on COVID-19 treatments and technologies and pressure to improve quality outcomes continues to mount under a shifting landscape.

The next Vizient TechFlash, to be published by early October, looks at four EUA-cleared extracorporeal blood purification devices intended to treat the cytokine storm sometimes associated with severe COVID-19.

For more information on how Vizient can support your organization’s technology assessment, acquisition, management and clinical use decisions, visit our Technology Assessment Program page.