St John of God Health Choices implementation of remote patient monitoring system utilising Intel Health Guide for Medibank Private funded trial.

1. Facilitating Self-Management of
Chronic Disease through Home
Based Tele-Monitoring for Patients
with CCF and COPD
Suzie Hooper
August 2011

2. Acknowledgement
• Jo McLaren RN
• Emma Boston RN
• Belinda Smith RN
• Sue Rowe RN
• Carmel Bourne RN

3. Background
• Chronic Obstructive Pulmonary Disease (COPD) and
Congestive Cardiac Failure (CCF) are two of the most
prevalent chronic disease in Australia
• Difficult to accurately estimate prevalence
• Prevalence is increasing with the aging population
• Both are considered to be major public health issues in
all Western countries
AIHW (2005), Abhayaratna (2006)

4. Project Background
• Funding for the pilot was through the Medibank Private
Special Purpose Fund.
• MBP and SJGHC wanted to collaborate to develop a
home-based CDM program utilising emerging
technology
• SJGHC investigated potential home monitoring systems
• Selected the Intel Health Guide
• Patients with current hospital cover with Medibank
Private were eligible for participation in the project.

5. Target group
Target group for the pilot:
• Patients with a diagnosis of CCF or COPD
• Recent hospitalisation for their condition and /
or a history of multiple admissions for this
condition
• Potential to reduce the likelihood of hospital
admission
• Patients from both metropolitan and regional
areas

6. St John of God Health Care
• Australia’s largest Catholic
not-for-profit private health
care group.
• Established in 1895 in WA by
the Sisters of St John of God.
• 15 hospitals in Australia and
NZ, metropolitan and rural /
regional

7. St John of God Health Choices
• Established in 2009
• Reduction in hospital admission rates,
bed days and associated hospitalisation costs
• Provides all levels of home-based nursing care:
 Community, PAC
 HITH
• Branches:
 Melbourne, Berwick,
 Geelong, Warrnambool, Bendigo,
Ballarat
 Perth

8. Project Aims
• To determine the effectiveness of a home based tele-
monitoring system for patients with COPD and CCF
• Identification of an ‘at risk’ cohort of Medibank Private
members who would benefit from the program,
following an admission to hospital for their condition
• Reduction in hospital admission rates, bed days and
associated hospitalisation costs

9. Project Aims
• Improved self-management of the disease
• Provision of an integrated program of care between
nurses, doctors, hospital and the community
• Improved member wellness (measured subjectively
and objectively)

10. Program elements
• Pre-program assessment and recruitment if suitable
• Initial home visit by Health Choices nurse to set up
system
• Daily home-based physiological tele-monitoring for 12
weeks

11. Program elements
• Daily monitoring of vital signs and
physical symptoms
• Web-based data upload to
central monitoring data centre.
• Interpretation of physiologic
parameters by a skilled
registered nurse centrally.
• Appropriate intervention as indicated.
• Weaning over 4 weeks.
• Data collection and analysis.

12. Equipment
• Intel Health-Guide (home based
monitoring system).
• Peripherals:
 Sphygmomanometer
 Pulse oximeter (blue tooth)
 Scales (blue tooth)

13. Monitoring System
• Web-based central monitoring system (Intel Health
Management Suite)
• On-line interface that allows nurses to securely monitor
their patient’s condition
• SJGHC developed EXCEL patient data base and
patient record

14. Monitoring System

15. Monitoring System

16. Monitoring System

17. Possible interventions
• Telephone consultation by the RN
• Home visit by a member of the Health Choices
nursing team (clinical or technical)
• Liaison with patient’s GP/Specialist if indicated

18. Patient Enrolment
• 62 eligible
• 14 did not continue (no Special Purpose Fund form
completed)
– 5 RIP
– 1 doctor refused
– 4 refused
– 4 other
• 46 Enrolled (Special Purpose Fund forms completed)

19. Patient Enrolment
• 46 approved by Medibank Private Special Purpose Fund
Committee
• 32 Active clients
– 6 patients refused
– 4 RIP
– 4 other reasons

20. Current Activity
• 32 Active clients (July 2011)
– 9 monitoring daily
– 3 currently weaning
– 20 completed – ceased monitoring
• 2 will be ongoing

21. Patient Demographics
SJGHC /MPL Tele-monitoring Pilot Program
Age Range
2011
0
5
10
15
20
25
30
35
51-60 61-70 71-80 81-90 91-100 Total
Age range
Numberofpatients

22. Patient Demographics
SJGHC /MPL Tele-monitoring Pilot Program
Patient Gender
2011
0
2
4
6
8
10
12
14
16
18
Male Female
Gender
Numberofpatients
Male
Female

23. Patient Demographics
SJGHC /MPL Tele-monitoring Pilot Program
Region
2011
0
5
10
15
20
25
Bendigo Berwick Nepean
Region
Numberofpatients
Bendigo
Berwick
Nepean

24. Patient Demographics
SJGHC/MPL Tele-monitoring Pilot Project
Diagnosis
2011
31%
63%
6%
CCF
COPD
CCF/COPD

25. Health Service Utilisation
• Number of Admissions to hospital - 6
• Number of admitted days – to be determined
• Days between hospitalisation for the chronic condition –
to be determined
• Number of unscheduled home nursing visits
– Clinical - 3
– Technical (system management) - 21

26. Hospitalisation
• Number of Admissions to hospital - 7
• Reason for admission
1. Worsening disease  palliative
2. Cardiac complications  full time care
3. Chest Infection  10 day stay  recommenced monitoring
(had commenced weaning)
4. Blood transfusion (leukaemia)  1 day stay 
recommenced monitoring
5. Back surgery  currently in hospital
6. Pneumonia  7 day stay  recommenced monitoring (had
not commenced weaning)
7. Chest infection  10 day stay – home with PICC line and
recommenced monitoring

27. Clinician Feedback
Successes
- Good system that is very easy for the patients to use
- Currently assessing patient and carer satisfaction
- Comprehensive system of data that provides the
whole picture that usually indicates when intervention
is needed (some exceptions)
- Minimal requirement for phone follow up related to
clinical issues

28. Clinician Feedback
Difficulties
- Connectivity issues in outer-metro and regional areas
related to wireless internet
- Issues with firewall protection within SJGHC (unable
to use videoconferencing)
- Clinicians need reasonable computer skills
- Complexities related to multiple clinicians monitoring
patients – knowledge of patients reduces necessity
for patient contact

29. Patient Feedback
• COPD patient who has had 6 hospital admissions in the
last half of 2010 has now stayed out of hospital for 10
months and feels he is in control of his health – remains
out of hospital and wife went on overseas for a holiday.
• COPD / CCF patient admitted monthly prior to
monitoring and rehab program – feels more in control of
her health - remains out of hospital 14 weeks.

30. Patient Feedback
• COPD / CCF patient – remained out of hospital –
increased confidence – has taken a trip to Sydney to
meet her first great grand child.
• CCF patient – remained out of hospital – severe CCF –
monitoring provides reassurance regarding condition.
• Many patients and carers express general sense of
increased confidence in managing their condition.

31. Issues for consideration
• Need for broadband internet to facilitate consistent
monitoring and utilise video capability
• Need the formal data analysis to determine quantitative
and qualitative outcomes
• Develop proposals to access funding more broadly

32. Thanks to our collaborators
• Steve Hall (CEO, St John of God Health Choices)
• Rebecca Redpath (Medibank Private)
• Dianne Paynter (Medibank Private)
• Dr Steve Bunker (Medibank Private)
• Anthony Fanning (Healthe Tech Pty Ltd)
• Scott Moller-Neilson (Healthe Tech Pty Ltd)
• George Margellis (Care Innovations an Intel GE Company)

33. References
1. Australian Institute of Health and Welfare (2005) Chronic Respiratory Disease in
Australia. Their prevalence, consequences and prevention.
2. Abhayaratna, Smith, Becker, Marwick, Jeffery and McGill (2006) Prevalence of heart
failure and systolic ventricular dysfunction. MJA 184(4) 151-154
3. Australian Bureau of Statistics (2001) National Health Survey
4. Krum H. and Stewart S. (2006) Chronic Heart Failure; time to recognise this major public
health problem. MJA 184(4) 147-148
5. Australian Institute of Health and Welfare (2004) Heart, Stroke and Vascular Disease –
Australian Facts 2004
6. Krum H. , Jelinek M., Stewart S., Sindone A., Atherton J., Hawkes A., (2006) Guidelines
for the prevention , detection and management of people with chronic heart failure in
Australia 2006
7. Pfeffer M.,Swedberg K., Granger C., Held C, McMurray J., Michelson, Olofsson B.,
Östergren J., Yusuf S., for the CHARM Investigators and Committees (2003). Effects of
Candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-
Overall programme. The Lancet, Vol 362. 759-766