‘Last mile’ Problem in Remote Patient Monitoring at Home: the Use of Instant Messaging Applications

Telemedicine is one of the most evolving areas of healthcare that meets the needs of the patient of modern times: mobile accessibility, personalized approach, and rapid service delivery. However, no matter how good the telemonitoring system is, the patient will tend not to use it if it is excessively expensive, hard to apprehend, or if it hardly interferes with everyday life (the ‘last mile” problem). In this study, we investigate how instant messaging (1M) applications can help overcome the ‘last mile” problem. A simple experimental tool was developed and patented, which enables the medical professionals to set the self-assessment questionnaire automatically sent through 1M to the patients daily at a given time. The results are collected and analyzed in the cloud, where the ‘traffic lights” colored flags are set, with a red-colored flag indicating an urge of immediate reaction. To prove the eligibility of the use of 1M, we asked 25 patients with chronic heart failure to receive and answer the questionnaire (6 or 7 questions on a person's health condition with predefined answers, depending on the day of the week) for 3 months. The adherence was considered positive if the questionnaire was filled out daily (24 hours were given to finish the task) for the whole period of observation, or negative if there was at least one missed or incomplete response. Out of 25 patients, 17 showed positive adherence (68%). Thus, we can conclude about the viability of such an interface of patient interaction with telemedicine care and the high potential of using 1M to solve the ‘last mile” problem in telemedical continuous monitoring of patients at home.