Skip to main content

A Clinician’s View of Next-Generation Remote Healthcare System

  • Chapter
  • First Online:
Book cover Systems Design for Remote Healthcare

Abstract

There are few critical questions to answer in relation to remote healthcare systems and the pertinent technologies implied in transferring surveillance and care next to the patients: (1) will they help reducing and/or at least rationalizing care and lower hospitalizations and connected high costs?; (2) will this be really at hand in the near future?; and (3) what are the relevant parameters to obtain and follow in order to make remote healthcare an impacting reality on health systems? “There will be titanic changes ahead—Medicine can and will be rebooted and reinvented one individual at a time”: cultural, technological and scientific features will have a stronger relevance and impact on orienting the future revolution and decision than administrative and merely technological processes. However, the future remote healthcare model should be based not only on Darwin’s selection of a more and more powerful market (hundreds of billions in Europe), or cumbersome, restrictive, national (or even local) rules. It should start from strong ethical and scientific bases. The great potential benefits should be addressed on humans and on processes of care. Continuity of care, prevention and healthcare throughout the person’s life are an excellent beginning. The future will not depend on our technological capacities but on our decision-making capacity of creating systems based on a global approach, in order to cope with the complexity of healthcare environment. Remote healthcare should involve physicians, patients, academics, health service organizations and industries, integrating all their different points of views, not neglecting the final user’s needs. Use case scenarios are reviewed here, from pre- to post-hospitalization and from the management of congestive heart failure to chronic obstructive pulmonary disease, hypertension and diabetes and renal diseases. It seems that future remote health system should provide the parameters to evaluate trends and short-term predictive indexes and may thus help paving the road for a great revolution in Medicine, based on decision-logic module that computes in an automated way the potential risk of an impending episode by information fusion of heterogeneous sensor, demographic data and evidence-based clinical diagnosis process.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • European Union: European Union Action Plan 2012-2020 (2012) Innovative healthcare in the 21st century

    Google Scholar 

  • Abraham WT, Adamson PB, Bourge RC et al (2011) Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 377:658–666

    Article  Google Scholar 

  • Ahn AC, Tewari M, Poon C-S, Phillips RS (2006a) The limits of reductionism in medicine: could systems biology offer an alternative? PLoS Med 3:e208

    Article  Google Scholar 

  • Ahn AC, Tewari M, Poon C-S, Phillips RS (2006b) The clinical applications of a systems approach. PLoS Med 3:e209

    Article  Google Scholar 

  • Black AD, Car J, Pagliari C et al (2011) The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med 8:e1000387.

    Article  Google Scholar 

  • Blobel B (2013) Knowledge representation and management enabling intelligent interoperability-principles and standards. In: Blobel B et al (Eds) Data and knowledge for medical decision support, p 3. http://www.deastore.com/book/data-and-knowledge-for-medical-b-blobel-ios-press/9781614992394.html

  • Bloland P, Simone P, Burkholder B et al (2012) The role of Public Health Institutions in global health system strengthening efforts: the US CDC’s perspective. PLoS Med 9:e1001199

    Article  Google Scholar 

  • Bonfiglio S (2012) Fostering a continuum of care. Impact analysis of solutions for chronic disease prevention and management. Springer, Heidelberg, pp 35–41

    Book  Google Scholar 

  • Bradley EH, Herrin J, Wang Y et al (2006) Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 355:2308–2320

    Article  Google Scholar 

  • Catanzariti D, Lunati M, Landolina M et al (2009) Monitoring intrathoracic impedance with an implantable defibrillator reduces hospitalizations in patients with heart failure. Pacing Clin Electrophysiol 32:363–370

    Article  Google Scholar 

  • Catwell L, Sheikh A (2009) Evaluating eHealth interventions: the need for continuous systemic evaluation. PLoS Med 6:e1000126

    Article  Google Scholar 

  • Catwell L, Sheikh A, Catwell L, Sheikh A (2009) Information technology (IT) system users must be allowed to decide on the future direction of major national IT initiatives. But the task of redistributing power equally amongst stakeholders will not be an easy one. Inform Prim Care 17:1

    Google Scholar 

  • Chaudhry SI, Phillips CO, Stewart SS et al (2007) Telemonitoring for patients with chronic heart failure: a systematic review. J Card Fail 13:56–62

    Article  Google Scholar 

  • Chaudhry SI, Mattera JA, Curtis JP et al (2010) Telemonitoring in patients with heart failure. N Engl J Med 363:2301–2309

    Article  Google Scholar 

  • Chen C-C, Tseng C-H, Cheng S-H (2013) Continuity of care, medication adherence, and health care outcomes among patients with newly diagnosed type 2 diabetes: a longitudinal analysis. Med Care 51:231–237

    Article  Google Scholar 

  • Clark RA, Inglis SC, McAlister FA et al (2007) Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ 334:942

    Article  Google Scholar 

  • Clermont G, Auffray C, Moreau Y et al (2009) Bridging the gap between systems biology and medicine. Genome Med 1:88

    Article  Google Scholar 

  • Conraads VM, Tavazzi L, Santini M et al (2011) Sensitivity and positive predictive value of implantable intrathoracic impedance monitoring as a predictor of heart failure hospitalizations: the SENSE-HF trial. Eur Heart J 32:2266–2273

    Article  Google Scholar 

  • Control TD, Group CTR (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986

    Article  Google Scholar 

  • Davies AA, Borland RM, Blake C, West HE (2011) The dynamics of health and return migration. PLoS Med 8:e1001046

    Article  Google Scholar 

  • de la Torre-Díez I, González S, López-Coronado M (2013) EHR systems in the Spanish Public Health National System: the lack of interoperability between primary and specialty care. J Med Syst 37:1–7

    Article  Google Scholar 

  • Department of Health (2011) Whole System Demonstrator Programme: headline findings. www.dh.gov.uk (search for gateway ref 16972)

  • Diemberger I, Biffi M, Valzania C et al (2008) Telecardiology and remote monitoring of implanted electrical devices: the potential for fresh clinical care perspectives. J Gen Intern Med 23:73–77

    Article  Google Scholar 

  • Dy SM, Apostol C, Martinez KA, Aslakson RA (2013) Continuity, coordination, and transitions of care for patients with serious and advanced illness: a systematic review of interventions. J Palliat Med 16:436–445

    Article  Google Scholar 

  • Eapen ZJ, Reed SD, Curtis LH et al (2011) Do heart failure disease management programs make financial sense under a bundled payment system? Am Heart J 161:916–922

    Article  Google Scholar 

  • Eisner C, Sommer P, Piorkowski C et al (2006) A prospective multicenter comparison trial of home monitoring against regular follow-up in MADIT II patients: additional visits and cost impact. Comput Cardiol 2006:241–244

    Google Scholar 

  • Fazio F, Simonetti G, Casolari P et al (2010) Criteri di appropriatezza clinica, tecnologica e strutturale nell’assistenza alle malattie del sistema cardiovascolare. In: Quaderni del Ministero della Salute, n°1, gennaio—febbraio 2010. Ministero della Salute, Roma. http://www.quadernidellasalute.it/quaderni-html/6-novembre-dicembre-2010.php#6

  • Fedele F, Scalvini S (2009) Modelli di telecardiologia attualmente in uso. G Ital Cardiol 10:31S–33S

    Google Scholar 

  • Fedele F, Genuini I, De Lazzari C et al (2010) La telecardiologia 1° Edizione. Società Editrice Universo, Roma

    Google Scholar 

  • Gabbrielli F (2013) Telemedicine R&D influencing incoming strategies and organization models. Telehealth Netw Hosp Serv New Methodol 250–264. http://www.igi-global.com/chapter/telemedicine-influencing-incoming-strategies-organization/74654

  • Gaddi A, Capello F, Manca M (2013) eHealth, care and quality of life. http://www.springer.com/medicine/book/978-88-470-5252-9

  • Gallagher N, MacFarlane A, Murphy AW et al (2013) Service users’ and caregivers’ perspectives on continuity of care in out-of-hours primary care. Qual Health Res 23:407–421

    Article  Google Scholar 

  • Geissbuhler A (2013) Lessons learned implementing a regional health information exchange in Geneva as a pilot for the Swiss national eHealth strategy. Int J Med Inform 82:E118–E124

    Article  Google Scholar 

  • Giovanni R, Gaddi A, Capello F (2013) Medical data, information economy and federative networks: the concepts underlying the comprehensive electronic clinical record framework. Nova Science, Hauppauge, NY

    Google Scholar 

  • Granados D, Lefranc A, Reiter R et al (2005) Disability-adjusted life years: an instrument for defining public health priorities? Revue d’épidémiologie et de santé publique 53:111

    Google Scholar 

  • Greenhalgh T, Russell J, Ashcroft RE, Parsons W (2011) Why national ehealth programs need dead philosophers: Wittgensteinian reflections on policymakers’ reluctance to learn from history. Milbank Q 89:533–563

    Article  Google Scholar 

  • Hebert MA, Korabek B, Scott RE (2006) Moving research into practice: a decision framework for integrating home telehealth into chronic illness care. Int J Med Inform 75:786–794

    Article  Google Scholar 

  • Henderson C, Knapp M, Fernández J-L et al (2013) Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ 346:f2065

    Article  Google Scholar 

  • Hong J-S, Kang H-C (2013) Continuity of ambulatory care and health outcomes in adult patients with type 2 diabetes in Korea. Health Policy 109:158–165

    Article  Google Scholar 

  • Hsieh J, Yu K, Yang C-C (2009) The realization of ubiquitous 12-lead ECG diagnosis in emergency telemedicine. Telemed E Health 15:898–906

    Article  Google Scholar 

  • http://onlinelibrary.wiley.com/doi/10.1111/j.1756-5391.2010.01104.x/full

  • Inglis SC, Clark RA, Cleland JG et al (2010) Structured telephone support or telemonitoring programs for patients with chronic heart failure. Cochrane Database Syst Rev 8:CD007228

    Google Scholar 

  • Jencks SF, Huff ED, Cuerdon T (2003) Change in the quality of care delivered to Medicare beneficiaries, 1998-1999 to 2000-2001. JAMA 289:305–312

    Article  Google Scholar 

  • Kearns JW, Bowerman D, Kemmis K et al (2012) Group diabetes education administered through telemedicine: tools used and lessons learned. Telemed E Health 18:347–353

    Article  Google Scholar 

  • Khan M, Kozelhova M, Patel D (2006) Hospitalization due to atrial fibrillation in patients with cardiac resynchronization therapy. Heart Rhythm 3:P4–P104

    Google Scholar 

  • Klersy C, De Silvestri A, Gabutti G et al (2009) A meta-analysis of remote monitoring of heart failure patients. J Am Coll Cardiol 54:1683–1694

    Article  Google Scholar 

  • Koehler F, Winkler S, Schieber M et al (2011) Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure clinical perspective: the telemedical interventional monitoring in heart failure study. Circulation 123:1873–1880

    Article  Google Scholar 

  • Kuhn TS (1996) The structure of scientific revolutions. University of Chicago Press, Chicago

    Book  Google Scholar 

  • Lazarus A (2007) Remote, wireless, ambulatory monitoring of implantable pacemakers, cardioverter defibrillators, and cardiac resynchronization therapy systems: analysis of a worldwide database. Pacing Clin Electrophysiol 30:S2–S12

    Article  Google Scholar 

  • Marschollek M (2012) Decision support at home (DS@ HOME)-system architectures and requirements. BMC Med Inform Decis Mak 12:43

    Article  Google Scholar 

  • McBride A, Burey L, Megahed M et al (2013) The role of patient-held alert cards in promoting continuity of care for heart failure patients. Eur J Cardiovasc Nurs. doi: 10.1177/1474515113478531

    Google Scholar 

  • McLean S, Nurmatov U, Liu J et al (2011) Telehealthcare for chronic obstructive pulmonary disease. Cochrane Database Syst Rev (7):CD007718

    Google Scholar 

  • McMillan A, Trompeter J, Havrda D, Fox J (2013) Continuity of care between family practice physicians and hospitalist services. J Healthc Qual 35:41–49

    Article  Google Scholar 

  • McNamara RL, Herrin J, Bradley EH et al (2006) Hospital improvement in time to reperfusion in patients with acute myocardial infarction, 1999 to 2002. J Am Coll Cardiol 47:45–51

    Article  Google Scholar 

  • Michalsen A, Kӧnig G, Thimme W (1998) Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 80:437–441

    Google Scholar 

  • Mitchell J, Disney A (1997) Clinical applications of renal telemedicine. J Telemed Telecare 3:158–162

    Article  Google Scholar 

  • Mortimer D, Segal L (2008) Comparing the incomparable? A systematic review of competing techniques for converting descriptive measures of health status into QALY-weights. Med Decis Making 28:66–89

    Article  Google Scholar 

  • Parati G, Omboni S, Compare A et al (2013) Blood pressure control and treatment adherence in hypertensive patients with metabolic syndrome: protocol of a randomized controlled study based on home blood pressure telemonitoring vs. conventional management and assessment of psychological determinants of adherence (TELEBPMET Study). Trials 14:22

    Article  Google Scholar 

  • Paré G, Moqadem K, Pineau G, St-Hilaire C (2010) Clinical effects of home telemonitoring in the context of diabetes, asthma, heart failure and hypertension: a systematic review. J Med Internet Res 12:e21

    Article  Google Scholar 

  • Patel RP, Taylor SD (2002) Factors affecting medication adherence in hypertensive patients. Ann Pharmacother 36:40–45

    Article  Google Scholar 

  • Pattenden J, Coulton S, Spilsbury K et al (2008) The development and impact of the British Heart Foundation and Big Lottery Fund heart failure specialist nurse services in England: final report April 2008. The University of York, North Yorkshire

    Google Scholar 

  • Poole JE, Johnson GW, Hellkamp AS et al (2008) Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 359:1009–1017

    Article  Google Scholar 

  • Prieto L, Sacristán JA et al (2003) Problems and solutions in calculating quality-adjusted life years (QALYs). Health Qual Life Outcomes 1:80

    Article  Google Scholar 

  • Puddu PE, Morgan JM, Torromeo C et al (2012) A clinical observational study in the CHIRON project: rationale and expected results. Impact analysis of solutions for chronic disease prevention and management. Springer, Heildelberg, pp 74–82

    Google Scholar 

  • Riezebos RK (2011) ACP Journal Club. Telemonitoring did not reduce readmissions or mortality in patients recently hospitalized for heart failure. Ann Intern Med 154:JC3–JC8

    Article  Google Scholar 

  • Robertson A, Cresswell K, Takian A et al (2010) Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. BMJ 341:c4564

    Article  Google Scholar 

  • Sable C (2001) Telecardiology: potential impact on acute care. Crit Care Med 29:N159–N165

    Article  Google Scholar 

  • Sack S, Wende CM, Nägele H et al (2011) Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home-CARE (Home Monitoring in Cardiac Resynchronization Therapy) study. Eur J Heart Fail 13:1019–1027

    Article  Google Scholar 

  • Sackett DL (1969) Clinical epidemiology. Am J Epidemiol 89:125–128

    Google Scholar 

  • Sackett DL (2002) Clinical epidemiology: what, who, and whither. J Clin Epidemiol 55:1161–1166

    Article  Google Scholar 

  • Sackett DL, Haynes RB, Tugwell P et al (1985) Clinical epidemiology: a basic science for clinical medicine. Little, Brown and Company, Boston

    Google Scholar 

  • Seemungal TA, Donaldson GC, Paul EA et al (1998) Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157:1418–1422

    Article  Google Scholar 

  • Sheikh A, Cornford T, Barber N et al (2011) Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals. BMJ 343:888

    Google Scholar 

  • Siddiqui M, Pollack CE (2013) Continuity in a changing health care environment. J Gen Intern Med 28:493–494

    Article  Google Scholar 

  • Small RS, Wickemeyer W, Germany R et al (2009) Changes in intrathoracic impedance are associated with subsequent risk of hospitalizations for acute decompensated heart failure: clinical utility of implanted device monitoring without a patient alert. J Cardiac Fail 15:475–481

    Article  Google Scholar 

  • Spinsante S, Antonicelli R, Mazzanti I, Gambi E (2012) Technological approaches to remote monitoring of elderly people in cardiology: a usability perspective. Int J Telemed Appl 2012:3

    Google Scholar 

  • Steventon A, Bardsley M, Billings J et al (2012) Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 344:e3874

    Article  Google Scholar 

  • Steventon A, Bardsley M, Billings J et al (2013) Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial. Age Ageing 42:501–508

    Article  Google Scholar 

  • Swedberg K, Wolf A, Ekman I (2011) Telemonitoring in patients with heart failure. N Engl J Med 364:1078

    Article  Google Scholar 

  • Tompkins C, Orwat J (2009) A randomized trial of telemonitoring heart failure patients. J Healthc Manag 55:312–322

    Google Scholar 

  • Topol EJ (2012) The creative destruction of medicine. Basic Books, New York

    Google Scholar 

  • Varma N, Stambler B, Chun S (2005) Detection of atrial fibrillation by implanted devices with wireless data transmission capability. Pacing Clin Electrophysiol 28:S133–S136

    Article  Google Scholar 

  • Varma N, Epstein AE, Irimpen A et al (2010) Efficacy and safety of automatic remote monitoring for implantable cardioverter-defibrillator follow-up the Lumos-T Safely Reduces Routine Office Device Follow-Up (TRUST) trial. Circulation 122:325–332

    Article  Google Scholar 

  • Wade MJ, Desai AS, Spettell CM et al (2011) Telemonitoring with case management for seniors with heart failure. Am J Manag Care 17:71–79

    Google Scholar 

  • Wang H-Q, Li J-S, Zhang Y-F et al (2013) Creating personalised clinical pathways by semantic interoperability with electronic health records. Artif Intell Med 58(2):81–89

    Google Scholar 

  • Whellan DJ, Ousdigian KT, Al-Khatib SM et al (2010) Combined heart failure device diagnostics identify patients at higher risk of subsequent heart failure hospitalizations: results from PARTNERS HF (Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure) study. J Am Coll Cardiol 55:1803–1810

    Article  Google Scholar 

  • White J et al (2013) Rethinking health IT standards. Expected savings will follow with the right framework for interoperability. Mod Healthc 43:26

    Google Scholar 

  • Yu C-M, Wang L, Chau E et al (2005) Intrathoracic impedance monitoring in patients with heart failure correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 112:841–848

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paolo Emilio Puddu .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Puddu, P.E. et al. (2014). A Clinician’s View of Next-Generation Remote Healthcare System. In: Maharatna, K., Bonfiglio, S. (eds) Systems Design for Remote Healthcare. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8842-2_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8842-2_1

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8841-5

  • Online ISBN: 978-1-4614-8842-2

  • eBook Packages: EngineeringEngineering (R0)

Publish with us

Policies and ethics