Transcript The Issues - Instituto Edumed

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
Camera
Connects to a wide
variety of sensors
Thermometer
ECG
Blood pressure
30
9
Pulse O22
Digital Scale
Blood sugar
Stethoscope
Touch screen has large
buttons and user help
Flexible, convenient, and easy to use
Architecture
HOME
VA Connecticut
Hospital Server
Toll Free access
MS RAS Connection
Ethernet
Text and image data
Archived.
56k
DSL
VSB
Patient or Care
Provider takes
measurements
SQL Server 7.0
Windows 2000
Data is linked to
Intranet and sent to VistA
Firewall
Encryption
PKI
VISTA
Internet
Intranet
Hospital
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
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.
VCR Pricing Trend
($) Cost
(1,000 units)
1,200
25,000
1,000
20,000
800
15,000
600
10,000
400
5,000
200
0
0
78 980 982 984 986 988 990 992 994 996 998 000
19
1
1
1
1
1
1
1
1
1
1
2
Average Price
Unit Sold
“There’s No Place Like Home”
For more information contact Donna Vogel at: [email protected]