How Penn Medicine saved lives with text messaging during the pandemic—and what doctors can learn from it

When COVID-19 caused hospitals to surge to capacity, depleting resources and requiring patients with mild symptoms to isolate at home, healthcare professionals scrambled to manage the crisis. As a result, researchers and clinicians creatively set their sights on text messaging as a potentially powerful healthcare tool—and their work paid off.

Among the standout efforts is Penn Medicine’s COVID Watch. In order to maximize outpatient care at the height of COVID, Penn quickly created an automated text messaging service to monitor symptoms in patients at home.

Texting as a tool against COVID

COVID Watch allows patients in self-isolation at home to update the system on their symptoms at any time, according to Penn Medicine’s website.^[] The program automatically sends each patient two text messages daily. If the patient reports worsening symptoms, an RN working with COVID Watch contacts the patient soon after to discuss the details. COVID Watch RNs require access to a phone and PennChart, the organization’s electronic health record system, to complete their work remotely.

COVID Watch proved effective, according to a study published in ACP Journals, which compared 30- and 60-day outcomes for patients enrolled in the program with those who received usual care.^[] To qualify for eligibility in the program, patients had to be over 18 and could not be receiving home, hospice, or long-term care. Researchers noted factors such as age, sex, race and ethnicity, comorbidities, income, and insurance coverage status.

After 30 days, 0.09% (3 of 3,488) of COVID Watch patients died compared with the 0.27% (12 of 4,377) of patients who died receiving usual care. No deaths among the COVID Watch group occurred outside of the hospital, while six of the patients receiving usual care died at home. By day 60, two additional deaths of patients enrolled in COVID Watch took place in-hospital, while four additional deaths occurred in the usual care group.

While a third of usual care group patient deaths took place at home, all deaths in the COVID Watch group occurred in-hospital. Those enrolled in COVID Watch were more likely to be admitted, and they were admitted earlier than those who received usual care.

These promising results could pave the way for physicians to use text messaging programs regularly, especially as COVID variants continue to emerge and case numbers increase.

Responding to unforeseen circumstances

Penn Medicine researchers began the study during a COVID-19 surge in August 2021. At that time, there were about 153,000 cases per day, and hospitals in several areas of the country were at capacity. Most patients who tested positive were told to quarantine at home and monitor their symptoms.

But COVID-19 is a highly unpredictable disease. Symptoms may intensify quickly, and so might the need for hospitalization. Patients who rapidly decline at home may wait to seek and receive proper care or face delays when hospitals become overwhelmed.

COVID Watch has the potential to provide patients with emergency department and hospital-level care from the comfort of their homes, researchers noted, which saves space, beds, and other resources for patients who require hospitalization. When hospitals surge to capacity, technology as simple as text messaging could mean the difference between life or death for some patients.

Penn Medicine is extending COVID Watch into a new program, called COVID Pulse, which provides patients with a pulse oximeter to monitor oxygen saturation at home. Just like with COVID Watch, when a patient’s oxygen saturation drops to a dangerous level, the patient can text a clinician, who will respond within an hour. Once the program is complete, patients return their oximeters. Staff sanitize the devices before passing them off to new patients.

Amplifying the voices of doctors and patients

“The pandemic has resulted in a saturation of information, whether correct or misinformed, which can contribute to one's fear of seeking help,” one clinician said. “After speaking with one patient, she agreed to go to the ED, where she was diagnosed with pneumonia. Having outreach, monitoring, and extension of care through COVID Watch has helped prevent delays in care for patients.”

Patients, meanwhile, are happy to have access to the service.

“The check-ins were very helpful for peace of mind, which is extremely helpful when you have a brand-new virus that even the best scientists and doctors don’t know much about yet,” one patient said. “It’s a little unnerving, to say the least. Especially for people who live alone, I can see where this would be a godsend. Thank you.”