Evaluating the evidence base for the use of home telehealth remote monitoring in elderly with heart failure.

Information and communication technology offers promise for better coordination of care for patients with congestive heart failure (CHF). MEDLINE, EMBASE, and CINHAL databases were searched for evidence on remote monitoring of patients with heart failure (HF). The search was restricted to randomized controlled trials using either automated monitoring of signs and symptoms or automated physiologic monitoring. For this review, telephone-based monitoring of signs and symptoms was not considered remote monitoring. Studies were also excluded if they did not present outcomes related to healthcare utilization. Nine studies met selection criteria, with interventions that varied greatly. Four three-arm studies directly compared the effectiveness of two different interventions to usual care. Six of the nine studies suggested a 27%-40% reduction in overall admissions. Two two-arm studies demonstrated a 40%-46% reduction in HF-related admissions while two other three-arm studies showed similar trends; however, this was not statistically significant. Three of nine studies suggested a significant reduction in mortality (30%-67%) and three studies showed significant reduction in healthcare utilization costs. Two studies suggested a 53%-62% reduction in bed days of care. Two studies showed significant reduction in the number of Emergency Department visits. Three two-arm studies and one three-arm study demonstrated significant overall improvement in outcomes with use of telemonitoring. Available data suggest that telemonitoring is a promising strategy. More data are needed to determine the ideal patient population, technology, and parameters, frequency and duration of telemonitoring, and the exact combination of case management and close monitoring that would assure consistent and improved outcomes with cost reductions in HF.

Research recommendations for the american telemedicine association.

The American Telemedicine Association (ATA) convened a panel of experts to generate a research agenda for the telemedicine community to further support and promote the long-term acceptance and use of telehealth. Three principles to guide research and four key areas within which research is greatly needed were identified. These four areas are technical, clinical, human factors and ergonomics, and economic analyses. It is the hope of the panel that the research recommendations put forth in this document will give investigators the inspiration, tools and goals to make this happen.

The diffusion of a medical innovation: where teleradiology is and where it is going.

Teleradiology is one of the more successful applications of telemedicine as measured by a bibliometric analysis of teleradiology research publications. The organizational diffusion of innovation framework is helpful in understanding the diffusion of teleradiology. Teleradiology had become part of the practices of two-thirds of radiologists who responded to the American College of Radiology survey in 1999. It is clear that teleradiology has become routinized even though quantitative data are hard to find. Telecardiology may be the next successfully diffused form of telemedicine. The potential cloud on the horizon for telediagnostics is political pressure to avoid outsourcing to foreign countries, particularly those to which US information technology jobs have already been transferred. How the outsourcing issue is resolved will have a significant effect on teleradiology specifically, and, perhaps, telemedicine generally.

Home telehealth special interest group: past, present, and future.

The American Telemedicine Association (ATA) established the Home Telehealth Special Interest Group (SIG) in 1999. Its mission is to support the expansion and use of telehealth, remote monitoring and disease management applications in the home. The SIG has many areas of interest and has focused on raising public and professional awareness about the benefits of home telehealth, developing and standardizing clinical guidelines for the delivery of services and advocating for reimbursement through state and federal funding. SIG membership has grown dramatically, to more than 425 members today. These numbers make it the fastest growing and largest of the ATA's Special Interest Groups.

New home telehealth toolkit available.

A new Home Telehealth Toolkit is available for those interested in establishing a new home telehealth program or improving an existing one. Developed by members of the American Telemedicine Association's (ATA) Home Telehealth Special Interest Group (SIG) contains guidelines, procedures, and sample protocols that can be adapted for all phases of a home care telehealth program.

Outcomes of an integrated telehealth network demonstration project.

An integrated telehealth network that linked three hospitals, a federally qualified health care clinic with six sites, a county dental clinic, and patient homes was developed and implemented using both private and federal funding. The goal of the network was to deliver 10 different medical, dental, and behavioral health services to a rural community. The network served patients from nine different counties and two states. Outcomes from the disease management programs for congestive heart failure and diabetes, as well as crisis telehealth and teledental health, were reported. Results for the diabetes disease management program increased the number of diabetics who brought their blood sugar under control. Additionally, based on hospital days per patient per year with and without intervention, and the cost of intervention by telehealth, it was projected that the national cost of care for CHF hospitalizations could be reduced from 8 billion dollars to 4.2 billion dollars. This telehealth network can serve as a model for integrating health services in each county of the state. Once each county had an integrated telehealth network, the county networks could be linked to provide regional services and coordination on a statewide basis.