Presented by Elizabeth Lee Kelsey Madden Judith Mercatili TeleHomeCare Presented by Elizabeth Lee Kelsey Madden Judith Mercatili

Objectives Describe TeleHomeCare Monitoring Describe hardware List, describe, and evaluate software Describe and review the information system Describe advantages/disadvantages Examine legal and ethical issues Describe the technology related competencies of the professional nurse working with TeleHomeCare Describe the functions of the informatics nurse working with TeleHomeCare

TeleHomeCare Monitoring Description Collects and securely transmits data quickly Records and tracks patient information 24/7 Completes health assessments accurately in the home environment Features automatic prompting; and Includes technological support (Honeywell, 2008)

System Hardware Sentry Telehealth monitor Genesis Telemonitor Collects and transmits patient data Genesis Telemonitor Monitors patient vital signs (Honeywell, 2008) Sentry Telehealth monitor- Used to quickly collect and transmit data on heart rate, blood pressure, oxygen saturation, temperature, and weight. The monitor is able to guide patients through the monitoring process through the use of text or voice prompts. -The monitor will ask the patient subjective questions to assist in assessments. -Information is sent to the Central Station Diagnostic Software via a telephone line Genesis Telehealth Monitor- -Monitors heart rate, blood pressure, and weight -Asks disease-related questions to provide a complete picture of the patients health -Prompts patients when it is time to take vital signs -Allows clinicians to focus on particular disease states -Has the ability to add peripherals such as glucose meter or PT/INR device -If the users vital signs are outside the set parameters, or they fail to respond, the monitor alerts the local healthcare agency

System Hardware cont’d Computer system Medical sensors -sphygmomanometer and stethoscope -scale -pulse oximetry Human interface Standard modem (Honeywell, 2008) Medical sensors are modified commercial products-periphery could be basic as listed and could include BGM, video, and ECG. Human interface includes the buttons to send information to the central monitoring station (not a keyboard).

Software Windows 95 or newer Syngo -Windows 95 or newer is used to display and graph client data through the main system at the central monitoring station --Syngo- “The software platform for medical systems and applications”

Siemens Syngo software Workflow applications Imaging applications Knowledge applications Soarian quality measures (Siemens, 2009) -This software uses diagnostic, therapeutic, and information technologies to connect departmental levels with acute point of care -Syngo- “The software platform for medical systems and applications” -Workflow applications- Increase workflow efficiency - Faster report turn-around - Increased patient satisfaction -Imaging applications- Improve confidence when making diagnoses -Knowledge applications- Measures and improves quality of care -Soarian quality measures- Eliminates manual charting Faster feedback Improved quality of care

Usability of software Useful and safe Increases productivity Decreases cost Manages resources i.e. time, energy, error rates (Staggers, 2003) According to Staggers, usability goals include effectiveness, efficiency, and satisfaction of users Syngo software is: -Safe and effective in incorporating human-machine interaction -Efficient in managing resources -Easy to learn

Hospital information system Manages information needed for daily operations Associated with patient care information systems (McGonigle and Mastrian, 2009) -Patient care information systems- Focused on collecting data and disseminating information related to direct care -Comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital

Software review Hospital information system Used by Registered Nurses Function Recommendation (Siemens, 2009) Siemens Syngo Applications -Classified as a hospital information system -Designed for human-machine interaction -Used in healthcare to monitor patients from home -Integration with other systems -Ensures smooth functioning of healthcare -Provides support for organizational processes Function: Monitors vital signs of patients with chronic illness. We would recommend this system for Telehealth Monitoring. -Honeywell Hommed won 2008 Medical Design Excellence Award -Increased patient satisfaction

Honeywell HomMed Evaluation Patient Testimonial Professional Testimonial

Advantages Increase in: Communication between patient and provider Patient and professional satisfaction Reduction in: Hospital stays Home visits Recertification (Gauthier 2006)

Disadvantages Less nurse-client interaction Technical failure Patient knowledge High cost of equipment Physician resistance Reimbursement for services Less nurse-client interaction- Many clients rely on being able to ask questions and learn by example. Technical Failure- power outage, computer reliability, transmission failure. Patient Knowledge- Due to the decrease in nurse-client interaction, it is difficult to assess the comprehension of each patient and may take multiple home visits to teach patients. Base system costs around $5,000 per unit not including staff training and peripheral add-ons. Some insurances may not cover telehealth monitoring

Ethical/ Legal Issues HIPAA Possible violation within agency or home -Patient monitors grouped together -Accessible to all healthcare personnel -Home results available to all members of home

Nurse Competencies Effective, proficient, and safe use of telehealth technologies/medical devices Understanding of technology limitations Understanding of the knowledge, skills, and judgment necessary to identify, acknowledge, and interpret the changes that a distance factor creates The body of nursing knowledge and competencies remain constant, it is the medium of delivery that is different from traditional nursing care. There may be specific competencies required for the effective use of various technologies used.

Nurse Competencies (cont’d) Adequate knowledge to facilitate decisions about when a client requires an in-person evaluation Enhanced communication skills are an integral part of using this medium to deliver healthcare

Functions of the Informatics Nurse Specialist Responsibilities While using telehome care monitors the informatics nurse must be able to: -Use home monitors -Educate client on use of monitors -Use hospital monitors to translate data -Recognize critical values and/or system failure

Telehomecare Monitoring Overview Collects and securely transmits data Automatic prompting Records and tracks patient data Decreases ER visits and hospital stays Telehomecare monitoring collects patient data and transmits it to the healthcare agency where the patients vital signs can be monitored The system will automatically prompt the patient when it is time to use the machine

References Honeywell HomMed. (2007). The future of telehealth at your fingertips. Retrieved January 26, 2009, from Honeywell Web site: http://hommed.com McGonigle, D., Mastrian, K., (2009). Nursing Informatics and the Foundation of  Knowledge. Sudbury, MA: Jones and Bartlett Publishers. Siemens. (2009). Siemens healthcare. Retrieved February 20, 2009, from Siemens website: http://www.medical.siemens.com/webapp/wcs/stores/servlet/CategoryDisplay~q_catalogId~e_-1~a_categoryId~e_1017869~a_catTree~e_100010,1008631,1017866,1017869~a_langId~e_-1~a_storeId~e_10001.htm St-Jule, D. & Gauthier, Margaret. (2006). Regional home care service for chronic pulmonary diseases of Montreal. Retrieved January 26,2009, from Newittech Web site: http://www.newittech.com/homecare/telehealth/technical/documents/IDPM_COPD_Clinical_Study.pdf Staggers, Nancy (2003).Human factors: Imperative concepts for critical care. AACN Clinical issues. 14, 310-319.