- 1. Lessons from Home Telemonitoring in cardiovascular disease
Simon de Lusignan Senior Lecturer St Georges Hospital Medical
School LONDON
2. St Georges: 3. Primary Care Informatics
http://www.gpinformatics.org
- Information in the consulting room
4. Overview of presentation:
- Telemonitoring studies involved in
-
- Intermittent and continuous monitoring
- A simple Model for looking at patients withCHF...
- Where the studies so far fit in
5. Three home-telemonitoring studies
- 1. Pilot study of home-telemonitoring of CHF patients drawn
from General Practice- intermittent monitoring..
- 2. Continuoustelemonitoring pilot
- 3. UK data collection hub for TEN-HMS (???- Home monitoring
service)
- intermittent monitoring..
6. 1. Pilot 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
7. 1.1Pilot in Primary Care NHSnet PSTN ISDN Home Hub HR BPother
vital signs Video Phone connection Case Manager Video Phone Info
via Internet Browser Server Router Firewall Devices 8. Weight
-chartNormal variation in body weight 1.3 The resultsinterface 9.
1.3 Primary Care Pilot results
- 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
10. 1.4 Typical early weight trend 11. 1.5Early BP + pulse trend
12. 1.6 Anecdotal benefit 13. 1.7Primary Care pilot 3/12 results
14. 1.8 Primary Care Pilot lessons:
- Patients complied with monitoring all year
- Improvement in first 3 months - possibly related to
compliance
- Changed role of nurse to case manager
- Mild to moderate patients only
- Narrow-band video consulting of little added value
15. 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
16. 2.1 Continuous monitoring 17. 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
18. 19. 20. 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
21. 3.TEN-HMS
- Patients selected from hospital population
- Same approach as Primary Care Pilot but
-
- no teleconsulting, but single channel ECG
- Currently recruiting but results not available yet
- UK data collection server
22. 3.1TEN-HMS - Study Elements Medical CHF PatientCare at Home
Extend toother diseases Patient - Diabetes - Hypertension - Renal
Failure - (High risk pregnancy) Home Monitoring Tele- Care
TelephoneManagement ConventionalCare Health Care Organization
Seamless management betweenPrimary &Secondary Care 23. 24. 3.2
TEN-HMS Interface 25. A simple model for patients with CHF... 26.
Model for patients with CHF Time + deteriorating heart failure
Costs + healthcare input 27. Telemonitoring CHF where the studies
fit... Primary Care Pilot TEN-HMS Continuostelemonitoring Time +
deteriorating heart failure Costs + healthcare input 28. The
Future. 29. Home telemonitoring future...
- Patients for diagnostic monitoring/optimisation of therapy
- Patients for on-going monitoring
30. What telemonitoring where.
-
- Intermittent monitoring to optimise therapy measuring wt, P,
BP
-
- Intermittent monitoring to:
-
-
- Ongoing monitoring of severely ill
31. Summary home- telemonitoring 1Optimisingtherapy 2 care IP2
Optimisingtherapy 3 care critically ill 2 diagnosis 3 criticallyill
Research Time + deteriorating heart failure Costs + healthcare
input 32. 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