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COVID Oximetry @home - digital and data services

We’re delivering digital and data services for COVID Oximetry @home, a service to monitor patients with coronavirus (COVID-19) symptoms in their own home or care home.

Overview

COVID Oximetry @home involves the remote monitoring of patients with coronavirus symptoms. Patients use a pulse oximeter, a small monitor clipped to their finger, to measure their oxygen saturation levels three times a day.

They record their results using one of the following:

  • smartphone app
  • web portal
  • paper diary

The paper-based option is available at all sites for patients who are uncomfortable with or unable to use a digital solution to record their readings.

Patients are supported by clinical staff locally, so that if they need further treatment they can be admitted to hospital at the right time.


Benefits of the programme

We know patients with serious coronavirus symptoms often do not go to hospital early enough, and this can negatively impact patient outcomes.

Some patient groups more likely to present late include:

  • healthcare workers
  • BAME patients

For every day of delay in hospital admission the chance of death increases by 1%, observational data suggests.

Our role in national implementation

The COVID Oximetry @home programme is led by NHS England. NHS Digital’s primary role is to deliver Oximetry @home data and digital architecture, and to support an evaluation.

Our role includes:

  • sending to Oximetry @home providers a daily list of patients in their area who have tested positive for coronavirus, with indicators included for those who meet the recommended eligibility criteria for Oximetry @home (aged 65+ and/or considered Clinically Extremely Vulnerable and/or are symptomatic at the point of testing)
  • collecting data from Clinical Commissioning Groups (CCGs) weekly about patients onboarded and offboarded
  • disseminating data for evaluation and management information purposes
  • creating new SNOMED codes so that providers can code Oximetry @home activity accurately
  • updating NHS Pathways to enable COVID Oximetry @home patients to be identified and triaged effectively
  • updating NHS systems to make other services aware that a patient is being monitored by COVID Oximetry @home – this may include changes like adding a flag to the summary care record
  • standardising templates to be used in GP systems
  • supporting the integration of COVID Oximetry @home apps with other NHS systems

We have also undertaken discovery and research into user needs, including patients, NHS staff and the NHS nationally.


Clinical codes - SNOMED CT

New SNOMED clinical codes have been created for use by COVID Oximetry @home providers. 

Find out more about the codes.

NHS Digital encourages the use of data entry templates and SNOMED coding to ensure data is recorded accurately.


Data collection

We're collecting a dataset from clinical commissioning groups, on a weekly basis, using the Secure Data Collection Service (SDCS).

We're asking for the least amount of data possible, to keep admin time for frontline staff to a minimum.

The collection includes information on:

  • patients who have started or stopped using the COVID Oximetry @home service

The information will be used to manage and evaluate the service.


Adding onboarded patients to the Summary Care Record

Please ensure that when you onboard a patient to the COVID Oximetry @home care pathway, information about this event is recorded in your local system so that it can be shared beyond your GP Practice in shared records, such as the Summary Care Record (SCR) with Additional Information.

The SNOMED code 1325191000000108 Telehealth pulse oximetry monitoring started (situation) should be used to consistently record onboarding to the COVID Oximetry @home pathway.

The COVID Oximetry @home pathway typically lasts for 14 days but this may vary slightly due to patient factors or local service configuration.

To add the SNOMED code in SCR Additional Information:

  • EMIS Web users should record the code as an active problem - please ensure that the problem status is configured so that it remains active for a duration appropriate to the COVID Oximetry @home pathway
  • SystmOne users record the code as an active problem - on or after discharge from the pathway, the problem status should be made inactive to update the patient’s SCR so that it is no longer included
  • Vision users should record the code as Priority 1 or an active problem - on or after discharge from the pathway, the Priority 1 or active problem status should be removed to update the patient’s SCR so that it is no longer included

Upon closing and saving the GP record, an SCR update will be triggered. For patients who have opted out or who have chosen not to have Additional Information in their SCR, an update will not be triggered, and in this case, the information will not be available on SCR.

If your GP Practice is using a template to record COVID Oximetry @home care, please ensure that the template is configured to record: 
1325191000000108 Telehealth pulse oximetry monitoring started (situation) as described above.

Find further guidance on SCR Additional Information.


Helping providers identify potential oximetry @home patients

We send providers of oximetry @home services a list, every day, containing:

  • patients who have tested positive for COVID-19 who live or are registered in their CCG area
  • indicators highlighting those patients who meet the recommended criteria for being considered for oximetry @home - those over 65 and/or those regarded as Clinically Extremely Vulnerable and/or those who are symptomatic at the point of testing.

If you are a provider who needs this information and is not currently receiving it, email us.

Information we provide

General patient information: 

  • NHS number
  • given name/forename
  • family name/surname
  • full patient postcode
  • contact number
  • registered GP practice

Diagnosis of COVID-19:

  • COVID test result and pillar
  • Date of COVID result
  • Symptomatic indicator
  • Lateral flow test indicator

Age:

  • date of birth
  • age
  • age over 65 indicator

Clinical extreme vulnerability:

  • clinical extreme vulnerability indicator

COVID Oximetry @home Clinical Safety

The following information is intended to assist health and care organisations who will be deploying the COVID Oximetry @home service.  Deploying organisations are legally obliged to follow the Clinical Risk Management standard DCB0160.

To assist deploying organisations with their DCB0160 clinical risk management activities we have provided: 

  1. The most recent DCB0129 Clinical Safety Case Report and its associated Hazard Log. This is because there will be some hazards identified during the development of COVID Oximetry @home by NHS Digital, where control measures to reduce the level of clinical risk associated will fall on the deploying organisation. Read more about DCB0129.
  2. A template DCB0160 Clinical Safety Case Report for use by organisations deploying COVID Oximetry @home. The template is intended to assist deploying organisations complete their clinical risk management requirements and contains information applicable to COVID Oximetry @home and additional guidance. Use of this template is not mandatory.

Description of the mandatory DCB0160 standard

The DCB0160 is aimed at health and social care organisations that are procuring, implementing, deploying or decommissioning health IT systems.

DCB0160 is mandatory in England. Its purpose is to ensure effective Clinical Risk Management is carried out by deploying organisations, to help establish best practice and enable organisations to plan and follow a systematic and consistent approach to Clinical Risk Management. It is also to ensure that the extent of Clinical Risk Management is proportionate to the scale, complexity and level of clinical risk associated with the Health IT system.

Also shown is information regarding the responsibilities which fall on deploying organisations regarding the control measures required to reduce the level of clinical risk associated with the deployment of COVID Oximetry @home.

The DCB0160 standard consists of two documents: 

  • Specification which describes what must be done to comply with the standard and 
  • Implementation Guidance, which provides guidance to support the interpretation of the requirements

Find further information relating to DCB0160 
The Specification and Implementation Guidance for DCB0160 can be found in the ‘Current Release’ section.

The standard uses the terms MUST or SHOULD. MUST demonstrates an absolute requirement of the standard and SHOULD demonstrates a requirement which, if applicable, is recommended but is not mandatory.

Examples of some of the DCB0160 requirements which MUST be met by a deploying organisation when considering the deployment of a system such as COVID Oximetry @home are:

  • identifying and documenting known and foreseeable hazards to patients (Section 4)
  • estimating the initial level of clinical risk for each hazard (Section 4)
  • evaluating whether the initial clinical risk is acceptable (Section 5)
  • identifying appropriate clinical risk control measures to remove an unacceptable clinical risk. (Section 6)
  • implementing the clinical risk control measures. (Section 6)

This is not a complete list of requirements and is included for illustration purposes.

Deploying organisation’s responsibilities

Organisations responsible for manufacturing, developing and modifying health and social care IT Systems which have a direct impact on patient care must follow DCB0129. This is also a mandatory standard which has been followed during the development and manufacture of COVID Oximetry @home by NHS Digital.

Some hazards were identified during the development of COVID Oximetry @home where the responsibility for implementing the control measures to reduce the level of clinical risk associated with the deployment will fall on the deploying organisation. Therefore, it will be necessary for the deploying organisation to consider the hazards identified during the development of COVID Oximetry @home and their control measures when carrying out their own risk analysis.

These hazards and control measures are recorded in the DCB0129 Clinical Safety Case Report titled ‘Clinical Safety Case Report for COVID Oximetry @home’ and the associated Hazard Log. The latest versions of these documents can be found on the NHS Digital COVID Oximetry @home web page.

DCB0160 Support Tool

To help deploying organisations ensure they are compliant with the mandatory DCB0160 standard, a useful support tool titled ‘Compliance Assessment Template’ can be found in the ‘Previous Release’ section of the DCB0160 webpage. This is in the form of an Excel spreadsheet and has been developed to help manufacturers and health and care organisations measure compliance with the standard.

The tool lists the requirements of the standard and has an option to record the level of compliance. The level of compliance is recorded in the Summary tab of the spreadsheet. The tool can also help organisations to check compliance of their clinical risk management processes before undertaking a project.


Pilot study

NHS Digital was involved in a pilot study that focused on the use of pulse oximetry and the remote monitoring of patients with coronavirus at home, then referred to as ‘virtual wards’.

The pilot study focused on three locations:

  • Tees Valley
  • Slough
  • North West London

The study aimed to address the clinical problem that patients with severe coronavirus sometimes present to hospital relatively late – mainly due to the fact that in coronavirus oxygen levels can fall to dangerously low levels with very few symptoms.

During the pilot, we worked with academic partners to develop a dataset for both primary and secondary care. This also included the oximeter reading entries from patients. We facilitated the data collection from the pilot sites and then disseminated this for analysis.


Contact us

If you are part of a local team at a CCG, a provider or a supplier establishing a COVID Oximetry @home pathway, and have questions for NHS Digital on any of the elements of the programme listed above that relate to our role, email covidoximetryathome.nhsd@nhs.net.


Further information

internal COVID Oximetry @home: transparency notice

Version 1: 22 January 2021. We process patients’ personal data in order to provide the COVID Oximetry @home programme. This notice outlines what data is collected, how it is processed, and what we do with it. 

Last edited: 7 May 2021 3:17 pm