Alert Reduction and Telemonitoring Process Optimization for Improving Efficiency in Remote Patient Monitoring Programs: Framework Development Study
Bibliographic record
Abstract
Background: Telemonitoring can enhance the efficiency of health care delivery by enabling risk stratification, thereby allowing health care professionals to focus on high-risk patients. Additionally, it reduces the need for physical care. In contrast, telemonitoring programs require a significant time investment for implementation and alert processing. A structured method for telemonitoring process optimization is lacking. Objective: We propose a framework for optimizing efficient care delivery in telemonitoring programs based on alert data analysis and scenario analysis of a telemonitoring program for hypertension combined with a narrative literature review on methods to improve efficient telemonitoring care delivery. Methods: We extracted 1-year alert processing data from the telemonitoring platform and electronic health records (June 2022-May 2023) from all users participating in the hypertension telemonitoring program in the outpatient clinic of the Department of Internal Medicine of the Maasstad Hospital. We analyzed the alert burden and alert processing data. Additionally, a scenario analysis with different threshold values was conducted for existing blood pressure alerts to assess the impact of threshold adjustments on the overall alert burden and processing. We searched for English language academic research papers and conference abstracts reporting clinical alert or workflow optimization in telemonitoring programs on May 24, 2024 in Embase, Medline, Cochrane, Web of Science, and Google Scholar. Results: In total, 174 users were included and analyzed. On average, each user was active in the telemonitoring program for 207 days and a total of 30,184 measurements were performed. These triggered a total of 17,293 simple, complex, and inactive or overdue alerts: 13,647 were processed automatically by the telemonitoring platform, and 3646 were processed manually by e-nurses from the telemonitoring center, equivalent to 21 manually processed alerts per user. Additional analysis of the manually processed alerts revealed that 25 (15%) users triggered more than 50% of these specific alerts. Furthermore, scenario analysis of the alert thresholds revealed that a single increase of 5 and 10 mmHg for the diastolic and systolic blood pressure alerts would reduce the number of alerts by about 50%, resulting in a total reduced time investment for the e-nurse of 5973 minutes over 1 year. Literature search yielded 251 articles, of which 7 studies reported methods to improve efficiency in telemonitoring programs, including the introduction of complex alerts and clinical algorithms to triage alerts, scenario analysis with alert threshold adjustments, and a qualitative analysis to create an alert triage algorithm. Conclusions: Based on the data analysis and literature review, a 4-step framework was developed to optimize the efficiency of telemonitoring programs. The 4 steps include ensuring accurate measurements, telemonitoring algorithm and alert optimization, focusing on individual users' and user groups' needs, and improving telemonitoring process efficiency. This framework can be an important first step to improve the efficiency of 21st-century telemonitoring programs.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".