DOC@HOME has been implemented at the Medical University of Vienna to enhance the quality of life for cancer patients undergoing treatment.

DOC@HOME, a remote monitoring solution developed by Graphnet, has been implemented at the Medical University of Vienna to enhance the quality of life for cancer patients undergoing treatment. The haematology outpatient clinic at the Medical University of Vienna is using DOC@HOME to allow cancer patients to monitor their symptoms from home. The team have been reporting excellent feedback from patients and clinicians and the solution has shown significant improvements in patient outcomes.

Background and how the project started

This initiative grew out of the European project, eSMART, a collaboration across five European countries which demonstrated the efficacy of remote monitoring compared to standard care. The project had 829 participants, including 140 from the Medical University of Vienna. After the success of the project, the team at the Medical University of Vienna, including Dr Simone Lubowitzki, wanted to build on the excellent results and so continued to use the Docobo Remote Monitoring solution.

Dr Simone Lubowitzki, Clinical Project Manager, Medical University of Vienna says:

Our decision to adopt Graphnet's technology was influenced by their long-standing expertise in remote monitoring and the impressive results from the eSMART trial.

DOC@HOME is a remote monitoring technology solution that allows patients to track and report their symptoms from home using a smartphone or tablet app. DOC@HOME was developed by Graphnet, which has been specialising in remote monitoring since 2001. It is used widely across the UK and elsewhere.

How does the remote monitoring technology work at the Medical University of Vienna?

The team at the haematology outpatient clinic onboard patients going through any kind of cancer treatment so they can be monitored at home. Patients use an app on their smartphones or a tablet to record their symptoms at various stages of the day, which are then automatically transmitted to a clinical hub in real time.

Patients report their symptoms daily, including nausea, vomiting, diarrhoea, constipation, mucositis, polyneuropathy, pain, fever, flu-like symptoms, fatigue and body aches. The app includes an image of the body that patients can use to indicate where they feel pain. When the collected data is transferred to the server in real time, a risk algorithm classifies the symptoms according to a traffic light principle. The system alerts clinicians if thresholds are exceeded and enables the clinical team to respond directly to patients. Amber alerts indicate a need for action, while red alerts signal more serious symptoms requiring immediate attention.

Patients can also use the app to find out specific information about common concerns such as hair loss and managing fatigue.

Impacts and outcomes of using remote monitoring

Simone continues:

This technology optimises treatment and enhances symptom control.  The remote monitoring system has shown a positive impact on cancer patient survival and early identification of relapses, leading to optimised therapy. Additionally, the app collects validated questionnaires on disease-related quality of life, providing patients with access to evidence-based information about cancer and chemotherapy at any time.

Patients have expressed appreciation for DOC@HOME, which not only helps them manage their symptoms but also provides general information about their condition. For clinicians, the app saves time by making patient data readily accessible, allowing them to focus more on patient care. The clinician website allows for the monitoring of symptom progress on a daily basis, offering relief to the medical team and improving overall efficiency.

At the start of the eSMART study, one 78-year-old study participant did not own a smartphone herself and was initially hesitant about participating. After being trained on the device, she tried it out and was ultimately unwilling to give it back towards the end of the study, as the contact with the study team was a support to her during her chemotherapy treatment.

Integration into clinical routines

The integration of DOC@HOME into the clinical routine is crucial for maximising its benefits and ensuring seamless patient care. Effective integration allows for continuous monitoring of patient symptoms, facilitating timely interventions and reducing the burden on healthcare providers. Clinicians can manage alerts efficiently  and the integration not only enhances the ability to track and respond to patient needs, but also contributes to the overall workflow by providing easy access to patient data.

The collection and use of patient-reported outcomes (PROs) are important for optimal patient care, enabling monitoring of treatment progress, enhanced care planning, decision-making, and therapeutic goal setting. PROs also support quality monitoring and benchmarking within health systems. The use of validated, controlled, and published questionnaires has been recommended by the FDA and EMA to demonstrate the efficacy of medicinal products.

Patients report on 13 symptoms daily, such as nausea, vomiting, diarrhoea, constipation, mucositis, polyneuropathy, pain, fever, flu-like symptoms, fatigue, and body aches. The data were transmitted in real-time to a server, where a risk algorithm classified the symptoms based on a traffic light system, allowing the clinical team to respond promptly.

By embedding DOC@HOME into the daily operations, the medical team can ensure consistent and high-quality care, ultimately leading to better patient outcomes and a more efficient healthcare system.

Impact and Outcomes

The DOC@HOME initiative at the Medical University of Vienna has proven to be a significant advancement in patient care at home. Simone says:

This technology optimises treatment and enhances symptom control. Our decision to adopt Graphnet's technology was influenced by their long-standing expertise in remote monitoring and the impressive results from the eSMART trial. The remote monitoring system has shown a positive impact on cancer patient survival and early identification of relapses, leading to optimised therapy. Additionally, the app collects validated questionnaires on disease-related quality of life, providing patients with access to evidence-based information about cancer and chemotherapy at any time.

Initially, patients often experience anxiety at the start of their treatment. To address this, the use of Patient-Reported Outcomes (PROs) is critical. Every participant, including those in the control group, fills out PROs, which provided valuable multi-dimensional data on various health attributes. This approach was essential in demonstrating the efficacy of the DOC@HOME system.

Patients are really happy using DOC@HOME, reporting improved quality of life. The Docobo app facilitates easier data collection, as well as patient monitoring. The app was tested with 142 patients in the haematology and oncology departments, further confirming its effectiveness. The success of this test phase convinced the nursing management of its value, leading to a pilot program that has integrated DOC@HOME into clinical routines.

Implementing DOC@HOME is a significant milestone for healthcare in Austria, representing a major step forward despite the challenges of introducing new ideas into established systems.

Patients have expressed appreciation for DOC@HOME, which not only helps them manage their symptoms but also provides general information about their condition. For clinicians, the app saves time by making patient data readily accessible, allowing them to focus more on patient care.

The positive reception from both patients and healthcare professionals underscores the importance and potential of this innovative approach in enhancing patient care and outcomes.

Adrian Flowerday, Managing Director at Docobo, remarked:

This project has demonstrated the flexibility of DOC@HOME, particularly with its ability to adapt to any language, resulting in excellent outcomes internationally. Designed for global use, DOC@HOME supports complex conditions, long-term conditions, and multimorbidity.

Expansion and Future Prospects

The DOC@HOME app, available on Android and iOS platforms, continues to evolve, integrating into clinical routines and expanding its capabilities, to cover other diseases beyond cancer, facilitating a broader application of remote monitoring across different clinical departments. This expansion represents a step towards more personalised medicine and care.

The Medical University of Vienna has established a working group to address the integration of telehealth applications into clinical practice, aiming to create a unified platform for telemedical solutions across different medical disciplines.

Adrian Flowerday, Managing Director at Docobo, remarked:

This project has demonstrated the flexibility of DOC@HOME, particularly with its ability to adapt to any language, resulting in excellent outcomes internationally. Designed for global use, DOC@HOME supports complex conditions, long-term conditions, and multimorbidity.

The deployment of DOC@HOME at the Medical University of Vienna represents a significant advancement in patient care, demonstrating the potential of telemedicine to improve outcomes and enhance the quality of life for cancer patients.

Notes for Editors

The eSMART study, conducted from 2014 to 2019 across twelve clinics in five European countries, utilised the Advanced Symptom Management System (ASyMS), developed in 2005 at a Scottish oncology centre. The study involved 829 cancer patients, with a randomised controlled design comparing standard care to standard care plus remote monitoring. Participants included patients with non-metastatic breast cancer, colorectal cancer, Hodgkin’s disease, or non-Hodgkin’s lymphoma, receiving adjuvant chemotherapy or chemotherapy for the first time in five years.