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

Data Quality

Telemonitoring

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

The future?

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

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

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

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

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

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

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

Wireless radio telemetry

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

• telephone support arm

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

• optimise therapy

• early discharge

• avoid hospital admission

Patients for on-going monitoring

• multiple admissions

• severely ill

30. 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

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