A Mobile Phone Based Remote Patient Monitoring System For Chronic Disease Management

Background: 
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.

System Development: 
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 wirelessly transmitted to a mobile phone and sent automatically by the phone 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.    

Evaluation: 
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.    

Future Work: 
In addition to the ongoing hypertension RCT, plans are underway for winter 08/09 to conduct a study for women who develop gestational diabetes (i.e. women who develop diabetes during pregnancy).  This population requires very close monitoring of blood sugar levels.   The real-time transmission of the blood glucose data from our system would be ideal for both alerting the healthcare team and the patient to potentially dangerous blood sugar elevations.      

In 2009, a RCT of remote monitoring for heart failure management will be performed.  Measurements of physiological parameters, such as daily weight, can reveal early signs of deteriorating health.  The could help prevent the frequent and costly rehospitalizations from heart failure.  The remote monitoring system will include monitoring of weight, blood pressure, symptoms, and ECG.   

The use of the remote monitoring system is also being investigated for other chronic diseases, such as chronic kidney disease.

Conclusion:
A remote patient monitoring system was developed to facilitate patient empowerment and also to provide accurate and timely data to the care provider to help with disease management.  This system has been evaluated in populations with diabetes and hypertension.  It provides a cost effective method to improve chronic disease management and will be extended to other patient populations, such as people with heart failure and chronic kidney disease.