Often, patients with serious coronavirus (COVID-19) symptoms do not go to hospital early enough, particularly with the strong “stay at home” messages during the pandemic and our societal desire to protect the NHS.

COVID-19 can cause silent hypoxia, where a person’s oxygen levels fall to a dangerously low level before they realise anything is wrong. In the hospital, it’s usually detected and treated early with regular checks of a patient’s vital signs.

At home or in the community, however, silent hypoxia can go unnoticed until the person suddenly becomes really sick. When they do go to hospital, their health outcomes are often worse – it’s estimated that for every day of delay into hospital admission, the chance of death increases by 1%. That’s a lot of people when you think of the scale of the pandemic.

So the challenge was, how do you avoid unnecessary hospital admissions for coronavirus patients while also ensuring they’re not suffering from silent hypoxia at home?

To solve this, NHS England created the Oximetry @home programme, which provides patients with a pulse oximeter – a small monitor which patients clip to their finger – to measure their oxygen saturation levels 3 times a day. This enables local clinical staff to monitor the patient remotely and identify whether they need further treatment and admission to hospital if necessary.

Following successful pilots in Northwest London, Slough and South Tees, the service was rolled out nationally in November 2021.

The role of NHS Digital is to deliver the data and digital architecture necessary to support the programme. We helped with identifying who needed to be monitored and capturing their daily oximetry readings.

To do this, our architecture team designed the digital process that takes the list of patients with a positive COVID-19 test result from the National Pathology Exchange (NPEX), an information exchange hub which connects all UK labs together, and the Second-Generation Surveillance System, the national laboratory reporting system in England, to capture data on infectious diseases and antimicrobial resistance. This is then processed via the Data Processing Service (DPS).

The information is compiled with other patient data, such as identifying whether the patient is on the Shielded Patient List, aged over 65 or are symptomatic at the point of testing. This data is then sent to the relevant Clinical Commissioning Groups (CCGs) who decide which patients to onboard for remote monitoring.

Once those patients have been identified, they’re provided with an oximeter and record their results either through a smartphone app, a web portal, via their GP or a paper diary.

Information about which patients are starting on or leaving the service is updated weekly and NHS systems are updated to make other services aware that a patient is being monitored by COVID Oximetry @home – for instance, by adding a flag to the patients’ Summary Care Records (SCR).

The process is described in the picture below:

The programme has a need to evaluate the effectiveness of home oximetry monitoring in achieving the desired clinical outcomes for COVID-19 patients. Academic partners including University College London (UCL) and Imperial College are assisting with this evaluation. The team also provides service management information to NHSX and NHSE&I.

Gathering the data required to fulfil these needs is quite a challenge as the monitoring services have been rolled out using different models around the country. Some are GP led while others use a ‘centralised’ regional team to manage the service.

Adding to the challenge, where patients are using digital solutions like apps to record their readings, there are 16 suppliers providing these services across the country. This means that the data needed lives in lots of different systems, and there aren’t yet any standards defined for collecting it.

As CCGs were having to submit the information needed to evaluate the service manually, we needed to tackle this problem to try and eliminate this burden on the system. We’ve worked closely with all 16 suppliers to understand the data they hold and define a way to enable them to submit it to us using our existing national components like MESH. We’ve been able to offer a flexible solution which allows the suppliers to submit data in a way that fits with how their system works: either near real-time as events happen or using a more traditional regular batch basis.

We’re also looking into whether information recorded in GP systems can be gathered for evaluation from the GP Data for Pandemic Planning and Research data collection. This means that we can use SNOMED codes which makes it easier to collect the relevant data. You can find out more about how important the introduction of SNOMED codes has been to the NHS in Denise Downs’ blog post.

The oximetry team at NHS Digital is now working closely with the wider NHS @home programme. We aim to ensure that learning from the work done to date benefits the remote monitoring of other conditions and pathways such as blood pressure and pulmonary rehabilitation. We’re also starting work with colleagues at NHS X and the Professional Record Standards Body (PRSB) to define standards for remote monitoring data and interoperability.