Clear goals, protocols required for effective telemonitoring

A study of clinicians in The Netherlands using Internet-based telemonitoring with heart failure patients found it didn't live up to their expectations, according to research published at the Journal of Medical Internet Research.

The study found that though telemonitoring is considered a breakthrough technology for treating heart failure patients, the clinics tended to lack a clear profile of the optimal patient and had begun working with the technology without guidelines, protocols and solid evidence of its usefulness.

And 20 of the 31 participating clinics said they were considering switching to a different telemonitoring system, making it unclear whether they were dissatisfied with that particular model or telemonitoring as a whole.

Clinicians at the 31 clinics completed a 19-question survey about their goals and experiences. Eleven of the questions dealt with the providers' goals, which could be grouped into three categories:

  • Direct patient care, including better self-management, improving quality of care, and reducing readmissions.
  • Telemonitoring system aspects, including development, innovation and better guideline adherence.
  • Organizational aspects, such as treating more patients, reducing workload and lowering costs.

The most common patient-care goals were "monitoring physical condition" (91 percent), "monitoring treatment" (74 percent), "adjusting medication" (56 percent), and "educating patients" (77 patients).

The largest differences between expectations and actual experiences occurred with reducing workload and cutting expenses. "Keeping up with current developments" was the only area in which experience closely matched expectations.

The authors said that telemonitoring needs an organization surrounding it in which nurses coordinate care, that proper training is provided and procedures are established for receiving, handling and interpreting data.

While it noted the system's usefulness in ensuring medication adherence, it called for more work on establishing a profile of patients who can benefit from telemonitoring.

A panel at the recent mHealth Summit in Washington, D.C., sponsored by FierceMobileHealthcare, focused on the role of telemonitoring in reducing readmissions. Alan Snell, chief medical informatics officer at Indianapolis-based St. Vincent Health, told the group that a pilot program at his system involving remote videoconferencing between nurses and discharged patients helped to reduce readmissions by a whopping 75 percent.

Research from the Mayo Clinic and Purdue University also shows success at keeping heart failure patients with implantable defibrillators out of the hospital. 

Meanwhile, a study from Spain highlighted the need for adequate training and tech support for primary care physicians in order to encourage them to adopt telemonitoring for chronic care patients.

To learn more:
- read the study