Barriers to Use of Remote Monitoring Technologies Used to Support Patients With COVID-19: Rapid Review

Abstract

Background The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. Objective The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. Methods A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. Results Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19–specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality “best practice” guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7). Conclusions Results of this rapid review highlight the breadth of RMTs being used to monitor and inform treatment of COVID-19, the potential benefits of using these technologies, and existing barriers to their use. Results can be used to prioritize further efforts in the implementation of RMTs (eg, developing “best practice” guidelines for use of RMTs and generating strategies to improve equitable access for marginalized populations).

Identifying and addressing digital health risks associated with emergency pandemic response: Problem identification, scoping review, and directions toward evidence-based evaluation

“…Patient-centrality, equality and diversity have obtained wide public recognition in recent decades, and these values have become important core concepts [4] , [10] , [14] , [17] , [20] , [21] , [34] , [37] , [46] , [75] , [89] , [12] , [90] of health informatics design in different high-income [5] , [22] , [23] , [25] , [32] , [39] , [48] , [91] , [92] , [93] and low- and middle-income [16] , [51] , [52] , [70] countries. Integration of care pathways, patients’ individuality and preferences, and understanding of problems in accessing services are all identified as important aspects that should be built into modern data systems [94] , [95] , [96] .…”

“…Control of citizen’s confidentiality, privacy and data protection may also be compromised [4] , [10] , [12] , [14] , [16] , [18] , [22] , [32] , [34] , [11] , [36] , [37] , [46] , [47] , [49] , [33] , [52] , [67] , [75] , [76] , [82] , [91] , [93] , [99] , [100] , [101] , [102] , [103] . In particular, contact tracing apps have been widely adopted for tracking COVID-19 infections [104] , raising privacy concerns regarding personal data breach [20] , [21] , [23] , [24] , [25] , [38] , [39] , [50] , [55] , [56] , [70] , [105] , [106] , [107] .…”

“…The varied expedient digital health responses implemented without the normal design and function checks should be evaluated and validated to restore and strengthen both professional and public trust, and an appreciation of digital health benefits. The risk is that any inbuilt flaws and frictions, if uncorrected, will undermine trust and credibility into the future [4] , [12] , [14] , [20] , [23] , [25] , [34] , [36] , [37] , [38] , [50] , [55] , [70] , [100] , [101] , [105] , [107] , [108] .…”

“…Subsequently, there is not only the likelihood of defects being embedded into existing health IT systems (if imperfect systems continue to be used after the emergency), but also inefficiencies and errors caused by the rapid rollout may undermine public confidence toward e-health in general [7] . Since the beginning of the pandemic, many digital health commentaries, reviews, and studies have focused on the e-health benefits in supporting COVID-19 [2] , [3] , [8] , [9] , as well as its lessons learned [10] , [11] , [12] . Our work expands the existing literature body to develop a comprehensive conceptual framework that addresses challenges and risks incurred under such rapid e-health ramp-up in the face of the pandemic.…”

Long-Term Care Facilities and Nursing Homes during the First Wave of the COVID-19 Pandemic: A Scoping Review of the Perspectives of Professionals, Families and Residents

“…Our results show that few studies have explored the perspectives of residents and their families [ 33 , 38 , 43 ], perhaps due to the restrictions limiting access to nursing homes for research purposes. Meanwhile, the use of digital platforms as tools for data collection (interviews) may have been hindered by a lack of familiarity with this technology among residents and a shortage of devices or resources (internet connection) [ 48 ]. Most of the literature focuses on professionals and on the impacts of the pandemic on their organisation and their relationships with residents and their families [ 32 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 ].…”