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

Blood sugarBlood sugar

Blood pressureBlood pressure

ThermometerThermometer

StethoscopeStethoscope

ECGECG

Pulse O2Pulse O2

CameraCamera

Digital ScaleDigital Scale

309

Connects to a wide variety of sensors

Touch screen has large buttons and user help

Flexible, convenient, and easy to use

Architecture

SQL Server 7.0Windows 2000

Text and image data Archived.

Data is linked toIntranet and sent to VistA

HOMEHOMEHOMEHOME Toll Free access

MS RAS Connection

Ethernet

56k

DSL

VISTA

Intranet

Patient or Care Provider takes measurements

VSB

HospitalInternet

Firewall

Encryption

PKI

VA ConnecticutVA Connecticut Hospital ServerHospital ServerVA ConnecticutVA Connecticut Hospital ServerHospital Server

Expected Outcomes… .

• Improved level of independence• 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

Clinician’s Report

Clinician selects ‘Clinician’s Report’ to view their patient’s data

Secure Web Site

Web Page Displays Patient Data

Vital sign data from the telemedicine unit

CPRS COVER SHEET IN VISTA

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.

Patients select an education module to view

Web-Based Disease Modules

After reading content, patient can respond to questionnaire

Web-Based Questionnaire

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

Learning Assessment

Patient Education Progress Note

Progress Note

‘SUBJECT’ shows which education module was passed or failed

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

The ‘Advice’ button opens an email list showing messages from clinician.

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

VCR Pricing Trend

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($) Cost (1,000 units)

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

COST

“There’s No Place Like Home”

For more information contact Donna Vogel at: donna.vogel@med.va.gov