Monitoring Health Status and Delivering Health Education Via Home Telemedicine ‘There’s No Place Like Home…’

Donna C. Vogel MSN,CCM ATA 6-06-01 Home Telemedicine Team: Joseph Erdos MD, Ph.D; Helen Noel Ph.D., APN; Donna Vogel MSN, CCM; Forrest Levin MS; Kathleen O’Neill APRN; Leo Calderone MS; David Cornwall MBA

Why Telemonitoring?

• VHA – world’s largest HMO – Serves > 3.6 million patients – Over 178,000 patients receive home services daily • Changing resources – Patients need more health self-management options – Dx best managed by telemedicine - CHF, COPD, DM, CAPD http://www.ntia.doc.gov/reports/telemed/execsum.htm

• Increased emphasis on health prevention, frequent monitoring, education & documentation • Pts have increasing difficulty traveling – Transporting patients to clinics is time consuming, costly & fails to prevent unpredictable events at home • Focus on ambulatory, primary & home care – Moving to a model of care that extends beyond the walls of the hospital and clinics

Goals

• Improve access to care • Monitor patients’ physiologic status & pain – BP, T, pulse oximetry, blood glucose, ECG, weight, breath & heart sounds; camera for visualization; questionnaire • Improve patient education • Expand home-based care • Unique Internet based technology – Simple & easy to use – Active server technology • Integrate telemedicine data with HIS – VISTA - Veterans Health Information System and Technology Architecture

Home Unit Monitors Health Status & Delivers Web-Based Education

Flexible Sensor Connectivity Connects to a wide variety of sensors

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Pulse O

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Touch screen has large buttons and user help

Flexible, convenient, and easy to use

HOME

Architecture

Toll Free access MS RAS Connection

Patient or Care Provider takes measurements VSB

Ethernet 56k DSL Firewall Encryption PKI

VA Connecticut Hospital Server SQL Server 7.0

Windows 2000 Text and image data Archived.

Data is linked to Intranet and sent to VistA VISTA Hospital Internet Intranet

Expected Outcomes…

• Improved knowledge & management of disease – Patient empowered to manage their health through education – Efficient daily monitoring with feedback available to patients • Improved continuity of care & quality of life • Improved compliance with plan of care & advance directives • Improved patient/provider satisfaction • Decreased healthcare costs – Move data not people – Decrease # of ER/Unscheduled visits – Avoid hospitalization • Timely diagnostics for rapid intervention

Monitoring Physiologic Data

• Web-based data-reporting – All data sent from home is available on a secure web site • Clinicians see data organized by patient, date, compliance status and physiologic measurement type . • Trend charts show monitored vital sign results • Data Integrated with VISTA • Specific vital signs (including pain) on CPRS cover sheet • Indicates data obtained via home telemedicine • Trend charts show monitored vital sign results

Secure Web Site Clinician’s Report Clinician selects ‘Clinician’s Report’ to view their patient’s data

Web Page Displays Patient Data

CPRS COVER SHEET IN VISTA

Vital sign data from the telemedicine unit

Health Education Features

• Disease-specific web modules – Modules can be accessed from home – Content available in text, streaming video, and audio – Web-based questionnaire to assess learning – Trend charts show modules accessed • Progress note automatically sent to VISTA – Results of patient education is documented • Appointments also sent from VISTA to home unit

Web-based Education

Selecting the Web button will connect the patient to their personalized web site. The site will give access to educational modules, their medical records, VA appointments and more.

Web-Based Disease Modules

Patients select an education module to view

Web-Based Questionnaire After reading content, patient can respond to questionnaire

Learning Assessment Patient responses are recorded and sent to VISTA as a Progress Note.

Patient Education Progress Note ‘SUBJECT’ shows which education module was passed or failed Progress Note

Education Features… more

• Medication reminders – Audible tone reminds patients to take a specific medication – Self-monitoring tools record when medications were taken, forgotten or purposefully omitted – Visual compliance feedback to providers and patients using easy-to-read, real-time charting

Audible Reminder Feature

Education Features…more

• Hospital to Home messaging – Clinicians can send email messages to patients providing valuable education and feedback to encourage self-care. • Video conferencing ability – User initiates call to clinician for face-to-face meeting and provide/reinforce education.

Email Messaging & Video Conferencing The ‘Advice’ button opens an email list showing messages from clinician.

The ‘Video Phone’ creates a a video conference session with the provider at the appointed time.

Disease Management

• Clinician Alerts – Digital alert system for timely intervention through: • Digital pagers • email • Web – Alerted when: • a patient’s vital signs exceed pre-set limits • patient has failed an educational module • a medication noncompliance event is detected

Clinician Alerts

This page shows the clinician a list of their patients that have triggered an alert. The alerts can be linked to an out-of-limit condition for a particular vital sign, or an unsatisfactory score on the patient education questionnaire as seen here.

Clinician Response

By selecting the small ‘+’ by the patient’s name, the clinician can enter any pertinent comments. The alert is cleared after a comment is entered.

Technology and Security

• Microsoft software for client and servers (NT/2000, SQL7, IIS, Exchange) • Full NT security model followed – Username/Password Authentication – Firewall protection for dial-up lines • Patient Confidentiality addressed – Computer Access Agreement – Consent forms for data and images

Lessons Learned

• Educating patients/caregivers & staff is critical – Not every patient will be suitable • Training support staff is essential • Skilled IT support for database integration • Close vendor relationship is key

COST

As the use of home telehealth technology increases, costs will decline.

($) Cost 1,200

VCR Pricing Trend

(1,000 units) 25,000 1,000 20,000 800 15,000 600 10,000 400 200 0 19 78 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 Average Price Unit Sold 5,000 0

“There’s No Place Like Home”

For more information contact Donna Vogel at: [email protected]