Telemedicine and Remote Management of Patients with Heart Failure: From Theory to Daily Practice.

Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients' complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care.

Exploring the Environmental Impact of Telemedicine: A Life Cycle Assessment.

BACKGROUND: Telemedicine has emerged as a potential solution to mitigate the significant greenhouse gas emissions of the healthcare sector. A comprehensive evaluation is required to quantify the environmental benefits of its implementation. OBJECTIVES: The study aims to compare the environmental sustainability of in-person and virtual examinations for heart failure patients. METHODS: A standard life cycle assessment has been applied to quantify the equivalent CO2 of direct and indirect activities required to release a medical examination (virtual or physical) for a patient in an Italian hospital. Inputs of the analysis include electronic devices of hospital and patients, energy consumption, wastes, internet usage and patient travel. Depending on the type of visit (virtual or physical), inputs have been processed differently, considering actual consumption and utilization. RESULTS: Televisit reduces emissions from 9.77 kgCO2e to 0.41 kgCO2e. Transport and internet data use are key inputs for in-person (i.e., 98%) and telemedicine visits (i.e., 72%), respectively. DISCUSSION: Given the frequent car travels, telemedicine emerges as a tool to improve environmental benefits and reduce time for patients and caregivers.

Usability of a continuous oxygen saturation device for home telemonitoring.

Background: The emergency for the COVID-19 pandemic has led to greater use of home telemonitoring devices. The aim of this study was to assess the usability of continuous home-monitoring care with an oxygen saturation device on post-COVID-19 patients. Method: The system consists of a digital continuous pulse oximeter and a smartphone with an App, which were provided to patients. A survey composed of a standard Post-Study System Usability Questionnaire, and a satisfaction questionnaire was exploited to conduct a usability and feasibility analysis of the service. Results: A total of 29 patients (17.2% female) with a mean age of 65 ± 11.5 years were enrolled: 20 patients were smartphone users (69%) with a mean age of 60.2 ± 9.5 years, and 9 patients (31%) did not own a smartphone (mean age 76.8 ± 5.9). The monitoring period was 1 month: a total of 444 recordings were conducted, 15 recordings per patient averagely. In total, 82% of the recordings performed did not require any intervention, while 18% led to the production of a report and subsequent intervention by a nurse who verified, together with the specialist, the need to intervene (i.e. the patient accessed the clinic for medical control and/or modification of oxygen therapy). A total of 17 patients compiled a usability questionnaire. The service was perceived as useful and well-structured, although it often required caregiver support. Conclusions: Using continuous home-monitoring care with an oxygen saturation device seems feasible and useful for patients who could be followed at home avoiding going back to the hospital every time a trend oximetry is needed. Further improvements in connections, data flow processes, and simplifications, based on patients' feedback, are needed to scale up the service.

Sustainability in Healthcare: Methods and Tools for the Assessment.

BACKGROUND: Healthcare sector has a significant impact on the environment and people well-being. Therefore, it is interesting to understand how healthcare contributes to sustainable development. OBJECTIVE: The study aims to perform a literature review on the methodologies applied to quantify environmental impact in healthcare with an attention to telemedicine activities. METHODS: Scopus and PubMed databases were investigated between 2018 and 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) frameworks was followed for article selection. RESULTS: From initial 183 articles, 50 full-studies were included. Life-cycle assessment method proved to be a standard for assessing the impact of devices used in clinical practice. Indeed, for the investigation of care activities a unique methodology was not defined. The assessment of telemedicine is mainly based on avoided travels, and a standard methodology is still missing. CONCLUSIONS: To move toward a sustainable development other aspects of sustainability should be investigated.

Definition of a Method for the Evaluation of Telemedicine Platforms in the Italian Context.

Background: The COVID-19 outbreak led to the diffusion of several telemedicine solutions. The choice of the correct platform is crucial for ensuring the release of effective assistance. However, there is a lack of an objective method for the assessment of technical features. Objective: This study proposes a methodology for the evaluation of functional requirements of telemedicine platforms. This approach also permits the comparison of solutions in the Italian market by means of defined parameters, thus directing the choice of health care professionals. Methods: The study is divided into three phases. First, a mapping of the telemedicine platforms operating in Italy is performed. Then, the available platforms are selected based on the offered telemedicine activity. Finally, a method for evaluating the investigated platforms is defined. Results: Thirty-three (n = 33) technological systems were identified through an accurate investigation on the web and interviews with IT companies. Fifteen parameters were defined and organized into three categories: (1) usability of the telemedicine platform, (2) security, and (3) technological and organizational aspects. A score between 1 and 4 was assigned to each parameter, proportionally to the completeness of the platform. In particular, 62.96% of platforms reached an average score between 3.01 and 4 points; 33.33% of them had scores between 2.01 and 3, while the remaining 3.70% of solutions obtained a result between 1.01 and 2. Conclusions: The study provides an evaluation approach that is easily usable by health professionals to select the most suitable platform. The number of solutions and quality of information could be updated to obtain a complete tool.

A patient-specific image-based approach to estimate pulmonary artery stiffness based on vessel constitutive model.

An accurate non-invasive evaluation of the mechanical properties of the vessel wall is important for a variety of screening protocols and surgical treatments. In this work, we focused on a section of the Pulmonary Artery (PA), and developed a patient-specific approach to estimate its stiffness in terms of the Young's modulus along the circumferential direction (E). First, we developed a patient-specific semi-automatic approach to estimate its expected value and standard deviation. To this end, pressure-length curves were derived from magnetic resonance images acquired during the cardiac cycle and information on vessel pressure obtained by catheterization. Then, the estimates of E were derived through a maximum likelihood estimation approach based on a vessel constitutive law. In particular, we analyzed the entire PA boundary and an arc free from surrounding organs. Second, we applied the approach to the study of pulmonary endarterectomy (PEA) for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). We observed a decrease in the circumferential E after PEA for the whole boundary, while no clear trend was observed for the free arc. The low standard deviations associated with the estimates showed high accuracy when considering the entire boundary, while greater variability was observed for the free arc, which was however limited. Finally, reliable hysteretic behavior was obtained from the reconstructed pressure-length curves.

Improving the user experience of televisits and telemonitoring for heart failure patients in less than 6 months: a methodological approach.

BACKGROUND: With the spread of COVID-19, telemedicine solutions became crucial to release continuous and remote assistance to chronic patients. The rapid transition to telemedicine solutions did not allow a complete assessment of the user experience by both patients and medical personnel. Despite the well-known benefits in remote care, the lack of usability evaluation of already existing technologies for the vital signs measurement has emerged. A telemedicine platform must match video communication between patients and the medical staff with the possibility to measure vital parameters. Furthermore, technological assistance may overcome the unfamiliarity with telemedicine and drastically reduce the learning time for both patients and medical personnel. OBJECTIVES: The research work presents a method to improve the user experience of a telemedicine service based on the combination of televisits and telemonitoring with wearable sensors for heart failure patients. Skilled technological staff is proposed by the presented method to lead the learning process of both medical personnel and patients in order to reach a high level of usability in less than 6 months. METHODS: The proposed method is composed of 5 steps: identification of technological staff and end users; selection of the telemedicine platform; design of questionnaires for usability analysis; training of clinicians and patients; final usability evaluation of the telemedicine platform by means of customized satisfaction questionnaires and Post-Study System Usability Questionnaires (PSSUQs). The methodological approach has been tested in collaboration with a heart failure clinic by involving 5 physicians, 5 nurses, 15 heart failure patients, a research engineer and 4 technicians. A platform with 3 wearable sensors has been chosen: a wireless thermometer, a finger pulse-oximeter and an undershirt have been used for the detection of ECG trace. While these devices allowed asynchronous measurements of physiological data, scheduled televisits have been used for direct communication between physicians and patients. RESULTS: Satisfaction questionnaires of patients and clinicians reached respectively 65.18% and 65.83%, while PSSUQ scores were respectively 91.73% and 81.70%. Both groups of end users confirmed a good level of usability and their satisfaction about the ease of use and the perceived quality of the instrumentation. Moreover, 73% of patients did not require help from caregivers to use the kit of sensors. The results have been reached in 5.5 months according to the aim defined initially. Research engineers have played a crucial role in helping clinicians and patients to improve the user experience with the telemedicine platform. CONCLUSIONS: The high level of usability and satisfaction confirmed that the proposed methodological approach helps to learn the technological features of the telemedicine platforms, which are based on different types of technology, such as web applications, wearable sensors and virtual calls. The positive results with heart failure patients encouraged to plan further research studies by using the designed method with other categories of chronic patients.