monitoring health status and delivering health education via home telemedicine ‘there’s no place...
TRANSCRIPT
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
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.
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
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
• 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
0
200
400
600
800
1,000
1,200
19781980
19821984
19861988
19901992
19941996
19982000
0
5,000
10,000
15,000
20,000
25,000
Average Price Unit Sold
($) 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: [email protected]