Health Professionals' Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics

Background Although telemonitoring is increasingly used in heart failure care, data on expectations, experiences, and organizational implications concerning telemonitoring are rarely addressed, and the optimal profile of patients who can benefit from telemonitoring has yet to be defined. Objective To assess the actual status of use of telemonitoring and to describe the expectations, experiences, and organizational aspects involved in working with telemonitoring in heart failure in the Netherlands. Methods In collaboration with the Netherlands Organization for Applied Scientific Research (TNO), a 19-item survey was sent to all outpatient heart failure clinics in the Netherlands, addressed to cardiologists and heart failure nurses working in the clinics. Results Of the 109 heart failure clinics who received a survey, 86 clinics responded (79%). In total, 31 out of 86 (36%) heart failure clinics were using telemonitoring and 12 heart failure clinics (14%) planned to use telemonitoring within one year. The number of heart failure patients receiving telemonitoring generally varied between 10 and 50; although in two clinics more than 75 patients used telemonitoring. The main goals for using telemonitoring are “monitoring physical condition”, “monitoring signs of deterioration” (n=39, 91%), “monitoring treatment” (n=32, 74%), “adjusting medication” (n=24, 56%), and “educating patients” (n=33, 77%). Most patients using telemonitoring were in the New York Heart Association (NYHA) functional classes II (n=19, 61%) and III (n=27, 87%) and were offered the use of the telemonitoring system “as long as needed” or without a time limit. However, the expectations of the use of telemonitoring were not met after implementation. Eight of the 11 items about expectations versus experiences were significantly decreased (P<.001). Health care professionals experienced the most changes related to the use of telemonitoring in their work, in particular with respect to “keeping up with current development” (before 7.2, after 6.8, P=.15), “being innovative” (before 7.0, after 6.1, P=.003), and “better guideline adherence” (before 6.3, after 5.3, P=.005). Strikingly, 20 out of 31 heart failure clinics stated that they were considering using a different telemonitoring system than the system used at the time. Conclusions One third of all heart failure clinics surveyed were using telemonitoring as part of their care without any transparent, predefined criteria of user requirements. Prior expectations of telemonitoring were not reflected in actual experiences, possibly leading to disappointment.

[1]  Nancy M. Lorenzi,et al.  Organizational ISSUES=change , 2003, Int. J. Medical Informatics.

[2]  Dimos Mastrogiannis,et al.  Telemonitoring in Chronic Heart Failure: A Systematic Review , 2012, Cardiology research and practice.

[3]  Akshay S. Desai,et al.  Connecting the circle from home to heart-failure disease management. , 2010, The New England journal of medicine.

[4]  E. Seto,et al.  Perceptions and Experiences of Heart Failure Patients and Clinicians on the Use of Mobile Phone-Based Telemonitoring , 2012, Journal of medical Internet research.

[5]  Michael Böhm,et al.  Impact of Remote Telemedical Management on Mortality and Hospitalizations in Ambulatory Patients With Chronic Heart Failure: The Telemedical Interventional Monitoring in Heart Failure Study , 2011, Circulation.

[6]  Gianfranco Parati,et al.  Impact of Home Patient Telemonitoring on Use of β-Blockers in Congestive Heart Failure , 2010, Drugs & aging.

[7]  R. Wootton,et al.  Gaps in the systematic reviews of the telemedicine field , 2010, Journal of telemedicine and telecare.

[8]  J. Cleland,et al.  Which components of heart failure programmes are effective? A systematic review and meta‐analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: Abridged Cochrane Review , 2011, European journal of heart failure.

[9]  N. Bayley,et al.  Failure , 1890, The Hospital.

[10]  R. Elford Telemedicine: A Guide to Assessing Telecommunications in Health Care , 1997 .

[11]  Michael Böhm,et al.  Telemedicine in heart failure: pre-specified and exploratory subgroup analyses from the TIM-HF trial. , 2012, International journal of cardiology.

[12]  R. T. Riley,et al.  Managing change: an overview. , 2000, Journal of the American Medical Informatics Association : JAMIA.

[13]  Heather J Ross,et al.  Mobile Phone-Based Telemonitoring for Heart Failure Management: A Randomized Controlled Trial , 2012, Journal of medical Internet research.

[14]  R. T. Riley,et al.  Knowledge and change in health care organizations. , 2000, Studies in health technology and informatics.

[15]  H. Krumholz,et al.  Telemonitoring in patients with heart failure. , 2010, The New England journal of medicine.

[16]  H. Hillege,et al.  Follow-up and treatment of an instable patient with heart failure using telemonitoring and a computerised disease management system: a case report , 2012, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[17]  Chia-Ching Chang,et al.  Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes , 2009, Int. J. Medical Informatics.

[18]  M. Cowie,et al.  Telemonitoring in heart failure , 2009, Heart.

[19]  Steven A. Yourstone,et al.  Learning Curves in Health Care , 2003, Health care management review.

[20]  A. Strömberg,et al.  European Society of Cardiology Heart Failure Association Standards for delivering heart failure care , 2011, European journal of heart failure.

[21]  H. Hillege,et al.  The value of INnovative ICT guided disease management combined with Telemonitoring in OUtpatient clinics for Chronic Heart failure patients. Design and methodology of the IN TOUCH study: a multicenter randomised trial , 2011, BMC health services research.

[22]  G. Paré,et al.  Clinical Effects of Home Telemonitoring in the Context of Diabetes, Asthma, Heart Failure and Hypertension: A Systematic Review , 2010, Journal of medical Internet research.

[23]  Justin Keen,et al.  Key challenges in the development and implementation of telehealth projects , 2011, Journal of telemedicine and telecare.

[24]  A. de Silvestri,et al.  A meta-analysis of remote monitoring of heart failure patients. , 2009, Journal of the American College of Cardiology.

[25]  Stefan Störk,et al.  Mode of Action and Effects of Standardized Collaborative Disease Management on Mortality and Morbidity in Patients With Systolic Heart Failure: The Interdisciplinary Network for Heart Failure (INH) Study , 2012, Circulation. Heart failure.

[26]  Nancy M Lorenzi,et al.  Organizational impact of health information systems in healthcare. , 2002, Studies in health technology and informatics.