Real-world deployment and longitudinal evaluation of a human-in-the-loop telemedicine communication support system

Telemedicine platforms are increasingly used to support the long-term monitoring of chronically ill patients. However, continuous streams of patient-reported data and messages may impose substantial workload on telemedicine teams. To address this challenge, we developed a human-in-the-loop communication support system for telemedicine monitoring of kidney transplant recipients.

The system was integrated into the telemedicine program of the nephrology department at Charité - Universitätsmedizin Berlin. It analyzes telemedicine data in combination with locally stored electronic health record (EHR) data and generates suggested responses and reminders for clinical staff. All suggestions are reviewed by telemedicine personnel and can be accepted, modified, or discarded before being sent to patients. System usage was evaluated based on routine operation data collected since deployment.

The system has been in productive use since May 15, 2024. During the observation period, more than 22,000 message suggestions were generated, of which over 16,000 were sent without modification. Overall, approximately 76% of all generated suggestions resulted in patient communication. Usage increased steadily over time, indicating successful integration into routine telemedicine workflows. Standardized reminders and routine communication tasks showed particularly high utilization.

Our findings demonstrate the potential of automated communication support systems to assist routine telemedicine workflows while maintaining human oversight of patient communication. At the same time, practical challenges related to system integration, data timeliness, and context awareness remain important considerations for successful deployment in clinical environments.