Remote Patient Monitoring System Development
Issue
Although chronic diseases cannot be cured, they can be treated and managed by various lifestyle and drug therapies. Controlling parameters such as blood pressure and hyperglycemia in type II diabetics has been shown to reduce mortality and complications such as renal and cardiovascular disease. Unfortunately, current management of parameters such as blood pressure is well below accepted guidelines, in Canada and internationally.
The objective of this study was to develop a tele-management system that allows for home monitoring of physiological parameters. The system would actively engage patients in the process of care and provide reliable data to clinicians for decision making. Usability testing on existing remote patient monitoring (RPM) systems revealed significant shortcomings that would prevent their use and uptake in the Canadian healthcare system. Therefore, human factors principles were applied to the development of a new system that would meet the needs of both patients and providers.
Methods
Focus groups were held to assess both patient and physician preferences. The focus groups addressed the specific social context within which a remote monitoring system would be used (patient homes and primary care physician offices). Design principles were derived from the findings, taking into consideration issues that arose surrounding workflow, comfort with technology, liability, compensation, etc. A system was developed from these principles in conjunction with iterative usability testing on the prototype to ensure its ease of use for both groups. Finally, the system was trialed in a pilot study to assess effect on blood pressure as well patient and physician perceptions (determined by qualitative phone interviews and surveys) after four months of use.
Results
Twenty-four patients participated in one of four focus group sessions and 18 physicians took part in four separate sessions to provide initial input into the design. Biomedical engineers from the Medical Device Informatics (MDI) group here at the Centre for Global eHealth Innovation worked with the Healthcare Human Factors group to develop the system and iteratively refine the interfaces (see MDI project list for a description of the resulting system). A pilot study of the technology resulted in positive patient and clinician perceptions and a significant improvement in blood pressure control over the 31 patients in the trial. The high acceptance rate of the system underscores the benefit of an initial investment to understand the workflows and concerns of users.
Additional Learnings
Subsequent to the initial study, a website has been developed and undergone usability testing by both patients and providers. This website received positive feedback in a pilot trial with care providers in a multidisciplinary clinic, and will be used with patients and family physicians in an upcoming randomized controlled trial.