Electronic HouseCall transforms the chronically ill into responsible, self-caring patients

Atlanta 04 November 1999Since the beginning of the nineties, the Medical College of Georgia (MCG) and the Georgia Institute of Technology (GIT) are working together in a research programme to offer interactive health monitoring services to elderly patients who are chronically ill. The Electronic HouseCall (EHC) project has adopted the intelligent network approach to enable unattended patients who are staying alone in their homes, to use the EHC system after only a little bit of preliminary training. The graphical interface consists of icons allowing the patient to control the system through a touch screen monitor. In turn, there is a central monitoring station, equipped with Windows-based tools, in order to manage patients through the analysis of vital signs and condition-specific physiologic measurements.

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The EHC system actually combines videoconferencing and data capture facilities with remote physiologic sensors to enable care providers to monitor the health status from ageing and ailing patients residing at home. The patient-centric solution allows both the patient and health professional to establish contact via a TCP/IP wide area network. In essence, the patient may present to the central monitoring station at regular and fixed periods of time or on a non-scheduled basis. The personal medical record follows the patient through the network in order to provide the care provider actually on duty with sufficient clinical data to make an informed treatment decision. If no primary care physician is available, the system routs the patient to a 24-hour monitoring service staffed by health care professionals.

On- and off-line sensor data are automatically transmitted to a central server connected to the EHC network and accessible at any time. The touch screen monitor at the patient's home displays three different icons. One consists of a telephone initiating a call to the care provider when touched. A second one represents a stack of books to access medical information that is relevant to the user's physical condition. The data is offered via a CD ROM or hyperlinks to Web pages tailored for the patient. A third icon connects to the vital signs measurement devices which are integral to the patient system. In turn, the central monitoring station offers tools to store demographic data, access and initiate the patient's vital signs measurements, establish the videoconference calls with the residents at home, and control the patient's camera.

During the first pilot phase in 1995, the MCG and GIT collaborated with the Eisenhower Army Medical Center to implement computer-based monitoring stations in the homes of volunteer patients and in one skilled nursing home in the Augusta, Georgia area. The EHC initiative initially was funded by the Georgia Research Alliance, the American Army Medical Research Acquisition Activity, and MCG, with additional contributions from Jones InterCable, Inc. Soon enough, 25 patient residences and the nursing home were submitted to a series of clinical trials to validate the EHC system. In 1997, the technology was ready to be brought to market by a new commercial partner, CyberCare Inc., in a unique license agreement with GIT and MCG.

In early 1999, two new and independent EHC network test beds have been implemented by the project team. The first one constitutes a patient system installed in a retirement community in Jacksonville, Florida with the central monitoring station located in a physician's office. The patient database that supports this installation resides on a server, accessible both by the patient and physician. The second one consists of a system installed in two assisted living communities in the Atlanta, Georgia area, with the central monitoring station equally situated in a doctor's office. The physician can communicate with his patients at either assisted living community via the network, which is supported by a patient database allowing both parties to manage the data in electronic form.

The current network in Jacksonville is extended with patient systems located in an indigent care clinic and a retirement community. In the past months, a third central monitoring station has been installed in a doctor's office that is supported by the server in the original installation. Another installation is scheduled for Louisville, Georgia, connecting to a central monitoring station at MCG, to sustain a rural outreach programme. The initial installation will support the maternal care programme in Louisville with the intention to still expand to two remote communities. The project team believes that the EHC technology is capable of saving vital costs in replacing the expensive physical home health visits and in addressing care from a more proactive managerial point of view.

In the United States, an electronic consultation might substitute 50% of the patient visits at home. The average cost for an electronic visit is $40 against $85 for a conventional visit. This comes down to an annual cost reduction of $18 billion in the home health care sector. How to prevent patients suffering from chronic disease from frequent hospitalisation requires a more complex analysis. In this area, the annual health care expenditures are estimated at some $336 billion. In addition, an optimised management by physician and patient of the chronic condition could bring down hospitalisation costs with one third or even by half, resulting in a reduction of about $100 billion each year.

Another crucial factor relates to health care services in rural areas. These patients require special attention in order to prevent them from the dangers of social isolation, inadequate education, medication mismanagement, and unrecognised clinical deterioration. In this way, the EHC solution constitutes an excellent tool to monitor chronic patients in rural environments, also on a global scale. Indeed, the ability to implement advanced telecommunications technology to deliver health care services at regular basis to underdeveloped countries is a welcome opportunity for improving the quality of international health care. More information on the project is available at the Electronic HouseCall home page.


Leslie Versweyveld

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