Team-based care using home monitoring technologies
Preliminary results from a integrated home telehealth project involving team care arrangements and a variety of readily available technologies has shown that cost savings through nurse visiting and travel time can offset the cost of the equipment, and potentially lead to better health outcomes for patients living at home.
The $3.3 million Integrated Home Telehealth project, which involved remotely monitoring the vital signs of elderly patients living at home as well as nurse-led video conferencing and GP involvement in team-care planning using the cdmNet chronic disease management system, was one of the projects chosen as part of the NBN-enabled Telehealth Program, which was originally set up to test the capabilities of the NBN for telehealth provision.
It was later widened to include any broadband technology, including 3G/4G, ADSL2+ and both fibre to the home and fixed wireless, and this particular project also included commercially available equipment such as iPads, video conferencing and monitors for blood pressure, blood glucose, weight, pulse oximetry and spirometry.
While the results of the project are still being evaluated, preliminary results show that older people in the community are interested in helping to manage their health, there was an improvement in wellbeing in some participants, and the recording of vital signs and the use of cdmNet allowed GPs to address some health and lifestyle issues that could lead to better outcomes.
The project involved technology from the CSIRO, Cisco, Telstra and Tunstall, along with the cdmNet system from Precedence Health Care used by participating GPs and both in-home and remote monitoring from RDNS nurses. It had a chronic disease management focus and the results are being evaluated by the University of Melbourne and Monash University.
It involved four patient groups: one that received remote monitoring and video support utilising a fully featured solution and moderated by RDNS nurses; one group that received a lighter solution using remote vital sign monitoring and video moderated by RDNS; another in which the patient recorded their own data on cdmNet that was then reviewed by the GP; and the final group that used the CSIRO's Smarter Safer Homes technology.
While the use of home-based monitoring of older people or those with chronic illnesses is growing, particularly by visiting nursing services and community aged care providers, how to involve patients' regular GP in the process is a hurdle that many have not yet overcome.
For one group of patients in this project, information about their progress was shared between the patient, the GP and RDNS nurses through cdmNet, a cloud-based chronic disease management system that integrates into commonly used GP clinical software like MedicalDirector, Best Practice, Zedmed and Monet.
Precedence Health Care's clinical integration manager Marienne Hibbert told the HIC conference in Melbourne last year that the patient and their GP worked together to create a management plan, which included goals and tasks for each member of the team, including the patient and the visiting nurse.
Clinical data such as measurements and pathology were uploaded to cdmNet from the GP's desktop software, and the patients were assigned the task of taking their own measurements at home, which were automatically uploaded into cdmNet from the home monitoring equipment.
The RDNS nurse was also allocated to the care team so they could upload observations, and other members of the care team such as allied health providers can also be given web-based access.
“The ideal process for chronic disease management is that the GP and the patient should agree to what is required for that patient, and create a plan for what to do in terms of what is the best care for that patient,” Dr Hibbert said.
“In this case, it was a referral to a home nursing service for their ongoing care – and to include other health professionals, whether they need specialists, allied health and so on – and the patient is set up with the mobile devices and is trained in using those: blood pressure, weight, blood glucose monitoring and the use of the video on the iPad.
“The nurses and care team are then able to monitor and review the patient’s progress through the journey of health care and to communicate with the patient by video, but also electronically via cdmNet, so that the care team is fully informed and the patient is supported in that whole journey.”
Mat Tyler, project manager for telehealth and eHealth with RDNS, told the LASA national conference last year that while the results were still being evaluated, the project did show that receiving telehealth outside of RDNS’ traditional service delivery footprint did not discourage participants.
Some participants experienced an improvement in their vital signs or wellbeing, and others found that their health conditions stabilised due to actively monitoring and managing their health conditions. Better recording of vital signs and the use of cdmNet led to GPs addressing health issues and lifestyle changes, and a number of acute conditions were identified, he said.
Mr Tyler said participants were highly satisfied with their care and the service provided was seen as appropriate, safe and high quality.
Dr Hibbert said the pilot showed that the technology can be delivered successfully, and anecdotal data showed that patients liked the system. “They did things like take the iPad to the GP and say, look at this, see how I am doing,” she said.
“The carers also seemed to like it. They liked to be able to be included in that care team, have that communication with the healthcare providers and with the patients themselves.
“The nurses liked it because it helped them engage in the care provision for their patients. They were able to provide that virtual presence, be able to communicate virtually – they also had face to face visits – but they also had that remote video conference and being able to see how their patients are tracking behind the scenes.”
Statistical evidence for better health outcomes is still being evaluated, but Dr Hibbert said the objectives of the project also included the ability to involve the patient in their own care, as well as to be able to provide a foundation for a cost-effective, adaptable, scalable solution to provide those home care services.
In terms of a cost-benefit analysis, Mr Tyler said there were cost savings in terms of nurse visit time, nurse travel time and fleet costs for RDNS which were able to offset the cost of support, connectivity and IT.
“This will inform the selection of longer term solutions but the conclusion is that it's a sustainable model of care,” he said.
Posted in Australian eHealth