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  1. 1. Home Telemonitoring the lessons so far.. ….in 10 minutes Simon de Lusignan Senior Lecturer St George’s Hospital Medical School GP Woodbridge Hill Surgery
  2. 2. Primary Care Informatics <ul><li>Information in the consulting room </li></ul><ul><li>Data Quality </li></ul><ul><li>Telemonitoring </li></ul><ul><li>KSSnet 30 th September 2002 </li></ul>
  3. 3. 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><ul><ul><li>A proposal for Guildford and Waverley PCT </li></ul></ul>
  4. 4. 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 intermittent monitoring.. </li></ul>
  5. 5. Intermittent monitoring
  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 1.2 The results interface
  9. 9. 1.4 Anecdotal benefit
  10. 10. 1.4 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><ul><li>Now a pan-European study </li></ul>
  11. 11. Continuous monitoring
  12. 12. 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>
  13. 13. 2.1 Continuous monitoring
  14. 14. 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>
  15. 17. A simple model for patients with CHF...
  16. 18. Model for patients with CHF Time + deteriorating heart failure Costs + healthcare input
  17. 19. Telemonitoring CHF where the studies fit... Primary Care Pilot TEN-HMS Continuos telemonitoring Time + deteriorating heart failure Costs + healthcare input
  18. 20. The Future….
  19. 21. 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>
  20. 22. 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>
  21. 23. 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
  22. 24. Offer on the table…
  23. 25. Telemonitoring proposal… <ul><li>PCDQ to identify patients in need across whole PCT > Link to NSF requirements </li></ul><ul><li>NHS Direct to liase with patients – telemonitoring application provider </li></ul><ul><li>Philips to provide home monitoring + NHS access to data </li></ul><ul><li>PCDQ to evaluate impact of the service </li></ul>
  24. 26. 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>