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Telemonitoring for Ventilated Patients

Authors: An interview with Jean Louis Pépin
Centre Hospitalier Universitaire de Grenoble Alps, Grenoble, France
Published Online: June 4th 2019


Q. What value does telemonitoring bring to your care organisation and to your ventilated patients?

Telemonitoring is a really innovative way to manage these patients in the long term. Before telemonitoring, we were asking homecare providers to send us information regarding their patients every 6 months. Now, I am able to detect some unstable states and anticipate exacerbations – for example, for patients with chronic obstructive pulmonary disease (COPD). In routine clinical practice, we have information regarding adherence to non-invasive ventilation (NIV), as well as leaks and residual events, and we can adapt the management and the care planning of these patients.

Q. What barriers did you face when implementing telemonitoring in your organisation, and do those barriers reflect the general limits you see for a broader clinical adoption?

The limits are mainly regarding some ethical issues for the patients. Some patients do not easily accept having continuous information coming from their home to the hospital or to the care providers, so we have to provide patients with informed consent to explain why it is interesting for us to have continuous information for daily management. This is one point.

The second point is the organisation of the different platforms between the hospital, the care providers, and the patients to combine different information. For example, we have some electronic medical records with patients’ co-morbidities, medications, etc. and we have to synchronise this platform, the telemonitoring platform, and the electronic medical record to have the same information at the same level inside the hospital. We need some authorisation – we have to convince the hospital – that it’s important to develop some connection between the different caregivers for a given patient.

Q. Have you experienced any reluctance from patients? If so, what have been the main concerns?

No. Actually, we did publish a survey last year; it was not on NIV but it was for telemonitoring in patients with sleep apnoea, and we found that nearly 90% of the patients were fine and agreed to be telemonitored for following their obstructive sleep apnoea status. I think it’s the same for NIV so the reluctance is really limited.

Q. How does remote monitoring need to evolve and which functionalities need to be developed to be able to properly manage the growing population of ventilated patients in the future?

I think we need to organise the telemonitoring platform with shared management between the physicians and probably some dedicated nurses trained to identify the different levels of alerts. There are different ways to address this. Adherence is an issue but if you have an increase in the number of residual events, in leaks from NIV, this is a marker of an emergency and we need to organise these alerts. For this, probably a specific reimbursement should be associated with telemonitoring in patients receiving NIV.

There are also different strategies that should be implemented in different clinical situations. For example, obesity hypoventilation syndrome: in this sub-group of patients you do not have so many exacerbations so probably the organisation should not be the same as for patients with neuromuscular disorders, for example, who have a high risk of exacerbations and hospitalisation. We have to have some common organisation sharing, dedicated nurses, expert clinicians and some automation for the detection of problems, probably using artificial intelligence in the future.

Q. What impact can telemonitoring have on clinical practice now and in the future, and on the patient’s therapy/treatment?

Telemonitoring will be used more and more for titration of the settings for NIV. You can imagine that we do not need hospitalisation for an NIV initiation, or that there is a reduction in the length of stay in the hospital, and then you can progressively adapt the settings using telemonitoring. This is a completely new avenue. Reduction in costs is expected because the number of hospitalisations for follow-up and the number of visits – outpatient visits – is going to be reduced. Again, to achieve these goals we need an infrastructure regarding alerts, integrated care and different management by the nurses and physicians.

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Support: The preparation of this Insight was funded by ResMed.

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