Telehealth Monitoring Research Articles

Monitoring data quality for telehealth systems in the presence of missing data

BackgroundAll-in-one station-based health monitoring devices are implemented in elder homes in Hong Kong to support the monitoring of vital signs of the elderly. During a pilot study, it was discovered that the systolic blood pressure was incorrectly measured during multiple weeks. A real-time solution was needed to identify future data quality issues as soon as possible. MethodsControl charts are an effective tool for real-time monitoring and signaling issues (changes) in data. In this study, as in other healthcare applications, many observations are missing. Few methods are available for monitoring data with missing observations. A data quality monitoring method is developed to signal issues with the accuracy of the collected data quickly. This method has the ability to deal with missing observations. A Hotelling's T-squared control chart is selected as the basis for our proposed method. FindingsThe proposed method is retrospectively validated on a case study with a known measurement error in the systolic blood pressure measurements. The method is able to adequately detect this data quality problem. The proposed method was integrated into a personalized telehealth monitoring system and prospectively implemented in a second case study. It was found that the proposed scheme supports the control of data quality. ConclusionsData quality is an important issue and control charts are useful for real-time monitoring of data quality. However, these charts must be adjusted to account for missing data that often occur in healthcare context.

Developing smart Tele-ECG system for early detection and monitoring heart diseases based on ECG signal: progress and challenges

Abstract Technology is developed to benefit society. One of the applications of technology in the healthcare sector is telehealth monitoring system. The system proposes a new way of communication between the doctor and the patient, even in a very remote location. In this paper, we elaborate the progress and challenges regarding the development of Tele-ECG in Indonesia, which includes data acquisition, feature extraction, data compression, classification algorithm, mobile and web development system and small device implementation on an FPGA board. The classification is conducted by using LVQ, GLVQ, FNLVQ, FNLVQ-PSO, FNGLVQ, and AM-GLVQ. The compression is conducted by using SPIHT algorithm. Tele-ECG can assist in monitoring heartbeat anomalies and reduce the risk of heart attack. It could also be a solution for infrastructure discrepancy in healthcare.

431: Cost-effectiveness of telehealth blood pressure monitoring in postpartum women with hypertension

Postpartum hypertension is the leading cause of postpartum readmissions in the US. The objective of this study was to evaluate the cost-effectiveness of telehealth blood pressure monitoring of postpartum women with hypertensive disorders from the hospital’s perspective. A decision tree was developed based on results from a non-randomized controlled trial comparing telehealth to standard outpatient blood pressure monitoring. Upon postpartum discharge from the hospital, we issued remote monitoring equipment including a Bluetooth tablet, blood pressure cuff, and scale to postpartum women at a single academic center who were diagnosed with a hypertensive disorder in the antenatal or postnatal period. Patients transmitted vital signs daily to a telehealth nurse, who used an outpatient treatment algorithm to monitor patients, manage antihypertensive medications, or refer for emergent care if symptomatic. We followed patients for 6 weeks and performed cost-effectiveness analysis by using data from hospital and device manufacturer supplied charges and literature-derived utilities. A cost-effectiveness threshold was set at $100,000/quality-adjusted life years. One-way sensitivity analyses were performed to evaluate the robustness of our baseline assumptions. 214 telehealth and 214 control participants were enrolled. Telehealth monitoring significantly reduced postpartum readmissions, from 3.7% (8/214) to 0.5% (1/214). Our study demonstrated that telehealth monitoring was not only cost-effective, but cost-saving. The telehealth cost per patient was $319 and found to be cost-effective up to $423 per patient. Similarly, telehealth monitoring remained cost-effective down to an admission cost of $11,245 compared to our average admission cost of $14,401. Telehealth monitoring also remained cost-effective down to an admission rate of 2.9% with standard monitoring. Our study demonstrates that telehealth blood pressure monitoring of postpartum women with hypertension is cost-effective, cost-saving, and reduces postpartum readmissions.

Using Push Notification in Telehealth and Remote Patient Monitoring Systems

Abstract This paper discusses mobile notifications in the context of health monitoring system that measure and store vital signs of the patient that are included in this program. The values measured are temperature and cardiac rhythm. This has two Android application, one is used by the patient to monitor his vital signs and the other is used by the physician to be able to see and receive push notifications of each individual patient. The sensors are connected to a Raspberry Pi and these devices send information to the Android smartphone via Bluetooth. The physician can monitor patient data in real time. All the information that is gathered by the smartphone from the sensors are sent to the cloud, can project a history and can detect some anomalies, for example, if the cardiac pulse is not within the limits of an accepted interval.

Fuzzy vault-based biometric security method for tele-health monitoring systems

This study proposed an efficient fuzzy vault-based security method that adopts time-domain parameters extracted from physiological signals for tele-healthcare applications, including rehabilitation and stress management systems among others. One of the main challenges of the existing fuzzy vault-based approaches is that they depend on frequency-domain parameters of bio-signals to generate entities identifiers which require more processing time and energy consumption. Hence, we firstly designed a wearable platform for bio-signals collection, and later extracted time-domain features from the signals to generate efficient and distinctive identifiers for securing medical data in tele-healthcare applications. The statistical tests and hamming distances were applied to verify the performance of the generated identifiers regarding their uniqueness and randomness, respectively. This research work considered a total of 30 subjects data and the experimental results reveal that the proposed approach has better performance in WBSNs regarding processing time (0.168 ms) and energy consumption (1.423 mJ) than the traditional techniques.

WS12.3 Telehealth monitoring for home intravenous antibiotics in cystic fibrosis

WS12.3 Telehealth monitoring for home intravenous antibiotics in cystic fibrosis

Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial

Introduction The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital. Methods This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included. Results A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was –3.89 (95% confidence interval (CI): –9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: –12145, –961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria. Discussion The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.

Impact of patient-centred home telehealth programme on outcomes in heart failure

Background Telehealth is a promising intervention to reduce readmissions and healthcare-associated costs in patients with heart failure. Methods We performed a retrospective analysis of the impact of telehealth on 197 heart failure patients who had successfully completed one year of home telehealth monitoring following a heart failure admission as part of a clinically mandated programme at a Veterans Affairs Medical Center. Outcomes were compared both within the group (one year before and one year after home telehealth monitoring), and to a contemporary control cohort of 870 heart failure patients who were admitted but not enrolled in home telehealth. The following outcomes were analysed: admissions for any cause, heart failure admissions, total hospital days per patient, average length of stay per admission, urgent care and emergency room visits, and primary care visits. Results Both the home telehealth and control cohorts consisted of older male patients. Total hospital days per patient was significantly reduced by home telehealth monitoring in the home telehealth group (2.4 ± 3.5) in comparison to the previous year without monitoring (4.1 ± 4.6, p < 0.0001) and to the control group (3.8 ± 5.3, p < 0.001). A significantly lower admission rate (1.1 ± 1.6) and length of stay (5.7 ± 11.3 days) were observed during home telehealth monitoring within the home telehealth group compared to the prior year (1.6 ± 1.7, p < 0.05 and 9.5 ± 14 days, p < 0.01 respectively) but not in comparison with the control group (1.4 ± 2.0, p < 0.07). The home telehealth group also had a significantly lower length of stay when compared to the control group (5.7 ± 11.3 vs 9.0 ± 14.9, p < 0.01). The number of urgent care and emergency room visits, or primary care visits, was not significantly different during home telehealth monitoring as compared to the prior year. Conclusions Personalised and patient-centred home telehealth monitoring in heart failure patients was successful in reducing outcomes without an increase in outpatient and urgent care visits.

Chronic Kidney Disease: Implications for Progression Using Telehealth Monitoring

Background: Chronic Kidney Disease (CKD) is a complex and common medical condition requiring a multidisciplinary management approach, including control of multiple parameters to delay progression of the disease. Telehealth has been used for monitoring chronic conditions and can be used for managing chronic kidney disease.&#x0D; Materials and Methods: Patients (N = 34) with CKD Stage II-V were studied for four months. Vital signs, weight, intake and output, blood glucose level, oxygen saturation, and edema were checked twice weekly by trained nurses, transmitted via WhatsApp, and incorporated into the electronic medical records of the patients. Monthly serum creatinine, hemoglobin, and electrolytes were obtained and reviewed by a nephrologist. Necessary intervention was conveyed to the patients.&#x0D; Results: Patient satisfaction rate with telehealth management was high. Measured parameters were maintained in the recommended range in a higher percentage of the study group compared to the controls. Glomerular filtration rate was maintained in a significantly more patient in the study group (p&lt;0.001).&#x0D; Conclusions: Telehealth monitoring of patients with CKD (tele-nephrology) is a viable and effective option for management of this increasingly prevalent disease.&#x0D; Chronic kidney disease (CKD) is a worldwide public health problem with increasing severity in renal dysfunction extending to dialysis.

Mining productive-periodic frequent patterns in tele-health systems

Recently, tele-health systems have gained attention from vast research fields because they facilitate remote monitoring of patients (e.g. vital sign data, physical activities, etc.) by utlizing various technologies such as body sensor network, wireless communications, multimedia and human-computer interactions without interrupting the quality of lifestyle. As tele-health generates a huge amount of healthcare data consisting of much useful information, finding hidden information from the data is an important task. The purpose of this work is to facilitate a real-time warning alarm in the context of tele-health remote monitoring using data mining techniques. This can be utilized for the e-wellbeing applications, for example, rehabilitation, early identification of therapeutic issues and emergency warning. In particular, we focus on mining Productive Periodic frequent patterns from incremental databases (such as vital sign data of patients) for various decision makings. Exploring the correlations between periodic frequent vital sign data or items is important since the inherent relationships between the items of patterns are relevant. To mine the correlated periodic frequent patterns from incremental databases, we introduce the productive (i.e. useful) periodic frequent patterns (PPFP) as the set of periodic frequent patterns with periodicities that result from the occurrence of correlated items. We finally design and develop an efficient PPFP mining technique that can mine the complete set of useful periodically occurring patterns in incremental databases. Numerous experiments were performed on both real and synthetic data set to judge the effectiveness of the proposed pattern mining procedure when contrasted with existing best in class approaches.

Evaluating the Feasibility and Acceptability of a Telehealth Program in a Rural Palliative Care Population: TapCloud for Palliative Care

ContextThe impact of telehealth and remote patient monitoring has not been well established in palliative care populations in rural communities. ObjectivesThe objectives of this study were to 1) describe a telehealth palliative care program using the TapCloud remote patient monitoring application and videoconferencing; 2) evaluate the feasibility, usability, and acceptability of a telehealth system in palliative care; and 3) use a quality data assessment collection tool in addition to TapCloud ratings of symptom burden and hospice transitions. MethodsA mixed-methods approach was used to assess feasibility, usability, and acceptability. Quantitative assessments included patient symptom burden and improvement, hospice transitions, and advanced directives. Qualitative semistructured interviews on a subpopulation of telehealth patients, caregivers, and providers were performed to learn about their experiences using TapCloud. ResultsOne-hundred one palliative care patients in rural Western North Carolina were enrolled in the program. The mean age of patients enrolled was 72 years, with a majority (60%) being female and a pulmonary diagnosis accounting for the largest percentage of patients (23%). Remote patient monitoring using TapCloud resulted in improved symptom management, and patients in the model had a hospice transition rate of 35%. Patients, caregivers, and providers reported overwhelmingly positive experiences with telehealth with three main advantages: 1) access to clinicians, 2) quick responses, and 3) improved efficiency and quality of care. ConclusionThis is one of the first articles to describe a telehealth palliative care program and to demonstrate acceptability, feasibility, and usability as well as describe symptom outcomes and hospice transitions.

Japan and Its Rapid Ageing Society: Does e-health Technology Provide a Solution?

Japan can be called a rapidly ageing society. In 2016, one-quarter of the Japanese society was aged 65 and over. Against this backdrop, in this article I argue that a rapidly ageing society like Japan will rely heavily on technological solutions to ensure adequate care and a decent standard of living for elderly people. Thus, the country is predestined as a case study considering the relationship between ageing, professional care, e-health technology and other assistive devices. I use examples from Telehealth networks and monitoring sensor systems to shed some light on these recent and growing developments in the field of e-health technologies.

Development of a telehealth monitoring service after colorectal surgery: A feasibility study.

AIMTo evaluate the feasibility of a text-messaging system to remotely monitor and support patients after discharge following elective colorectal surgery, within an enhanced recovery protocol.METHODSFlorence (FLO) is a National Health Service telehealth solution utilised for monitoring chronic health conditions, such as hypertension, using text-messaging. New algorithms were designed to monitor the well-being, basic physiological observations and any patient-reported symptoms, and provide support messages to patients undergoing colorectal surgery within an enhanced recovery after surgery protocol for 30 d after discharge. All interactions with FLO and physiological readings were recorded and patients were invited to provide feedback.RESULTSOver a four-week period, 16 out of 17 patients used the FLO telehealth service at home. These patients did not receive telephone follow-up at three days, as per our standard protocol, unless they reported being unwell or did not make use of the technology. Three patients were readmitted within 30 d, and two of these were identified as being unwell by FLO prior to readmission. No adverse events attributable to the use of the technology were encountered.CONCLUSIONThe utilisation of telehealth in the early follow-up of patients who have undergone major colorectal surgery after discharge is feasible. The use of this technology may assist in the early recognition and management of complications after discharge.

Abstract 034: Remote Patient Monitoring for Postpartum Hypertension: A Pilot Study

Background: Postpartum hypertension is a leading indication for hospital readmission and maternal mortality. Objective: To conduct a pilot intervention to establish the feasibility of telehealth monitoring/treatment after hospital discharge for women with or at risk of developing severe postpartum hypertension (SBP &gt; 150 or DBP &gt; 105 mmHg). Methods: This prospective intervention at a Midwestern academic group practice included adult women with a hypertension-related diagnosis in the antenatal and/or postpartum period. Prior to discharge, patients received a tablet computer and blue tooth equipment (scale, blood pressure, oxygen saturation and heart rate monitor) to transmit home vital signs daily to a nurse. Patients had a nurse telehealth visit 48 hours and 7 days post-discharge. A nurse-driven outpatient treatment algorithm was developed and utilized for initiation and/or cessation of antihypertensive medications. Study follow-up was 6 weeks postpartum, followed by transfer to routine clinical care. Results: Among the 121 women with a hypertension-related disorder of pregnancy; 32 of the intended 55 have been enrolled to date (26%). [HJ2] Among the study patients, 6/32 (19%) were discharged on antihypertensive medication, of which 4/6 (67%) required an increase in the dose after discharge. After discharge, 10/32 (31%) required antihypertensive initiation after discharge due to development of severe hypertension. Overall, postpartum blood pressures became severe on day 4.9 (mean SBP was 158mmHg and DBP was 96mmHg). Among enrolled participants, there were two emergency room visits, however no hospital readmissions; 3/32 (9%) discontinued the study prior to study completion due to social situations. Conclusions: The preliminary results of our pilot intervention demonstrate feasibility and patient acceptability with telehealth monitoring for postpartum hypertension-related disorders. Furthermore, we demonstrated important temporal trends in the natural history of postpartum hypertension from discharge through 6 weeks postpartum which will guide larger clinical trials. Telehealth monitoring is a promising outpatient treatment strategy for postpartum hypertension to reduce readmissions and decrease maternal morbidity.

GeoICT for Meeting the Needs of Remote Patients Monitoring and Healthcare

Spatial Accessibility, a metric that combines medical resource availability and geographic accessibility, is a key determinant of healthcare access. It affects urban and rural patients and negatively impacts care-seeking, follow-up post-discharge, health literacy, and chronic disease management. Current and emerging Telehealth and Remote Patient Monitoring (RPM) platforms are ideal for patients with significant barriers to spatial accessibility, due to the versatility and adaptability of their modular designs. This review aims to (a) characterize negative impacts of barriers to spatial accessibility and (b) demonstrate potential and current capabilities of telehealth and RPM in mitigating many of these challenges, focusing on streamlining patient discharge from the hospital, improving patient and family health literacy, and supporting chronic disease management.

215 - Adherence to a Telehealth Heart Failure Program was Associated Fewer Hospitalizations

Adherence of patients plays an important role in the ability of patients to manage their heart failure (HF). As the utilization of telehealth increases, the effect of the technology and remote care on management of disease remains unknown. It is anticipated that those patients who are more adherent with the telehealth program will exhibit greater management of their HF. This study assessed the impact of a care management program which utilized telehealth technology (Medtronic Care Management Services) to offer improved heart failure care remotely. Methods: A prospective, single-arm, quality initiative program evaluating the expansion of a telehomecare network into rural areas was performed. Following discharge for a HF admission, high-risk patients with HF were enrolled into a telehealth heart failure monitoring program which consisted of daily weight and symptom questions transmitted via telehealth technology for evaluation by a site HF nurse. Follow-up visits were performed at 1 week and 30, 60 and 90 days post-discharge. Adherence was defined as the number of transmissions per week with adherent patients having 5 or more transmissions per week for at least 10 out of 14 weeks and nonadherent patients having less than 5 transmissions per week for 10 out of 14 weeks. The number of hospitalizations, both unscheduled all-cause and all-cause, was evaluated to determine overall disease management. Results: 844 patients (459 males, average age 70.2 ± 13.6 years) were followed for 9 months. Of those patients, at 31 days, 478 were found to be adherent and 238 nonadherent, whereas at 90 days, 477 were adherent and 234 were non-adherent. The unscheduled all-cause hospitalization rate for the adherent population was 7.7% and 12.6% and for the non-adherent population 12.6% and 36.3% at 31 (P = .05) and 90 (P = < 0.001) days, respectively. The all-cause rehospitalization rate was also lower in the adherent group at 31 (adherent = 9.0%, non-adherent 14.3%; P = .04) and 90 days (adherent = 21.6%, nonadherent = 44.0%; P < .001). Conclusion: Patients with the highest frequency of transmissions had fewer hospitalizations. Patients more adherent to transmissions were associated with better HF outcomes.

Arduino Based Infant Monitoring System

This paper proposes a system for monitoring infant in an incubator and records the relevant data into a computer. The data recorded by the system can be further referred by the neonatal intensive care unit (NICU) personnel for diagnostic or research purposes. The study focuses on designing the monitoring system that consists of an incubator equipped with humidity sensor to measure the humidity level, and a pulse sensor that can be attached on an infant placed inside the incubator to monitor infant’s heart pulse. The measurement results which are the pulse rate and humidity level are sent to the PC via Arduino microcontroller. The advantage of this system will be that in the future, it may also enable doctors to closely monitor the infant condition through local area network and internet. This work is aimed as an example of an application that contributes towards remote tele-health monitoring system.

Perspectives from the Kidney Health Initiative on Advancing Technologies to Facilitate Remote Monitoring of Patient Self-Care in RRT.

Telehealth and remote monitoring of a patient's health status has become more commonplace in the last decade and has been applied to conditions such as heart failure, diabetes mellitus, hypertension, and chronic obstructive pulmonary disease. Conversely, uptake of these technologies to help engender and support home RRTs has lagged. Although studies have looked at the role of telehealth in RRT, they are small and single-centered, and both outcome and cost-effectiveness data are needed to inform future decision making. Furthermore, alignment of payer and government (federal and state) regulations with telehealth procedures is needed along with a better understanding of the viewpoints of the various stakeholders in this process (patients, caregivers, clinicians, payers, dialysis organizations, and government regulators). Despite these barriers, telehealth has great potential to increase the acceptance of home dialysis, and improve outcomes and patient satisfaction while potentially decreasing costs. The Kidney Health Initiative convened a multidisciplinary workgroup to examine the current state of telehealth use in home RRTs as well as outline potential benefits and drawbacks, impediments to implementation, and key unanswered questions.

Reduction of medical hospitalizations in veterans with schizophrenia using home telehealth

This study tested the hypothesis that addition of telehealth to Intensive Case Monitoring (ICM) would reduce hospital admissions in Veterans with schizophrenia or schizoaffective disorder admitted for psychiatric care in response to suicidal behavior. Participants (n =51) were randomized to ICM or ICM plus telehealth monitoring. Telehealth participants responded to daily electronic queries about depression, suicidality, and medication adherence. Comparisons revealed that participants in the telehealth group had significantly less medical hospitalizations than the control group. This study found that telehealth augmentation is related to decreased number and length of medical hospitalizations in Veterans with schizophrenia and schizoaffective disorder.

Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data.

BackgroundThe increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD.ObjectiveThe aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission.MethodsA total of 23 participants received a telehealth-supported intervention. This paper reports on the analysis of data from a telehealth monitoring system that captured data from two sources: (1) data uploaded both manually and using Bluetooth peripheral devices by the 23 participants and (2) clinical records entered as nursing notes by the clinicians. Rules embedded in the telehealth monitoring system triggered system alerts to be reviewed by remote clinicians who determined whether clinical intervention was required. We also analyzed data on the frequency and length (bed days) of hospital admissions, frequency of hospital Accident and Emergency visits that did not lead to hospital admission, and frequency and type of community health care service contacts—other than the COPD discharge service—for all participants for the duration of the intervention and 6 months postintervention.ResultsPatients generated 512 alerts, 451 of which occurred during the first 42 days that all participants used the equipment. Patients generated fewer alerts over time with typically seven alerts per day within the first 10 days and four alerts per day thereafter. They also had three times more days without alerts than with alerts. Alerts were most commonly triggered by reports of being more tired, having difficulty with self-care, and blood pressure being out of range. During the 8-week intervention, and for 6-month follow-up, eight of the 23 patients were hospitalized. Hospital readmission rates (2/23, 9%) in the first 28 days of service were lower than the 20% UK norm.ConclusionsIt seems that the clinical team can identify exacerbations based on both an increase in alerts and the types of system-generated alerts as evidenced by their efforts to provided treatment interventions. There was some indication that telehealth monitoring potentially delayed hospitalizations until after patients had been discharged from the service. We suggest that telehealth-supported care can fulfill an important role in enabling patients with COPD to better manage their condition and remain out of hospital, but adequate resourcing and timely response to alerts is a critical factor in supporting patients to remain at home.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 68856013; http://www.isrctn.com/ISRCTN68856013 (Archived by WebCite at http://www.webcitation.org/6ofApNB2e)