PCC Remote Monitoring

1. Proposed Profile: Sharing Data from Remote Locations

Proposal Editor: Rita Scichilone
Profile Editor: TBD
Date: N/A (Wiki keeps history)
Version: N/A (Wiki keeps history)
Domain: Patient Care Coordination, Patient Care Devices(incl. home care/Continua)

2. The Problem

There is a need for exchanging information from medical devices designed to send and receive data from remote locations for the purpose of monitoring health status or response to treatment. At the present time there is no data or messaging standard applied to the process that would advance the use of remote monitoring devices for the convenience of the patient. The purpose of this profile is to demonstrate how the use of existing standards used in remote monitoring data sharing could be expanded to include a variety of devices and users (both patients and providers).

3. Key Use Case

<Describe a short use case scenario from the user perspective. The use case should demonstrate the integration/workflow problem.>

Patients with chronic disease or impaired functional status benefit from being monitored from remote locations, including their home. The ability for clinicians to remotely monitor vital signs, physiologic measurements or tests provides an efficient method of controlling costs and improving customer service. Use of remote monitoring devices or methods adds a coordination layer of support to the provider/patient relationship and enables the patient or his caregiver or advocate to participate more fully in treatment.

Interoperable data structures and use of messaging standards are needed to enable sharing of the information between the patient and clinician so that treatment progress may be monitored, prescribed interventions modified if needed and visits to the physician's office or hospital less frequent and more focused on non-routine issues.

At present there is no single standard for exchanging data between devices and the patient's residence to their "medical home". Actors in this use case include anyone involved with patient monitoring that occurs in one location that is useful when communicated to another location. The prescription for use of remote monitoring devices comes from physcians but the users of the data vary between the patient (self monitoring), the patient's caregiver (family, home health nurse, private nurse, etc.) or a clinical coordinator responsible for managing information to support an interdisciplinary care team.

The information is generated by the remote monitoring device which may or may not involve the user following instructions to make this happen and/or otherwise interacting with the device depending on the application. To be useful the device provides feedback (displays results to the user)then returns it to a system for data processing appropriate to the task: aggregation, graphic display, trending over time and so on. Processed information may then be returned to the patient (device user)again depending on the application involved.

Preconditions:

A health care provider (physician,hospital, home health agency, etc.) have previously established an agreement for sharing of health data using a remote monitoring device. There are four different perspective for data sharing that must be considered. Patient use of the device, the device manufacturer who builds it, the care coordinator who uses it for reporting and the clinician who uses the data for decision making regarding treatment.

Success Scenario:

1. Clinician recommends a specific remote monitoring device as part of the treatment plan for sharing data with more than one physician. 2. Patient acquires the device. 3. Patient is shown how to use the device by a care coordinator from the prescribing clinician 4. Device sends data to one or more clinicians able to receive it as directed by the prescribing clinician. 5. Patient avoids additional cost and inconvenience of office or hospital visits for monitoring. 6. Complete documentation of the monitoring and changes in treatment due to the information shared is stored in the health record of the patient's "medical home".

4. Standards & Systems

HL7 CDA Release 2.0
ASTM/HL7 Continuity of Care Document
ISO 17090-1 defines the basic concepts of a healthcare public key infrastructure (PKI and provides a scheme of interoperability requirements
ISO 9000-3 Quality Management and Assurance
IEEE 1073 Medical Device (Digital) Communications
IEEE 1532 In System Configuration of Programmable Devices
Standards specific to particular medical devices

5. Discussion

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<Why IHE would be a good venue to solve the problem and what you think IHE should do to solve it.>

<What might the IHE technical approach be? Existing Actors? New Transactions? Additional Profiles?>

<What are some of the risks or open issues to be addressed?>

<This is the brief proposal. Try to keep it to 1 or at most 2 pages>

Remote monitoring is an additional step to extend electronic health record data capture into the community for the patient's benefit. In situations where the "medical home" and the clinician prescribing a medical device be used for remote montitoring the health information exchange is more straightforward that instances where more than one health care provider is involved. When the clinician and the care coordinator are not using the same electronic health record system, the exchange of information from the remote monitoring device could occur via telephone or other specifed interactive technology.