Implementing A Remote Home Monitoring Program using Broadband Over the Power Lines

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Implementing A Remote Home Monitoring Program
using Broadband Over the Power Lines

• A presentation to the
• American Telemedicine Association
• May 9, 2006
• Presented by Ms. Susan Yeager and Francis P.
  Koster Ed. D.

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The Nemours Enterprise, 2006

• Nemours is one of the nations largest pediatric
  sub-specialty groups, employing 450 M. D.s
• Nemours mission is to Provide leadership,
  institutions, and services to restore and improve
  the health of children through care and programs
  not readily available, with one high standard of
  quality and distinction regardless of the
  recipient's financial status.
• 250 thousand individual children seen annually
• Over one million patient visits annually
• Owns and operates
• the Alfred I. duPont Hospital for Children in
  Wilmington, DE,
• major children's specialty centers in Wilmington,
  Jacksonville, Orlando, and Pensacola.

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NemoursRemote Monitoring Mission Statement

• Nemours will develop and demonstrate for
  internal use and national replication a model of
  an economically sustainable adjunct to the
  current pediatric system of care, which would be
  economically viable without Nemours subsidy,
  built on using e-health and remote monitoring
  technologies for disease management of chronic or
  complex pediatric patients, which results in a
  clinical outcome equal to or greater than the
  traditional model of care, equally available to
  all citizens, for less total healthcare
  expenditures.

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Behavior Environment

• Behavior and environment account for over 70 of
  avoidable mortality

Medical Services
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Genetics
Behavior
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50
Environment
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Leading Determinants of Health
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Our genetic predispositions affect the health
care we need, and our social circumstances affect
the health care we receive.
- McGinnis et al, Health Affairs, 2002.
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A matter of Public Policy the digital divide

• In 2004, members of President Bushs
  Administration wanted to try to bridge the
  Digital Divide by delivering Broadband Internet
  access via the installed electric grid in areas
  where DSL, or Cable was not available or too
  expensive.

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Program Objectives

• In early 2005, the United States Department of
  Commerce funded Nemours Children's Clinics to
  conduct a test of the Broadband over the
  Powerlines (BPL) technology, to carry video and
  biometric information over electric utility
  lines.
• At regularly scheduled times, 60 Nemours
  patients/families are to send from their homes
  the childs biologic health readings via the
  monitoring equipment. The biometric data is
  transferred from the patients unit and placed
  into their Electronic Medical Record at Nemours.

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Remote Home Monitoring via Broadband over Power
Lines
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Electric Overhead Distribution Pole Architecture
Electric Utility Space
BPL equipment is installed in the utility space
Telecom Carrier Pole Space
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The CURRENT BPL System

• Examples of BPL equipment currently deployed

OH Coupler Choke
Backhaul and Bridge
OH Coupler Assembly
Installed
Installed Coupler
HomePlug BPL Modems
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Typical BPL Installation with Current Equipment
Choke
Fuse Cutout
Minimum 5ft Space needed
Coupler
Power Line Bridge
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Utility Pole Physical Challenges

• Less than 5 ft of space between utility hardware
• No space available in the utility section for the
  installation of BPL equipment

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Additional Physical Challenges

• Congested overhead electric distribution
  infrastructure present additional physical
  challenges. Physical space is very limited and
  electric distribution designs did not consider
  BPL deployments.

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Other Broadband over PowerLines lessons learned

• BPL is not a useful technology if you are trying
  to cover large distances the signal degrades to
  much. This takes BPL off the table as a
  technology to solve the Digital Divide in rural
  areas.
• BPL ironically works well in areas with buried
  power lines modern subdivisions. Nemours and
  JEA are examining a test of this kind of
  installation now.

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Alternate Paths Forward

• Alternative 1
• Focus on telemedicine research and Remote Home
  Monitoring.
• Utilize the most cost effective
  telecommunications services available in the
  immediate area rather than focusing on the use of
  BPL as the telecommunications carrier.
• Allow additional time to obtain enough patients
  in the existing areas to complete the study (12
  month extension).

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Alternate Paths Forward

• Alternative 2
• Continue with focus on BPL as the
  telecommunications carrier for telemedicine and
  Remote Home Monitoring despite current
  challenges.
• Increase the feasibility by removing geographic
  restrictions (zip code and diagnosis
  restrictions) as specified by the grant.
• Allow additional time to obtain enough patients
  in the new areas to complete the BPL delivered
  study (18 month extension) barring significant
  hurricanes.

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Modifications to our thinking

• Because of the cost of installing BPL to a single
  home, we began to explore ways to serve many
  children with a single BPL installation.
• This led us to the work done by other members of
  ATA.

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TeleCoach
A program which combines the use of telehealth
tools with an asthma disease management program
to promote the health of middle-school children
with asthma.
Obtained from Sentara Home Care Services Rhonda
Chetney, MS, RN Presentation to The American
Telemedicine Assoc.
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Decline in missed school days, emergent care
visits and hospital admits
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Patient Recruitment Lessons Learned

• Scheduling families for registration is harder
  than anticipated due to parents working several
  low paying jobs to pay bills
• Confidentiality had to be addressed. Nemours
  could not inform JEA who the patients were until
  HIPPA requirements were met.
• Some patients declined, expressing reluctance to
  have cameras in their home

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The good news

• Grant Extension approved, new diagnosis and zip
  codes added
• Nemours realizes value of RM, the Board of
  Directors of Nemours has named it a 2006
  priority
• School/daycare set up seems to be warmly
  received
• Units test well on DSL and Cable, wireless tests
  underway
• Two groups of patients emerging
• Mildly ill asthma and diabetes and other similar
  diagnosis which can be school based,
• Hospice, Vent Dependent, home bound paralytics
• Private payers have agreed in principle to pay
  for service
• Florida Legislature just passed law requiring
  State of Florida Medicaid to pay for Remote
  Monitoring, on Governor Bush desk for signature.