Advances in the application of information and communication technologies in healthcare at the patient's home

Abstract

INTRODUCTION

The pressure to contain health costs, particularly by avoiding hospitalizations and promoting the early discharge of patients, is generating a greater demand for home healthcare at a time when this resource is rapidly becoming less available. Telemedicine has been defined as the use of information and communications technologies (ICT), to deliver health services and transmit health information at distance for the purpose of improving patient’s care and education and to facilitate communication between patients and healthcare professionals. Most of the studies on telemedicine showed a lot of potentialities and possibilities, but did not develop further in the clinical routine because of problems and difficulties involving the use of this technology. Therefore, it seems clear the need of simple and straightforward applications, which can provide useful and widely applicable services to healthcare and as well as reliable data to assess the actual impact of telemedicine on homecare.

2) GENERAL AIM

To design, develop, validate and assess the benefit of new Information and Communication Technology (ICT) applications in healthcare at patient’s home.

3) HYPOTHESES

1. An Internet-based support system for monitoring newborn patients after discharge from nursery would improve care, be well accepted by parents and reduce unplanned healthcare, particularly visits to the emergency department;

2. The development of a specific web-based tool could introduce a new strategy for the continuous positive airway pressure (CPAP) therapy follow-up of patients with obstructive sleep apnea syndrome (OSAS), which could improve the CPAP compliance, reduce face-to-face clinical visits, and be more cost-effective;

3. A new telemedicine system for remote CPAP therapy monitoring could provide valuable and useful data about treatment compliance and efficacy for the follow-up of OSAS patients.

4) STUDY 1

- A new Internet-based monitoring tool for the neonatal home care after discharge was successfully developed; - This new monitoring approach resulted in a high level of parental satisfaction with the service; - Using a societal perspective, the cost of the Internet-based follow-up resulted much lower than that of the conventional hospital-based follow-up. Additionally, ED visits in the first month of patients’ life decreased with the use of the Internet-based monitoring system. This telemedicine follow-up strategy proved absolute dominance (both more clinically effective and less costly) over the standard follow-up based on hospital visits; - This Internet-based tool has been effectively transferred to the health system since it is in routine clinical use at the Hospital de Sant Pau in Barcelona (www.petitsacasa.santpau.cat).

5) STUDY 2

- The opinion of the interviewed patients and medical staff about the helpfulness and satisfaction of the telemedicine monitoring approach indicated that the web-based support tool together with the televisit are potentially useful to support the home follow-up of CPAP treatment in OSAS patients; - The high patients’ compliance to the remote monitoring through the online questionnaire suggested this strategy to be helpful and practical for the long-period CPAP therapy control; - The multicenter support system we developed represents a new telemedicine approach to CPAP therapy follow-up for OSAS patients, which seeks enforcing patients’ confidence and improving therapy adherence; - The developed telemedicine support system has been effectively transferred to the health system since it is in use in a multinational clinical trial currently involving 18 hospitals (www.mi-cpap.com).

6) STUDY 3

- The geometry of the telemonitoring device (NOWAPI) does not influence the CPAP treatment; - NOWAPI showed good compatibility with the CPAP machines and an excellent performance in estimating the duration of the CPAP treatment and in detecting residual respiratory events in simulated OSAS patients. The results of this study demonstrated that NOWAPI system could be a valuable tool for telemonitoring the treatment of obstructive sleep apnea;