Home Telemonitoring the lessons so far.. .in 10 minutes

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Home Telemonitoring the lessons so far...in 10
minutes

• Simon de Lusignan
• Senior Lecturer
• St Georges Hospital Medical School
• GP
• Woodbridge Hill Surgery

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Primary Care Informaticshttp//www.gpinformatics.
org

• Information in the consulting room
• Data Quality
• Telemonitoring
• KSSnet www.kssnet.org 30thSeptember 2002

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Overview of presentation

• Telemonitoring studies involved in
• Intermittent and continuous monitoring
• A simple Model for looking at patients with
  CHF...
• Where the studies so far fit in
• The future?
• A proposal for Guildford and Waverley PCT

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Three home-telemonitoring studies

• 1. Pilot study of home-telemonitoring of CHF
  patients drawn from General Practice -
  intermittent monitoring..
• 2. Continuous telemonitoring pilot
• 3. UK data collection hub for TEN-HMS
  intermittent monitoring..

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Intermittent monitoring
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1. Pilot in Primary Care

• Centred in primary care
• 10 intervention and 10 control patients
• Monitored initially for 3 months, then extended
  to one year
• Home monitoring of P, BP, Wt, and tele-consulting

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1.1 Pilot in Primary Care
NHSnet
PSTN ISDN
Server Router Firewall
Devices
Home Hub
Info via Internet Browser
Video Phone connection
HR BP other vital signs
Case Manager
Video Phone
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1.2 The results interface
Weight -chart Normal variation in body weight
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1.4 Anecdotal benefit
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1.4 Primary Care Pilot results

• Acceptable to patients
• At 3 months almost significant difference
  between intervention and controls
• Less improvement after first 3 months
• Greater quality of life and better symptom scores
  in intervention group
• Intervention group used all other services less
• Now a pan-European study

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Continuous monitoring
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2. Continuous telemonitoring

• 20 Patients with chronic cardiopulmonary diseases
  monitored at home
• Continuous monitoring of heart rate, ECG,
  temperature, breathing
• Subjects monitored for 24 hours at weekly
  intervals
• Wireless radio telemetry

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2.1 Continuous monitoring
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2.2 Continuous monitoring - results

• Acceptable to patients, but shaving and repeated
  visits became less attractive
• Technology shown to be reliable compared with
  other automatic devices
• Anecdotal - diagnosis within 24 hours of bursts
  of VT and of OSA

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A simple model for patients with CHF...
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Model for patients with CHF
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Telemonitoring CHF where the studies fit...
TEN-HMS
Primary Care Pilot
Continuos telemonitoring
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The Future.
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Home telemonitoring future...

• Patients for diagnostic monitoring/optimisation
  of therapy
• optimise therapy
• early discharge
• avoid hospital admission
• Patients for on-going monitoring
• multiple admissions
• severely ill

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What telemonitoring where.

• Primary Care
• Intermittent monitoring to optimise therapy
  measuring wt, P, BP
• Secondary Care
• Intermittent monitoring to
• Optimise therapy
• Reduce hospital stays
• Ongoing monitoring of severely ill
• Continuous monitoring
• Diagnosis
• Research
• Critical monitoring

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Summary home- telemonitoring
3 care critically ill
2 care? IP
2 Optimising therapy
3 critically ill
1Optimising therapy
Research
2 diagnosis
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Offer on the table
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Telemonitoring proposal

• PCDQ to identify patients in need across whole
  PCT gt Link to NSF requirements
• NHS Direct to liase with patients
  telemonitoring application provider
• Philips to provide home monitoring NHS access
  to data
• PCDQ to evaluate impact of the service

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Acknowledgements

• Agilent - Healthcare Solutions Group
• (now part of Philips Medical Systems)
• funded this trip, the pilot telemonitoring study
  and are funding TEN HMS
• Nexan - funded the continuous telemonitoring
  study
• Colleagues on these studies
• Paul Johnson - key collaborator joint author
  John Radcliffe Oxford
• Sally Wells, Karen Meredith, Ann Althans study
  nurses - Ed Letham Cardiologist
• Chris Westerteicher - Agilent/Philips