Lessons from Home Telemonitoring in cardiovascular disease Simon de Lusignan Senior Lecturer St George’s Hospital Medical ...
St George’s:
Primary Care Informatics http://www.gpinformatics.org <ul><li>Information in the consulting room </li></ul><ul><li>Data Qu...
Overview of presentation: <ul><li>Telemonitoring studies involved in… </li></ul><ul><ul><li>Intermittent and continuous mo...
Three home-telemonitoring studies   <ul><li>1. Pilot study of home-telemonitoring of CHF patients drawn from General Pract...
1. Pilot in Primary Care <ul><li>Centred in primary care </li></ul><ul><li>10 intervention and 10 control patients </li></...
1.1  Pilot in Primary Care   NHSnet PSTN ISDN Home Hub HR BP  other vital signs Video Phone connection Case Manager Video ...
Weight -chart  Normal variation in body weight 1.3 The results  interface
1.3 Primary Care Pilot results <ul><li>Acceptable to patients </li></ul><ul><li>At 3 months “almost significant” differenc...
1.4 Typical early weight trend
1.5  Early BP + pulse trend
1.6 Anecdotal benefit
1.7  Primary Care pilot 3/12 results
1.8 Primary Care Pilot lessons: <ul><li>Patients complied with monitoring all year </li></ul><ul><li>Technology works! </l...
2. Continuous telemonitoring <ul><li>20 Patients with chronic cardiopulmonary diseases monitored at home </li></ul><ul><li...
2.1 Continuous monitoring
2.2 Continuous monitoring - results <ul><li>Acceptable to patients, but shaving and repeated visits became less attractive...
 
 
2.3 Continuous monitoring - lessons <ul><li>Collection of a massive data set at home is feasible </li></ul><ul><li>Data tr...
3.  TEN-HMS <ul><li>Patients selected from hospital population </li></ul><ul><li>Same approach as Primary Care Pilot but  ...
3.1  TEN-HMS -   Study Elements Medical CHF Patient  Care at Home Extend to  other diseases Patient - Diabetes - Hypertens...
 
3.2 TEN-HMS Interface
A simple model for patients with CHF...
Model for patients with CHF Time + deteriorating heart failure Costs + healthcare input
Telemonitoring CHF where the studies fit... Primary Care Pilot TEN-HMS Continuos  telemonitoring Time + deteriorating hear...
The Future….
Home telemonitoring future... <ul><li>Patients for diagnostic monitoring/optimisation of therapy </li></ul><ul><ul><li>opt...
What telemonitoring where…. <ul><li>Primary Care </li></ul><ul><ul><li>Intermittent monitoring to optimise therapy measuri...
Summary home- telemonitoring 1°Optimising  therapy 2° care   IP  2° Optimising  therapy 3° care critically ill 2° diagnos...
Acknowledgements: <ul><li>Agilent - Healthcare Solutions Group </li></ul><ul><li>(now part of Philips Medical Systems) </l...
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  1. 1. Lessons from Home Telemonitoring in cardiovascular disease Simon de Lusignan Senior Lecturer St George’s Hospital Medical School LONDON
  2. 2. St George’s:
  3. 3. Primary Care Informatics http://www.gpinformatics.org <ul><li>Information in the consulting room </li></ul><ul><li>Data Quality </li></ul><ul><li>Telemonitoring </li></ul>
  4. 4. Overview of presentation: <ul><li>Telemonitoring studies involved in… </li></ul><ul><ul><li>Intermittent and continuous monitoring </li></ul></ul><ul><li>A simple Model for looking at patients with CHF... </li></ul><ul><li>Where the studies so far fit in… </li></ul><ul><li>The future? </li></ul>
  5. 5. Three home-telemonitoring studies <ul><li>1. Pilot study of home-telemonitoring of CHF patients drawn from General Practice - intermittent monitoring.. </li></ul><ul><li>2. Continuous telemonitoring pilot </li></ul><ul><li>3. UK data collection hub for TEN-HMS (??? - Home monitoring service) </li></ul><ul><li>intermittent monitoring.. </li></ul>
  6. 6. 1. Pilot in Primary Care <ul><li>Centred in primary care </li></ul><ul><li>10 intervention and 10 control patients </li></ul><ul><li>Monitored initially for 3 months, then extended to one year </li></ul><ul><li>Home monitoring of P, BP, Wt, and tele-consulting </li></ul>
  7. 7. 1.1 Pilot in Primary Care NHSnet PSTN ISDN Home Hub HR BP other vital signs Video Phone connection Case Manager Video Phone Info via Internet Browser Server Router Firewall Devices
  8. 8. Weight -chart Normal variation in body weight 1.3 The results interface
  9. 9. 1.3 Primary Care Pilot results <ul><li>Acceptable to patients </li></ul><ul><li>At 3 months “almost significant” difference between intervention and controls </li></ul><ul><li>Less improvement after first 3 months </li></ul><ul><li>Greater quality of life and better symptom scores in intervention group </li></ul><ul><li>Intervention group used all other services less </li></ul>
  10. 10. 1.4 Typical early weight trend
  11. 11. 1.5 Early BP + pulse trend
  12. 12. 1.6 Anecdotal benefit
  13. 13. 1.7 Primary Care pilot 3/12 results
  14. 14. 1.8 Primary Care Pilot lessons: <ul><li>Patients complied with monitoring all year </li></ul><ul><li>Technology works! </li></ul><ul><li>Improvement in first 3 months - possibly related to compliance </li></ul><ul><li>Changed role of nurse to case manager </li></ul><ul><li>BUT </li></ul><ul><li>Mild to moderate patients only </li></ul><ul><li>Narrow-band video consulting of little added value </li></ul>
  15. 15. 2. Continuous telemonitoring <ul><li>20 Patients with chronic cardiopulmonary diseases monitored at home </li></ul><ul><li>Continuous monitoring of heart rate, ECG, temperature, breathing </li></ul><ul><li>Subjects monitored for 24 hours at weekly intervals </li></ul><ul><li>Wireless radio telemetry </li></ul>
  16. 16. 2.1 Continuous monitoring
  17. 17. 2.2 Continuous monitoring - results <ul><li>Acceptable to patients, but shaving and repeated visits became less attractive </li></ul><ul><li>Technology shown to be reliable compared with other automatic devices </li></ul><ul><li>Anecdotal - diagnosis within 24 hours of bursts of VT and of OSA </li></ul>
  18. 20. 2.3 Continuous monitoring - lessons <ul><li>Collection of a massive data set at home is feasible </li></ul><ul><li>Data transmission and collection technology worked well </li></ul><ul><li>Monitoring technical issues more complex, but soluble </li></ul><ul><li>Much more diagnostic detail than intermittent, but the algorithms to exploit this were not available </li></ul>
  19. 21. 3. TEN-HMS <ul><li>Patients selected from hospital population </li></ul><ul><li>Same approach as Primary Care Pilot but </li></ul><ul><ul><li>no teleconsulting, but single channel ECG </li></ul></ul><ul><ul><li>telephone support arm </li></ul></ul><ul><li>Currently recruiting but results not available yet </li></ul><ul><li>UK data collection server </li></ul>
  20. 22. 3.1 TEN-HMS - Study Elements Medical CHF Patient Care at Home Extend to other diseases Patient - Diabetes - Hypertension - Renal Failure - (High risk pregnancy) Home Monitoring Tele- Care Telephone Management Conventional Care Health Care Organization Seamless management between Primary & Secondary Care
  21. 24. 3.2 TEN-HMS Interface
  22. 25. A simple model for patients with CHF...
  23. 26. Model for patients with CHF Time + deteriorating heart failure Costs + healthcare input
  24. 27. Telemonitoring CHF where the studies fit... Primary Care Pilot TEN-HMS Continuos telemonitoring Time + deteriorating heart failure Costs + healthcare input
  25. 28. The Future….
  26. 29. Home telemonitoring future... <ul><li>Patients for diagnostic monitoring/optimisation of therapy </li></ul><ul><ul><li>optimise therapy </li></ul></ul><ul><ul><li>early discharge </li></ul></ul><ul><ul><li>avoid hospital admission </li></ul></ul><ul><li>Patients for on-going monitoring </li></ul><ul><ul><li>multiple admissions </li></ul></ul><ul><ul><li>severely ill </li></ul></ul>
  27. 30. What telemonitoring where…. <ul><li>Primary Care </li></ul><ul><ul><li>Intermittent monitoring to optimise therapy measuring wt, P, BP </li></ul></ul><ul><li>Secondary Care </li></ul><ul><ul><li>Intermittent monitoring to: </li></ul></ul><ul><ul><ul><li>Optimise therapy </li></ul></ul></ul><ul><ul><ul><li>Reduce hospital stays </li></ul></ul></ul><ul><ul><ul><li>Ongoing monitoring of severely ill </li></ul></ul></ul><ul><ul><li>Continuous monitoring </li></ul></ul><ul><ul><ul><li>Diagnosis </li></ul></ul></ul><ul><ul><ul><li>Research </li></ul></ul></ul><ul><ul><ul><li>Critical monitoring </li></ul></ul></ul>
  28. 31. Summary home- telemonitoring 1°Optimising therapy 2° care  IP 2° Optimising therapy 3° care critically ill 2° diagnosis 3° critically ill Research Time + deteriorating heart failure Costs + healthcare input
  29. 32. Acknowledgements: <ul><li>Agilent - Healthcare Solutions Group </li></ul><ul><li>(now part of Philips Medical Systems) </li></ul><ul><ul><li>funded this trip, the pilot telemonitoring study and are funding TEN HMS </li></ul></ul><ul><li>Nexan - funded the continuous telemonitoring study </li></ul><ul><li>Colleagues on these studies: </li></ul><ul><ul><li>Paul Johnson - key collaborator + joint author John Radcliffe Oxford </li></ul></ul><ul><ul><li>Sally Wells, Karen Meredith, Ann Althans study nurses - Ed Letham Cardiologist </li></ul></ul><ul><ul><li>Chris Westerteicher - Agilent/Philips </li></ul></ul>

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