First trial of home ECG and blood pressure telemonitoring system in Macau

The Role of Information and Communication Technology in Home Services: Telecare Does not Satisfy the Needs of the Elderly

Computer-based information and communication technology (ICT) is used in many service sectors. In home services, it has been considered whether it would be possible to support independent living of the elderly by using ICT; dependant on the needs of the elderly and whether those needs can be satisfied with ICT. In this study, the coping capabilities of 13 elderly clients of a Finnish home service office were assessed using the Finnish RaVa index. All the clients had severe dis abilities and needed help, e.g. to wash and dress. To satisfy such needs, telecare and the telemonitoring of homes are not enough; physical production and human labour are essential in the continuing absence of service robots. Thus, the major focus in organizing home services in the best possible way should be on the use of human labour, not on investing in ICT.

Clinical evaluation of a mobile heart rhythm telemonitoring system

Purpose. To evaluate the clinical applicability of a telemonitoring system: telemetric system for collection and distant surveillance of medical information (TEMEO). Methods. We evaluated 60 patients, applying simultaneously standard Holter ECG and telemonitoring. Two different comparisons were performed: (1) TEMEO ECG with standard 12-lead ECG; (2) TEMEO Holter with standard ECG Holter. Results. We found a very high coincidence rate (99.3%) between TEMEO derived ECGs and standard ECGs. Intraclass correlation coefficient analysis revealed high and significant correlation coefficients regarding average, maximal, and minimal heart rate, % of time in tachycardia, single supraventricular ectopic beats (SVEB), and single and couplets of ventricular ectopic beats (VEB) between Holter ECG and TEMEO derived parameters. Couplets of SVEB were recorded as different by the two monitoring systems, however, with a borderline statistical significance. Conclusions. TEMEO derived ECGs have a very high coincidence rate with standard ECGs. TEMEO patient monitoring provides results that are similar to those derived from a standard Holter ECG.

Performance analysis of a home telemonitoring system

Performance analysis is important for evaluating the system effectivity. In this paper, the queueing theory and discrete event simulation technology are applied to a performance study of a home ECG telemonitoring system. The data from a four-month trial is used to establish the input stream model of the medical service system. The input model includes the customer inter-arrival time distribution and the service time distribution of the server. With the input model, a queueing model is introduced to simulate the ECG monitoring system. The performance simulation results indicate the feasibility of the model. The results are helpful on designing an optimal service system with given properties of input stream and service procedures.

Home telehealth--current state and future trends

OBJECTIVE

The purpose of this paper is to give an overview about the state of the art in research on home telehealth in an international perspective.

METHOD

The study is based on a review of the scientific literature published between 1990 and 2003 and retrieved via Medline in January/February 2004. All together, the abstracts of 578 publications have been analyzed.

RESULTS

The majority of publications (44%) comes from the United States, followed by UK and Japan. Most publications deal with vital sign parameter (VSP) measurement and audio/video consultations ("virtual visits"). Publications about IT tools for improved information access and communication as well as decision support for staff, patients and relatives are relatively sparse. Clinical application domains are mainly chronic diseases, the elderly population and paediatrics.

CONCLUSIONS

Internationally, we observe a trend towards tools and services not only for professionals but also for patients and citizens. However, their impact on the patient-provider relationship and their design for special user groups, such as elderly and/or disabled needs to be further explored. In general, evaluation studies are rare and further research is critical to determine the impacts and benefits, and limitations, of potential solutions and to overcome a number of hinders and restrictions, such as - the lack of standards to combine incompatible information systems; - the lack of an evaluation framework considering legal, ethical, organisational, clinical, usability and technical aspects; - the lack of proper guidelines for practical implementation of home telehealth solutions.

Accuracy of Telemedicine in Detecting Uncontrolled Hypertension and Its Impact on Patient Management

This study was aimed at assessing the diagnostic accuracy of telemedicine among hypertensive patients. This was a cross-sectional analysis of patients attending a hypertension clinic over a year-long study. Patients were seen both by telemedicine and in-person on the same day with order of the encounters randomly determined. A telemedicine system, which utilized phone lines, was employed. For each type of encounter, whether telemedicine (TM) or in-person (IP), clinical data on blood pressure (BP) control as well as physician ordering patterns were collected. Receiver Operator Characteristic (ROC) curves were used to assess the validity of TM as compared to IP in the assessment of uncontrolled hypertension. Sixty-two patients participated resulting in 107-paired visits over the year-long study period. The mean age of the 62 participants was 67.1 +/- 11.4 years; 56.6% were men. ROC curves for detecting elevated mean blood pressure provided an area under the curve (auc) of 0.87 (95% CI, 0.80-0.95). ROC curves for the detection of uncontrolled systolic hypertension provided an auc of 0.86 (95% CI, 0.78-0.93). Telemedicine-determined BP differed slightly, but statistically significant (p < 0.05), from IP assessments. Meanwhile, there was no difference in ordering diagnostic tests or therapeutics detectable between the two encounter types. Telemedicine proved to be a valid means for detecting uncontrolled BP among hypertensive patients.

A pacemaker working status telemonitoring algorithm

To extend the application of a previously developed home ECG and blood pressure telemonitoring system for pacemaker users, a specially designed pacemaker working status analysis algorithm is developed in this paper. This paper includes four sections. First, a pacing beat and spontaneous beat recognition algorithm are established in which a FIR filter and three threshold methods are used to pick up the pacing spikes and a dynamic threshold modification method is proposed for error elimination. Second, a beat classification algorithm is developed based on decision rules for six commonly used pacemaker types. Third, a pacemaker malfunction recognition algorithm is established to evaluate the pacemaker working status. Fourth, the statistics of the analysis and the report are also provided. To validate the algorithm, clinical data were collected and manually classified by specialists. Then, the classification and recognition results were obtained with the clinical data. Results show that the algorithm can achieve a recognition rate of 98.4%. Results also indicate that the algorithm is capable of working in real-time speed. The algorithm has been incorporated into the telemonitoring system, and trial application cases are also reported.

Does products liability litigation threaten picture archiving and communication systems and/or telemedicine?

Numerous writers have commented on barriers to the growth and progress of telemedicine. Among these barriers are reimbursement concerns, professional liability exposure, licensing restrictions, hospital credentialing questions, and other problems. A legal threat not generally described in the literature to date is the possibility that products liability claims could be brought against manufacturers and distributors of hardware, software, and peripherals used in providing telemedicine services. Several of these concerns extend to picture archiving and communication systems (PACS), including, of course, teleradiology. This article considers that possibility in the context of several potential plaintiffs' theories, discusses currently applicable law, and proposes approaches to diminishing the magnitude and severity of this potential threat.

A communication server for telemedicine applications

The telemedicine applications, in some cases, need multipoint-to-multipoint communication. To meet the requirement of telemedicine communication, the development of a medical communication server is proposed in this paper. To make a working, as well as cost-effective, communication platform for the telemedicine applications, a specially designed communication server model is proposed in this work. This server is able to provide an effective multipoint-to-multipoint communication service for any level applications in telemedicine. The implementation program of this server is developed in a Windows'95 environment by using a winsocket. The trial application testing in a telemonitoring system is also presented to demonstrate the feasibility of taking such a structure with the server. By using the architecture of such a communication server in telemedicine applications, the multipoint-to-multipoint communication is easily managed and the communication processes are simplified and well controlled by the server.