3.

Isolated Patients
 Any patient who has a condition that must Home telemonitoring is effective for patients
be monitored is a candidate for home who cannot physically access healt care services.
telemonitoring. The homebound elderly have been among the
 Patients with chronic illnesses hae first to beneft from this carnology in conjunction
particularly benefited from ongoing monitor with the home health services they receie,With
to prevent acute episodes. increasing limits affecting the ability of patients
 Patient who are homebound or have limited to receive services in the home because of staff
access to transportation. ing shortages and coverage limitations,
telemonitoring technology takes on greater
1. Patients with Chronic Diseases importance in managing homebound patients.
Given demographics and advances in medical Patients in remote geographic areas have been
practice, there has been unprecedented growth longtime users of telemedicine interventions.
in the number of patients with chronic diseases. With few rural healthcare facilities being built
Those patients are at significant risk of having an and access problems becoming more difficult,
acute episode when subtle but significant the use of technology in the home will increase.
changes in their medical condition occur. The Even in suburban and rural areas, access is
ability to identify these changes in a timely becoming more problematic, requiring greater
fashion allows for changes in medication, use of home telemonitoring interventions. A lack
lifestyle, or treatment to occur. Identification ofa of primary care and emergency resources in
3-pound weight gain over 5 days in a patient many urban core areas has prompted many
with CHE, for example, allows for interventions health systems to consider managing certain
that could prevent an emergency room visit and patients through telemonitoring options and
subsequent hospiralization. The categories of better staging of patient access
patients with chronic diseases who are most
commonly monitored today include those with 4. Incarcerated Patients
CHE, COPD, or diabetes and those Who require Telehealth services are used extensively in
long-term wound care. These patients, several states to provide mandated medical
particularly those with higher actity hevels, are services for prison populations. Incarcerated
at significant righ of having a medical crisis that patients are considered a vulnerable population
might necessitate emerge less suscepanned and frequently have numerous chronic diseases
acute inter. of ions, Many other patients with (e.g., hepatitis C, HIV, COP, asthma, diabetes, and
chronic diseases are less susceptible to a healt hypertension) and mental health issues
ventions Wand greatly beneft from home (especially substance. abuse) that require
telemonitoring to improve cate and reduce continuous care
costs.
5. Hospitalized Patients
Home telemonitoring has proved effective in
2. At-Risk Populations managing the flow of patients into and but of
Telemonitoring can be used effectively on hospitals and other inpatient facilities. Patients
patients who are at greater risk for an episode of are monitored to determine when they are
acute illness. Patients who have a predisposition admitted, predict how long they might stay, and
to disease are at increased risk of medical prevent unfunded readmissions. Patients
problems associated with employment, lifestyle, undergoing semi-elective procedures can be
or location, and those patients who have better staged with scheduling options when they
displayed early signs of potentially serious are monitored in the home before admission. It
health problems could be placed on preventive deterioration of the patient's condition is
monitoring. In such cases, monitoring is used to observed, a procedure can be accelerated or
ensure that interventions are timely and acute planned interventions changed.
incidents avoided. Monitoring can also be used effectively in length-
of-stay reduction strategies.
Physicians and surgeons are more confident in
discharging patients early when they know that
vital signs will be monitored and any decline in Accountability Act (HIPAA) requirements. Two
condition noted in a timely fashion. additional requirements are that the provider
must use an. interactive video and audio
platform that permits real-time communication
6. Emergency Response Situations and a staff member at the facility must manage
Telemedicine will likely be a major component the technology during the telemedicine visit
of effective patient management in a major (CMS, 2020b). Some facilities have even used
disaster; large-scale nuclear or biochemical access to telemonitoring systems as an
attack; and, as we have experienced in 2020, the inducement to attract potential residents.
outbreak of a highly infectious disease. In such
situations, traditional healthcare delivery
systems may become overwhelmed, and patients 9. Employers and Wellness Programs
will need to be more effectively triaged and Health care is a vital concern for employers.
managed by remote providers. Telemedicine They have a direct financial interest in lowering
applications allow for a dramatic extension of costs and are financial beneficiaries of long-
patient management, triaging options, and term-illness preventive strategies. If they can
offsite providers to be involved in care. If an monitor their workers (e.g., offer telehealth
infectious or communicable disease is involved, options as a wellness program), they will see
patient isolation could be accomplished in the many benefits for themselves, such as reduced
home using telemedicine technology. absenteeism and increased productivity.
Effective monitoring programs can ultimately
lower healthcare costs and associated insurance
7. Concerned Patients and Families premiums. Some companies are now exploring
Perhaps the largest potential market for home the creation of financial incentives for
telemonitoring is patients and families Who employees who achieve healthcare objectives,
want to have reliable and obiective information such as appropriate weight, reduced blood
that allows for their involvement in healthcare pressure, and levels of exercise. Monitoring
decision-making. At one extreme is a young could very well be used as a means of tracking
person who wants to monitor physiologic data performance in this regard.
as part of a personal wellness or fitness program.
Ar the other extreme are families who was TOOLSOF HOME TELEHEALTH
formation on the status of a terminally I loved
one in another city. In between, there is a wide A wide and growing range of
range of opportunities for individuals and telecommunications-ready tools are available for
families to obtain information that promotes nurses and patients' use in the home. See Figure
realistic and meaningful dialogue with 18-3 for a depiction of how these tools are
healthcare professionals. combined to provide home telehealth
monitoring.

8. Assisted Living and Subacute Patients 1. Central Stations, Web Servers, and Portals
In assisted living facilities or subacute care Central stations, web servers, and portals are
centers, a kiosk can be used to obtain vital signs various terms for the technologies presently
for large groups of people. Vital signs reports can used as part of multifunctional telehealthcare
then be forwarded on a regularly established platforms and application servers.
schedule to physicians and others involved in These clinical management software programs
the patient's care. This approach allows for receive and display patients' vital signs and
better individual care management and lends other information transmitted from a medical
itself to developing intervention strategies and device, including blood pressure, weight, and
education options to benefit the entire glucose information. Such transmission was
population of a facility. The CMS issued a initially most commonly accomplished over
telehealth tool kit in response to the COVID-19 plain old telephone system (POTS) lines;
pandemic. The tool kit detailed the plan for however, network access and wireless
payment for telehealth Services and relaxed communication are more commonly used as
some of the Health Insurance Portability and technology advances and access improves.
 quality diagnostic images and point-to-point
2. Peripheral Biometric (Medical) Devices consultations in hospital-based or medical
Peripheral biometric (medical devices can center-based settings.
consist of fully integrated systems, such as a
Vital signs monitor, or they may be stand.abone
telecommunications-ready devices, such as 5. Personal Emergency Response Systems
blood pressure cuffs and bload glucose meters. Personal emergency response systems are
These devices plus directly tooth technology to signaling devices worn as a pendant or
transmit data. otherwise made easily accessible to patients to
into a houschold telephone lack to send data to a ensure their safety and enable them to quickly
central server location or use Blue-An ever- access emergency care when needed, usually in
increasing number of peripheral devices are case of a fall. A preset telephone number is
being introduced to the mar-ket. Examples of alerted by the patient's pushing a button on the
other peripheral devices seen today in home pendant; upon this signal, predesignated
telehealth include pulse oximeters, international emergency help is dispatched. Many newer
normalized ratio meters (measure prothrombin sensor options for tracking patients at home are
time), spi-rometers, peak flow meters, being incorporated into multifunctioning
electrocardiogram monitors, and card readers personal emergency response system devices,
and writers that use smart card technology and such as alerting a central call center to water
enable multiple users to use one device. flooding or smoke in a patient's home. The next
subsection provides details on these sensors and
monitors.
3. Telephones
Telephones are already the most familiar 6. Sensor and Activity-Monitoring Systems
household communications tool used in Sensor and activity inite in their eris.an track
telehealth care. A telephone device can be acrivities of daily living of seriors and serier
augmented with a lighted dial pad, an auto-dial arisk indeidialtinto behave reGresidence: These
system, or a louder ringer for easier use by sensors and montiergng. othes can provide inse.
patients who need such augmentation. ich techavirchanges that nightsignal changes it
Telephone systems are still and will continue to ding so reston of health status. Such technologies
be important when there is no internet access in consist of wireless motton sensor deterio.
the home. satategically placed around the widence and can
detect motion on a 24 hour base. a bata from
these sensors are wirelessly sent to a receiver
4. Video Cameras and Videophones and base station, which periodically transmit the
Video cameras and videophones are readily into eatin to a centralized server Sophisticate a
available consumer items that can be used in golidhns prayze and compile data our each
telehealth for show-and-tell demonstrations by individuals normal patterns of behavios,
nurses for patients or to capture wound healing notuding bathroom usage; sleep disturbance,
progress, among other applications. Typically, meal preparation, medication interacton and
these products operate as a standard telephone general levels of activity, including fall detection.
or as a video picture telephone, using standard Deviations from these norms and be emportant
telephone lines to transmit information or warning signs of emerging health problems, and
interactions. the alerts provtded can be able caregivers to
Currently, the image quality over a POTS is intervene early (AgingInPlace.org, 20206).
limited by the bandwidth of POTS technology, In addition to widely used fire, security, and
which favors use of such images for assessment, home gas detectors, other sensors can monitor
rather than delivering diagnostic-quality images. appliances to detect whether a household
These imaging capabilities will improve as appliance is turned on or off and, with some
integrated services digital network lines become devices, actually switch the appliance on and off
more widely available in the home environ-ment. for the resident.
Typically, medical centers and hospitals have
access to larger bandwidth capabilities for image 7. Medication Management Devices
transmission and viewing, thus ensuring high-
Medication management devices address a well- the Food and Drug Administration (FDA) is Tyto,
recognized major problem in health care, described by McDaniel et al. (2019) as follows:
medication management and compliance. The Tyto device (Tyto Care Ltd., Israel) is a novel
The failure of patients to take medications as examination system that includes a built-in
prescribed has become a national problem in examination camera, an infrared thermometer, a
health care today. This noncompliance can have wireless communication unit, a lithium ion
devastating consequences, particularly for those battery, and a touch screen. The system also
patients living with chronic illnesses. Lloyd et al. incorporates a digital stethoscope, a digital
(2019) reported that medication nonadherence otoscope, and a tongue de-pressor. The Tyto
ranged from 23% for heart failure to as high as platform enables the capacity for live video or
38% for managing hyperlipidemia. Annual costs store and forward applications, and users can be
of nonadherence, ranging in the bilions of dollars, directed by voice or on-screen instructions to
are based on emergency department visits and obtain images and sounds to comport with the
inpatient hospitalizations as a result of poor standard of care by enabling a remote physical
disease management. examination. (p. 2)
To address some of these very pressing
problems, a host of telecommunications ready Home Telehealth Software
medication devices have become available, and As important as the gathering of data is the
many more are in development. organizing of information to support decision-
Devices are as simple ass have h eat renads a making by clinical professionals. The telehealth
person to rake medications and pill Organizers software that supports home telehealth
with audible reminders, and some can even be programs has become much more sophisticated
programmed ro dispense pretled containers in recent years and now al lows for greater
wich medications and alert a patient or caregiver numbers of patients to be better managed by a
of a missed Case. Furthermore, some of these single clinician. Areas of significant
medication tools send data from the de intack improvement in software include trending,
192 central server So that patients medication triage, communications pro-tocols, access, and
compliance can be tracked. These sharing.
telecommunications-ready devices can organize,
manage, dispense, or remind, and they will play
an increasingly important role in helping people 1. Trending
live independenly and manage their disease One of the key advantages of home
processes through medication compliance. For telemonitoring is the creation of a digital health
more information on these devices, see the record that allows information to be recorded
Informatics Tools to Promote Patient Safety, over time. If patients take their weight and blood
Quality Out comes, and Interdisciplinary pressure daily, most software will graphically
Collaboration chapter. display these data over time so that subtle
trends can be observed. This type of trend data
8. Special Needs Telecommunications-Ready is much more useful in identifying emerging or
Devices developing conditions than is snapshot data,
Special needs telecommunications ready-devices which are collected every 6-8 weeks at a
can include preprogrammed, multifunctional physician's office. Trend information can also be
infusion pumps for meeting a range of infusion developed for groups of patients or populations,
needs, including medications for pain which allows for population-based analyses of
management and other infusion delivery needs, interventions. For example, one might gather
such as hydration and nutrition; peak flow trend information on patents with COPD,
meters; and electrocardiogram monitors. Many patients of a particular physician, or all patients
such tools are in development to meet the more receiving a certain medication.
demanding and challenging needs of today's ar-
home patients. The common goal of these tools
is to increase communications between nurse 2. Triage
and patient and increase the nurse's knowledge Mos home telemonitoring systems set an
of the patient's status in a timely man-ner. A acceptable range of values for individual patients
relatively new device approved for home use by when they are enrolled in the monitoring
program. For example if oxy-Bin saturation,
blood pressure, or weight values go above or
below predeserie danguns, then the sod
pressure, or weigh ropriate pary More
sophisticard sangie locksat readings from ware
alert tres or equipment on a single paren
andanse disher priority to par multiple pieces a c
episode. These systens heh dintans
Oter organize theft tents at disk range for
appropriate interventions.

3. Communications
Advanced telemonitoring software utilizes
sophisticated electronic notification proto. cols.
Often, when information will be communicated
and to whom it is sent are pre-determined.
Sophisticated protocols can be developed related
to both routine and ale information, thereby
more effectively organizing communications
with physicians, nurses, and caregivers. Some
systems also have the capacity to communicate
back to the patient or seek additional
information under predetermined circumstances.

4. Data Access and Information Sharing