Experiences and views of patients, carers and healthcare professionals on using modems in domiciliary non-invasive ventilation (NIV): a qualitative study.

BACKGROUND: Advances in technology means that domiciliary non-invasive ventilation (NIV) devices can be remotely monitored via modems in patients' homes. Possible benefits and challenges of modem technology have yet to be established. This study explored the perspectives and experiences of patients, their carers and healthcare professionals (HCPs) on the addition of modem technology in managing home NIV. METHODS: A qualitative study using a combination of focus groups for HCPs and interviews for carers/patients was undertaken. 12 HCPs and 22 patients/carers participated. These focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Five main themes were identified. 'Surveillance: a paradox of findings': HCPs were concerned about unduly scrutinising patients' lives, potentially impacting on HCP patient relationships. Conversely, patients welcomed modem monitoring and did not express concerns regarding invasion of privacy. 'Sanctions': HCPs reported the modem increased access to care and allowed appropriate assessment of ongoing treatment. 'Complacency and ethics': HCPs expressed concerns patients may become complacent in seeking help due to expectations of modem monitoring, as well as being concerned regarding the ethics of modems. There was a suggestion patients and carers' expectations of monitoring were different to that of clinical practice, resulting in complacency in some cases. 'Increased time for patient focused care': HCPs in the focus groups described a number of ways in which using modems was more efficient. 'Confidence: can be improved with technology': patients and carers were positive about the impact of the modems on their health and well-being, particularly their confidence. CONCLUSION: HCPs expressed concerns about surveillance were not corroborated by patients, suggesting acceptability of remote monitoring. Data suggests a need for increased clarity to patients/carers regarding clinical practice relating to responsiveness to modem data. The issue of complacency requires further consideration. Modem technology was acceptable and considered a useful addition by HCPs, patients and carers. TRIAL REGISTRATION NUMBER: NCT03905382.

Two-Way Radio Modem Data Transfer for Newborn Hearing Screening Devices.

INTRODUCTION: The success of a newborn hearing screening program depends on successful tracking and follow-up to ensure that children who have had positive screening results in the first few days of life receive appropriate and timely diagnostic and intervention services. The easy availability, through a suitable infrastructure, of the data necessary for the tracking, diagnosis, and care of children concerned is a major key to enhancing the quality and efficiency of newborn hearing screening programs. MATERIALS AND METHODS: Two systems for the automated two-way transmission of newborn hearing screening and configuration data, based on mobile communication technology, for the screening devices MADSEN AccuScreen® and Natus Echo-Screen® were developed and tested in a field study. Radio modem connections were compared with conventional analogue modem transmissions from Natus Echo-Screen devices for duration, transmission rate, number of lost connections, and frequency of use. RESULTS: The average session duration was significantly lower with the MADSEN AccuScreen (12 s) and Natus Echo-Screen both with radio modem (15 s) than the Natus Echo-Screen with analogue modem (108 s). The transmission rate was significantly higher (898 and 1,758 vs. 181 bytes/s) for the devices with radio modems. Both radio modem devices had significantly lower rates of broken connections after initial connection (2.1 and 0.9 vs. 5.5%). An increase in the frequency of data transmission from the clinics with mobile radio devices was found. CONCLUSIONS: The use of mobile communication technology in newborn hearing screening devices offers improvements in the average session duration, transmission rate, and reliability of the connection over analogue solutions. We observed a behavioral change in clinical staff using the new technology: the data exchange with the tracking center is more often used. The requirements for on-site support were reduced. These savings outweigh the small increase in costs for the Internet service provider.

The impact of using mobile-enabled devices on patient engagement in remote monitoring programs.

BACKGROUND: Different types of data transmission technologies are used in remote monitoring (RM) programs. This study reports on a retrospective analysis of how participants engage, based on the type of data transfer technology used in a blood pressure (BP) RM program, and its potential impact on RM program design and outcomes. METHODS: Thirty patients, aged 23-84 years (62 ± 14 years), who had completed at least 2 months in the program and were not participating in any other clinical trial were identified from the Remote Monitoring Data Repository. Half of these patients used wireless-based data transfer devices [wireless-based device (WBD)] while the other half used telephone modem-based data transfer devices [modem-based device (MBD)]. Participants were matched by practice and age. Engagement indices, which include frequency of BP measurements, frequency of data uploads, time to first BP measurement, and time to first data upload, were compared in both groups using the Wilcoxon-Mann-Whitney two-sample rank-sum test. Help desk call data were analyzed by Chi square test. RESULTS: The frequency of BP measurements and data uploads was significantly higher in the WBD group versus the MBD group [median = 0.66 versus 0.2 measurements/day (p = .01) and 0.46 versus 0.01 uploads/day (p < .001), respectively]. Time to first upload was significantly lower in the WBD group (median = 4 versus 7 days; p = .02), but time to first BP measurement did not differ between the two groups (median = 2 versus 1 day; p = .98). CONCLUSION: Wireless transmission ensures instantaneous transmission of readings, providing clinicians timely data to intervene on. Our findings suggest that mobile-enabled wireless technologies can positively impact patient engagement, outcomes, and operational workflow in RM programs.