An Automated Patient Self-Monitoring System to Reduce Health Care System Burden During the COVID-19 Pandemic in Malaysia: Development and Implementation Study

摘要

BACKGROUND:There was an urgent need to develop an automated COVID-19 symptoms monitoring system during the COVID-19 pandemic to reduce the burden of the healthcare system and provide better self-monitoring at home.OBJECTIVE:This paper aims to describe the development process of CoSMoS (COVID-19 Symptoms Monitoring System), which consists of a self-monitoring algorithm-based Telegram bot and a teleconsultation system. We describe all the essential steps from clinical perspectives and technical approaches in designing, developing, and integrating the system into the clinical practice during the COVID-19 pandemic and lessons learned from this development process.METHODS:CoSMoS was developed in three phases: 1) Requirement formation to identify clinical problems and drafting the clinical algorithm. 2) Development-testing iteration using the agile software development method. 3) Integration into clinical practice to design an effective clinical workflow using repeated simulations and role-plays.RESULTS:A total of 19 days was used to complete the development of CoSMoS. In phase 1 (requirement formation), we have identified three main functions: daily automated reminder system for patients to self-check their symptoms, safe patients' risk assessment to guide patients in clinical decision making, and active telemonitoring system with an in-time phone consultation. The system architecture of CoSMoS involved five components: Telegram instant messaging, clinician dashboard, system admin (backend), database, and DevOps infrastructure. The integration of CoSMoS in clinical practice involved the consideration of the COVID-19 infectivity and patient safety.CONCLUSIONS:This study demonstrated that developing a COVID-19 symptoms monitoring system within a short time during a pandemic is feasible using the agile development method. Time factor and communication between the technical and clinical teams were the main challenges in the development process. The development process and lessons learned from this study can guide future development of the digital monitoring system in the next pandemic, especially in developing countries.CLINICALTRIAL:Not applicable.