Home and Community Care Digest
Background: Use of information and communication technologies to monitor patients from a distance has the potential to provide more effective and efficient care. In particular, using remote monitoring technologies may be a means of addressing some of the human resources challenges facing the residential nursing sector. The purpose of this study, conducted in London, England, was to determine the feasibility and acceptability of remote monitoring in communal home settings (one nursing home and two residential homes) settings. A prototype system was developed and deployed for this project using wireless technologies and the Internet.
Methods: In this study, 24 residents were monitored in three homes and their associated medical centres between July 2003 and July 2004. Respiratory disorders, cardiac problems, high blood pressure, diabetes, and renal problems were monitored. Health professionals using the system (two doctors, four managers, one carer, and one nurse) were interviewed twice for their opinions and thoughts. In the first interview, participants commented on perceived advantages and disadvantages of using remote monitoring in residential homes. In a second interview, participants were asked if they would like to continue to use the technology, and if so, what additional features and/or changes they would like to see.
Findings: Health professionals commented that they considered remote monitoring was well received by residents and their families. They indicated the following advantages of remote-monitoring: facilitated better communication with the general practitioner; enabled earlier detection of deteriorations; provided a more continuous view of the patient's status; assisted in enhancing the use of the equipment; and gave peace of mind to the residents and families.
Some disadvantages identified related primarily to the technology: technical problems prevented the full potential of the telemonitoring system to be realized and physicians found the website difficult to use. Additional disadvantages cited were that not all physicians were involved in the project and that the absence of a 24-hour monitoring centre limited the ability to realize the full potential of the technology.
Users of the system suggested that future versions of the system should include: video-conferencing capabilities to allow for patient-provider communication; better design of the interface; weighing scales; and a camera for still images.
Conclusions: Overall, users were satisfied with the system in its present form, but were discouraged by technical difficulties. Technical difficulties tested the enthusiasm and perseverance of the users. In addition to clinical champions and organizational readiness, technical performance remains a critical success factor. Health care organizations may want to consider waiting and purchasing a more mature system from a vendor versus participating in new prototype technologies because of the difficulties and challenges of developing a reliable and robust system.
Reference: Bratan T, Clark M, Jones R, Larkworthy A, Paul, R. "Evaluation of the practical feasibility and acceptability of home monitoring in residential homes". Journal of Telemedicine and Telecare, 2005; 11 (S1), 29-31
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