Lessons from Home Telemonitoring in cardiovascular disease

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Lessons from Home Telemonitoring in
cardiovascular disease

• Simon de Lusignan
• Senior Lecturer
• St Georges Hospital Medical School
• LONDON

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St Georges
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Primary Care Informaticshttp//www.gpinformatics.
org

• Information in the consulting room
• Data Quality
• Telemonitoring

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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?

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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 (??? -
  Home monitoring service)
• 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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1.3 The results interface
Weight -chart Normal variation in body weight
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1.3 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

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1.4 Typical early weight trend
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1.5 Early BP pulse trend
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1.6 Anecdotal benefit
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1.7 Primary Care pilot 3/12 results
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1.8 Primary Care Pilot lessons

• Patients complied with monitoring all year
• Technology works!
• Improvement in first 3 months - possibly related
  to compliance
• Changed role of nurse to case manager
• BUT
• Mild to moderate patients only
• Narrow-band video consulting of little added value

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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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2.3 Continuous monitoring - lessons

• Collection of a massive data set at home is
  feasible
• Data transmission and collection technology
  worked well
• Monitoring technical issues more complex, but
  soluble
• Much more diagnostic detail than intermittent,
  but the algorithms to exploit this were not
  available

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3. TEN-HMS

• Patients selected from hospital population
• Same approach as Primary Care Pilot but
• no teleconsulting, but single channel ECG
• telephone support arm
• Currently recruiting but results not available
  yet
• UK data collection server

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3.1 TEN-HMS - Study Elements
Medical
CHF Patient Care at Home
- Diabetes
- Hypertension
- Renal Failure
Extend to other diseases
Patient
- (High risk
pregnancy)
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3.2 TEN-HMS Interface
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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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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