Monitoring Health Status and Delivering Health Education Via Home Telemedicine

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Monitoring Health Status and Delivering Health
Education Via Home TelemedicineTheres 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 ONeill APRN Leo
Calderone MS David Cornwall MBA
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Why Telemonitoring?

• VHA worlds largest HMO
• Serves gt 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/execs
  um.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

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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

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Home Unit Monitors Health Status Delivers
Web-Based Education
Connects to a wide variety of sensors
Touch screen has large buttons and user help
Flexible, convenient, and easy to use
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Architecture
VA Connecticut Hospital Server
Toll Free access MS RAS Connection
HOME
SQL Server 7.0 Windows 2000 Text and image data
Archived. Data is linked to Intranet and sent
to VistA
Ethernet 56k DSL
VSB
Patient or Care Provider takes measurements
Firewall Encryption PKI
VISTA
Intranet
Hospital
Internet
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Expected Outcomes

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• 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

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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

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Secure Web Site
Clinicians Report
Clinician selects Clinicians Report to view
their patients data
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Web Page Displays Patient Data
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CPRS COVER SHEET IN VISTA
Vital sign data from the telemedicine unit
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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

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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.
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Web-Based Disease Modules
Patients select an education module to view
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Web-Based Questionnaire
After reading content, patient can respond to
questionnaire
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Learning Assessment
Patient responses are recorded and sent to VISTA
as a Progress Note.
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Patient Education Progress Note
SUBJECT shows which education module was passed
or failed
Progress Note
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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

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Audible Reminder Feature
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Education Featuresmore

• 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.

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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.
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Disease Management

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

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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.
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Clinician Response
By selecting the small by the patients name,
the clinician can enter any pertinent comments.
The alert is cleared after a comment is entered.
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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

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VCR Pricing Trend
COST
As the use of home telehealth technology
increases, costs will decline.
() Cost
(1,000 units)
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Theres No Place Like Home
For more information contact Donna Vogel at
donna.vogel_at_med.va.gov