Mark Ledwidge - Heartbeat Trust
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This document discusses remote patient monitoring for heart failure patients using the HeartPhone system. It outlines challenges in remote monitoring including low sensitivity of weight-based monitoring alone and the need for an integrated healthcare ecosystem. The HeartPhone system aims to improve on manual monitoring by analyzing daily weight trends combined with other patient-reported data inputs. This enhanced algorithm could improve sensitivity for detecting worsening heart failure and reduce the workload of clinicians. Overall, remote monitoring provides an opportunity to better manage the growing chronic disease population in a sustainable way through an integrated patient-centered care model.
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Mark Ledwidge - Heartbeat Trust
- 1. HeartPhone – positioning remote patient monitoring in Heart Failure ecosystem Dr. Mark Ledwidge, Research Director, Heart Failure Unit, St Vincent’s University Hospital Sept 16th, 2011
- 2. Agenda Our journey in remote patient monitoring Challenges and opportunities What does the ecosystem need
- 3. Heart Failure – Ideal for remote patient monitoring 1-2% of population, high readmission rates, many are preventable Hospitalisation rates for heart failure 1971-2000 (NHLBI) age stratified rates US
- 4. Manual Remote Patient Monitoring 50 45 40 35 30 RC 25 Event Rate (%) MC 20 15 10 5 0 Rich '93 Rich '95 Stewart '99 McDonald 02 Components – outbound calls from trained healthcare professional, home weight monitoring
- 5. Weight monitoring in HF 2 Kg over 2-3 days
- 7. Non adherence > 30-50%
- 8. Assumes all patients are the same
- 10. TENS-HMS Remote Patient monitoring Telemonitoring Usual Care Cleland et al JACC 2005;45(10):1654–64
- 11. Heartphone Collaboration Crofton Cardiac Systems
- 13. DAILY WEIGHT TRENDS ANALYSIS Heartphone
- 14. 7/7 NURSE/REGISTRAR REVIEW DAILY WEIGHT CARDIOLOGIST REVIEW TRENDS ANALYSIS Heartphone
- 15. ADDITIONAL INPUTS 7/7 NURSE/REGISTRAR REVIEW DAILY WEIGHT CARDIOLOGIST REVIEW TRENDS ANALYSIS Heartphone
- 16. Large spread of patients
- 17. Large spread of patients Mr BF, West Cork
- 18. Mr BF, West Cork Unstable, high risk Referrals to GP
- 19. Mr BF, West Cork Unstable, high risk Referrals to GP Multiple GP referrals to hospital, no heart failure unit in CUH, 6 months echo waiting list, diagnostic BNP unavailable Compliance <50%, confidence reduced
- 20. Mr BF, West Cork Ecosystem not primed
- 23. The hype is over
- 24. Challenges Soft endpoints do not convince payers in heart failure care The Ecosystem needs integration Evidence base needs to evolve
- 25. Opportunity - improve the algorithm Better sensitivity Manual Weight Monitoring, N=34 consecutive HF events. Remote weight monitoring, n=28 consecutive HF events including 3 admissions
- 26. Opportunity - improve the algorithm Better sensitivity Manual Weight Monitoring, N=34 consecutive HF events. Remote weight monitoring, n=28 consecutive HF events including 3 admissions
- 27. Opportunity - improve the algorithm Better sensitivity ** ** **P<0.001 Manual Weight Monitoring, N=34 consecutive HF events. Remote weight monitoring, n=28 consecutive HF events including 3 admissions
- 28. Opportunity - improve the algorithm Example Reported Symptomatic Deterioration
- 29. Opportunity - improve the algorithm Example Reported Symptomatic Deterioration
- 30. Opportunity - improve the algorithm Example Reported Symptomatic Deterioration
- 31. Opportunity - improve the algorithm Example Reported Symptomatic Deterioration
- 32. Opportunity - Demographics 2010 1 in 10 60+ yrs old 30 2050 1 in 5
- 33. Opportunity – 80% of what we do Chronic disease, mostly managed poorly
- 34. Opportunity – 80% of what we do Chronic disease, mostly managed poorly
- 36. Opportunity - Economics ‘Healthcare Unbound’, Forrester
- 37. Opportunity - multimarkers 5 question daily patient reported outcome
- 38. Opportunity - multimarkers 5 question daily patient reported outcome Other peripherals: BP, glucometer, pulse Oximeter Improve the algorithm Reduce workload
- 41. Opportunity – this cannot continue
- 43. Opportunity – integrated ecosystem Government 3rd party payers Devices, Technical, Regulatory service providers, clinicians Patients Suppliers Carers
- 44. Patient Centred Care “It’s not an intrusion. It’s a great feeling of security.”
Notes de l'éditeur
- In 2010 1 in 10 people with be over 60 years of age. By 2015 that number will have changed to 1 in 5. By 2150 it is estimated that one third of the world’s population with be over 60.These changing figures mean that chronic illnesses will become more challenging and more costly to manage. Today chronic illnesses such as COPD, CHF and diabetes account for three quarters of our healthcare spend.It is estimated that remote telemonitoring systems can reduce 20-30% of costs associated with chronic illness.They also empower the patient to become involved in their own care.Benefits to healthcare providers and third party payers:Real-time, effective patient management, monitoring and therapyIllness prevention through timely, accurate diagnosis Reductions in treatment and management costsQuality care without pressures on healthcare staffIncreased efficiency through remote diagnosing and treatmentCost savings through minimized treatment in the hospitalBetter patient or disease management resourcesEnables personalized and interactive treatmentMinimizes patient security issues and post-treatment care issues Accurate data enables correct diagnosis of emerging deterioration that saves resourcesBenefits to PatientsPeace of mind and better quality of lifeAccess to anytime, anywhere quality treatment and careSecurity and comfort in acquiring immediate supportAbility to live as normally as possibleAssurance of treatment based on valid, authentic dataRelevant therapy and care through continuous monitoring