1. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Low Cost Standards-based TeleHomeCare Demonstration Project Stanley M Finkelstein, PhD Stuart M Speedie, PhD George Demiris, PhD Jan Marie Lundgren, BS Marshall Hoff, BA University of Minnesota, Minneapolis, MN Supported by Grant #27-60-98031 from the TIIAP, Dept of Commerce and matching funds from program clinical and industry partners http://www.telehomecare.umn.edu

2. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Program Partners University of Minnesota Fairview Home Care, Minneapolis HomeHealth Partnership, Crosby & Aitkin, MN Lakewood Health System, Staples, MN Tri-County Hospital, Wadena, MN CareFacts Information Systems, St Paul, MN Onvoy, Minneapolis, MN QRS, Minneapolis, MN

3. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Partner Sites

4. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Telemedicine The use of telecommunications and information technology to provide health care services within or across institutional boundaries between providers between patient and provider

5. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Telemedicine from Home Places patient directly in care loop Patient becomes an active contributor in the care process Easy, inexpensive approach to link patient and provider

6. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Home Health Care 11 million homebound patients Cost in 1998 estimated at $42 billion Medicare/Medicaid/out of pocket Often elderly and/or poor Rural and urban Long term condition, recovery from acute episode, permanent disability, terminal illness

7. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Objectives To demonstrate that a telemedicine program combining videoconferencing, Internet access, and physiological home monitoring within a home health care setting can improve quality of care reduce cost of care increase access to care improve patient satisfaction with care

8. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Outcome Measures Mortality and morbidity Time to transfer to higher level of care Patient satisfaction Utilization of services Patient/program costs

9. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Methods - Full Study Recruitment Plan Subjects with congestive heart failure, chronic obstructive pulmonary disease, chronic wound care (40/disease group) Control or Study Group 1 or Study Group 2 Control - standard home care (medical problem guidelines) Study Group 1 - standard care + videoconference + Internet Study Group 2 - standard care + videoconference + Internet + monitoring

10. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Methods Equipment -- Home Health Care Agency  Videophone/Camera (ViaTV VC105) Monitor VCR PC with clinical information system (CareFacts CIS)

11. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Nursing Work Station VCR CareFacts  Workstation with Internet Access ViaTV

12. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Methods Equipment -- Subject’s Home Station  Television Telephone Videoconferencing/Internet browser (ViaTV VC55) Camera (Philips eyeball, 512x492 pixels) Monitoring equipment (Study group 2)

13. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Internet Home Equipment

14. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Monitoring Components QRS Spirometer Pulse Oximeter Also includes a scale and blood pressure cuff

15. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Internet Home Page

16. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Patient Diary Forms

17. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Weekly Report - Numeric Data

18. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Weekly Report - Categorical Data

19. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Feasibility Study Results Number of subjects recruited : 24 Satisfactory participation: 13 –CHF: 4 COPD: 9 –Age: 73.8 +/- 12.9 SD yrs Unsatisfactory participation: 11 (1 drop-out, 7 refusals after sign-up, 3 homes not acceptable) –CHF: 3 COPD: 7 wounds: 1 –Age: 73.0 +/- 12.6 SD yrs

20. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Feasibility Study Results Average length of each case: 35 days Average number of virtual visits/subject: 6.7 Average time of virtual visits: 25 minutes Average number of actual visits/subject: 5.9 Average time of actual visit: 33 minutes Content of virtual and actual visits comparable (9 basic themes)

21. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Full Study - Initial Results 68 patients agreed to participate 53 (19 C, 15 V, 19 M) subjects completed study Failure to complete study due to illness/hosp, phone lines, concerns with equipment, move, another study, nurse change Average age/range (yrs): –active: 72.0 (50-89) in C, 79.3 (65-90) in V, 73.1 (50-85) in M –drop-outs: 78.0 in C, 77.8 (60-96) in V, 77.7 (68-87) in M

22. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Full Study - Initial Results # of actual visits: 440 in C, 262 in V, 325 in M # of virtual visits: 280 in V, 262 in M Technical quality of virtual visits, rated by HC nurses: 94.7% (range 57.1 - 100%) Usefulness of virtual visits, rated by HC nurses: 91.8% as good as actual visit Subject perception of telehomecare increased significantly after participating in the study 32% of C and 12% of V/M were d/c to nursing home or hospital

23. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Conclusions - TeleHomeCare Virtual visits can be conducted over POTS Nurses and patients can successfully interact in a virtual visit Virtual visits closely parallel actual visits in time and content Patients can learn to use monitoring devices, daily diaries via the Internet and web browsing Physiological monitoring can be a positive addition to the telemedicine portfolio Physiological monitoring and daily diaries can “fill the gaps” between home care visits (actual/virtual) Transition to home health care protocols is successful

24. TeleHomeCare TeleHomeCare Project Copyright University of Minnesota Major Challenges Reimbursement Identifying appropriate subjects Agency commitment to –administrative planning and promotion, –training and incentive for nurses, –identify nurse leader (technical aptitude and motivation) –provide technical support staff