A remote patient monitoring system was developed for improved chronic disease management for in-home monitoring. A smartphone core connects to Bluetooth-enabled medical devices such as a glucometer, a one-lead ECG or a weight scale, among other devices. The smartphone application gathers patient physiological information from the home and both stores it on-device and uploads it to a server where both patient and caregiver can review readings, view trends, etc. The caregiver can also adjust goal parameters to control the alerting system, which sends notifications to the patient of out-of-range readings, to the administrator of non-reporting patients, and so on. The system has been shown in clinical trial to produce effective outcomes.
Chronic disease presents a growing challenge to the health and social care systems in Canada. More than 80% of primary care visits and two thirds of medical admissions into hospital emergency departments are related to chronic diseases. Effective chronic disease management can result in improved health outcomes and increased quality of life. For example, controlling a parameter such as blood pressure in people with diabetes has been shown to reduce mortality and incidence of severe and costly complications such as renal and cardiovascular disease. Unfortunately, less than 15% of people with diabetes and hypertension have reached the accepted standard for blood pressure control.
The primary objective of this project was to design and develop a user-centric home monitoring system to improve chronic disease management. The design of the monitoring system was informed through patient and clinician focus groups.
The system utilizes affordable and commonly available technology. Patients monitor their blood pressure, glucose, weight, etc. using Bluetooth enabled medical devices. The system is intuitive and easy for patients to operate; the readings are gathered by a smartphone app which both stores it on-device and uploads it wirelessly to a central data repository. Clinical decision support algorithms are applied to the data. Alerts and reports are then generated and sent to the patients and/or clinicians as appropriate. The alerts and reports streamline seamlessly into the workflows of primary care physicians and healthcare teams.
Two pilot studies have been conducted, and we are in the midst of a randomized controlled trial (RCT) funded by the Heart and Stroke Foundation of Canada. The first pilot study looked at blood pressure control in people with diabetes. It took place in 2005 in the Greater Toronto Area and results are published in the American Journal of Hypertension and the Canadian Journal of Cardiology. A subsequent study was conducted with the addition of blood glucose monitoring in 2006 in the northern community of Chapleau, Ontario. Publications pending.
Ontario Ministry of Health – Primary Care Health Transition Fund
Research in Motion (in-kind)
Heart and Stroke Foundation of Canada
Centre for Global eHealth Innovation, University Health Network
Mt. Sinai Hospital