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Low Cost Telemedicine for Home Health Care

Low Cost Telemedicine for Home Health Care. S. Vasudevan and K.J Cleetus. WETICE 2001. Overview. Funded by National Library of Medicine Tele-health care for home based patients Precursor to using the Internet. E-Business. Health Care spending is $ 1 trillion

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Low Cost Telemedicine for Home Health Care

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  1. Low Cost Telemedicine for Home Health Care S. Vasudevan and K.J Cleetus WETICE 2001

  2. Overview • Funded by National Library of Medicine • Tele-health care for home based patients • Precursor to using the Internet

  3. E-Business • Health Care spending is $ 1 trillion • 25% in Information processing • IT is used primarily for payments • using old EDI • HIPAA imposes privacy of data But little exploitation of Networks for Clinical Purposes

  4. General E-Business Goals • Serve customers in situ • Provide services specific for each customer • Assure security • Lower cost of transactions • Enlarge geographical range of organization • Share information Clinical healthcare should have all the same goals

  5. Current Scenario • Nurse personally visits the patient • assessment, counseling and monitoring vital signs • Half a billion visits each year • $36 Billion spent in home care services in 1996 • Problems • - Cost • - Travel time • - Poor access to patient data for emergencies

  6. Existing Home Care Systems • Kansas Care, Inc. • Provides videoconferencing by videophone • Monitors vital signs remotely • Research Projects (some) • Georgia Institute of Technology • University of Kansas Medical Center • Focus • - Hi-res • - Hi-speed • - Tele-monitoring

  7. Problems with Existing Systems • High cost • Unavailability of wideband in rural areas • Absence of still image capture • Lack of facility for remote access • Clinical pathways specific to diagnoses absent • Inadequate security

  8. Objectives of this project • Support for multiple clients • Ease of use • Capture of still images • Remote access • Integration of home care agencies statewide • Security and confidentiality of patient data • Progress Tracking Cost as an overriding concern

  9. Solution • H.324 compliant video • V.34 modem at 33.Kbps, POTS • Patient Site • 13 inch TV , set-top codec, camera, speakerphone • Large LCD self-reading patient monitors • Nurse site • Computer, TV tuner card, camera, headset • Patient management software

  10. Approach Patient Monitors Computer Set-top Videoconference Patient at Home TV Set-top Videoconference Nurse at Home Health Agency(Mon County Health Dept) Patient at Home Monitoring of patient health & counseling

  11. DB System Architecture Web Browser Client Server Servlet JSP (Remote Access Application) Home Care Application Web Server Certificate Server Video Conf System Directory Server

  12. HHC Application Server Client 1 Nurse Workstation HHC Database Client 2 Sys Admin Workstation Client 3 Servlet/ Web client HHC System - Enterprise Java Beans

  13. Types of users & roles • Administrator • Nurse • Data Entry Operator • Physician - Remote user

  14. Administrator Functions • Highest privilege • Add, Update and Delete users • Users = Nurses, Physicians, Data Entry Operators

  15. Nurse Functions • Enroll new patients • Generate the customized Plan of Care • Embed clinical pathway for the diagnosis • Perform tele-visits • Track progress

  16. Top Level Interface for Nurse Visit Notes Vital Signs Enrollment Progress Tracking Video Conference Status Report Visit Scheduling QUERY

  17. Other user functions • Data Entry Operator • - Off-lineupdating of patient record • - Adding physical visit data • - But not a nurse, therefore cannot perform tele-visits • Remote user – Physician • - View visit details and review patient progress • - Leave notes/prescription changes/guidelines for nurse • - Authentication and encryption mandatory

  18. Remote Access System Client with valid Certificate Server Web Server Directory Server [LDAP] Secure [SSL] Servlet Engine JSP Servlet HHC Database Bean(s)

  19. Implementation • Language : Java version 1.2 [ Sun Microsystems JDK1.2 ] • Application Server : BEA Weblogic 4.5 • Database : Oracle 8.0 • Directory Server : Netscape Directory Server • Certificate Server : Microsoft Certificate Server • Web Server : Netscape Fast Track Server 3.1 • Servlet Engine : WAI CoolRunner by Gefion Software • Video Conferencing System : • - Via TV VC 1050 • - Howard NCK41CV Telecamera • - Aver Media TV tuner card

  20. Deployment • Deployed at County Health Department • (in Morgantown WV) • Linked two patients ~70 years old • Focused on type II diabetes • Conducted about 10 home tele-visits

  21. Analysis of process cost • Equipment cost at patient site: ~$800 • Equipment cost of nurse station: ~$2800 • Average time per tele-visit : 30 minutes

  22. Benefits • Avoids computer complexity at patient site • Uses POTS lines available in rural areas • Moderate patient site cost • Easy to use

  23. Limitations • Image capture to DB is a 2-stage process • for nurse • Resolution of captured images is low • Vital signs are not electronically transmitted • Cheap on-line health monitors are unavailable N.B. Physical visits still needed for intrusive procedures

  24. Conclusion and Future work • Feasible low cost approach to telemedical care for home-bound patients is proven • Future work • - Transmit vital signs electronically • - Make patient site an Internet appliance Prospective Payment System encourages efficiency in delivery

  25. Revisit E-Business Goals • Serve customers in situ – Yes, even for EKG • Provide services specific for each customer • – Yes, clinical pathway & Plan of care • Assure security • – Yes, DB access control & remote authentication • Lower cost of transactions – Yes, ~ $100 savings per tele-visit • Enlarge geographical range of organization • – Can serve wider area, if travel per patient is reduced • Share information – Yes, with referring physicians Clinical healthcare does attempt all the same goals!

  26. E-Business &Related Health Disciplines Policy Transactions Protocols Security Medicare Crypto OASIS Home Care Agency Networking Patients Database Nurses Collaborative Multimedia Physicians

  27. References • http://www.mcg.edu/Telemedicine/Index.html, Medical College of Georgia, Telemedicine Center • Meeting the Challenge of Telemedicine of Rural Home Health Care Delivery, C. Lindberg, Rural Development, Hays Medical Center, Hays, Kansas, 1996 AMIA Spring Congress Program • Home Telemedicine: HANC Network - Home Assisted Nursing Care: Concept and Realization, M.H. Paul, M.D., et al., Pediatrics and Biomedical Engineering, Northwestern University Medical School, Chicago, HealthTech Services Corporation, Northbrook, Illinois, 1996 AMIA Spring Congress Program

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