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Remote Monitoring

Nurse taking temperatureIt is a privilege to be able to participate and contribute to various boards and committees. It is also a way to learn a lot, meet great people and gain new perspectives. That has certainly been the case with my involvement at Danbury Hospital. For the past year I have been participating on the policy and technology committees of the board and as of this week I have been elected to the board of Danbury Health Systems, Inc. and Danbury Hospital. At a recent meeting of the policy committee, Ann Faraguna, executive director of the Danbury Visiting Nurses Association, made a presentation about the good work they are doing and mentioned that they are using technology to remotely monitor the condition of patients in their home. This really got my attention and I could not wait to learn more.
The Information Technology industry has been doing remote monitoring of computers for decades. IBM mainframe computers have had this capability since the 1970’s. The computer would monitor key components and capabilities of the system and if a problem is detected that requires human intervention, the computer automatically calls IBM Service and even tells them what replacement part to bring. A similar approach has been implemented by the Danbury VNA. Ann Faraguna and Fran Kass, one of the great VNA nurses, took me to visit one of their seven patients who are using the new monitoring system.
Joan turned her wheelchair around to greet us. Ann explained that we would like to see how she is using the monitoring equipment. She was more than happy — actually I think she was proud — to show us. The monitoring device — made by BCI, Inc. — looked about the size of table top radio. It is setup to measure five different things. The monitor says "Good morning" and then steps the patient through a sequence of measurements. First, Joan climbed from her wheelchair onto the electronic digital scale. Her weight was displayed on the bright red LED front panel. Next came the digital thermometer. Joan then inserted her arm into a blood pressure cuff and pressed the "BP Start" button. Seconds later her systolic and diastolic readings appeared. The final two measurements were taken when Joan put her finger into another of the devices called an oximeter which is connected to the monitor.
Pulse oximetry is a simple non-invasive method of monitoring the percentage of hemoglobin which is saturated with oxygen. This is a really important measurement, especially for elderly people. It is very predictive of certain medical conditions that may require treatment. A source of light originates from inside the finger device. The light is partly absorbed by hemoglobin, by amounts which differ depending on whether it is saturated or desaturated with oxygen. The device also measures the pulse. After the measurements are completed, the monitor begins to ask up to twenty-five questions which have been programmed into it by one of the VNA nurses. "How are you feeling today?", "Have you had any discomfort?", Have you been able to eat normally?", etc.
At the completion of the measurements and questions, the monitor places a phone call and transmits the data to a central monitoring station. If anything is out of normal boundaries or if the patient did not run the monitoring procedure on their normal schedule, a phone call is placed to the patient. If any of the measurements is significant, a VNA nurse can be dispatched to make a home visit.
The benefits to remote monitoring are significant. Doctors can now see a graph that shows trends — not just the measurements at today’s office visit, but months of trend data. Hospital and community costs can be reduced because of less emergency treatment. Trend data can show that something may be developing, a nurse can be dispatched to check further, and if necessary a doctor visit can be arranged. This is instead of waiting until something goes wrong and the patient needs to call 911. Patients can take more responsibility for their health. The data becomes their data — they collect it — and they can see the impact of certain dietary or activities on their key measurements.
The monitoring technology is expensive today but it is clear that the cost will come down as the number of devices increases. The cost impact on hospitals and the public healthcare system should be significant over time. Just like security monitoring stations are watching thousands of homes for intrusions or freezing conditions in the home, healthcare monitoring stations will be watching thousands of people. Over time the data will be able to be consolidated and data mining will enable predictive treatments based on what has worked for others. It goes without saying that security and privacy of the monitoring data must be assured.
About Danbury Health Systems, Inc. and Danbury Hospital

Danbury Hospital is a 371-bed not-for-profit community teaching hospital serving approximately 360,000 residents of western Connecticut and southeastern New York. Its specialized facilities include a Level II Trauma Center and the J. Benton Egee, MD, Emergency Department, The Praxair Cancer Center, a Family Birth Center and Level II neonatal intensive care unit, the Western Connecticut Cardiac Center, Jack and Richard Lawrence Cardiac Catheterization Laboratory and the Marcus Cardiac Rehabilitation Center, the Nelson Gelfman, M.D., Dialysis Unit, the Duracell Center for Ambulatory Surgery, an accredited sleep disorders center, advanced radiologic and oncology care via two linear accelerators, MRI, CAT, PET Scan and interventional radiology, Main Street Physical Rehabilitation Center, a pediatric pulmonary/asthma management program and the Seifert & Ford Family Community Health Center.
Danbury Hospital has 10 clinical departments and a medical and dental staff of more than 500 physicians. The hospital is the area’s largest employer with close to 3,000 employees and 67 resident physicians. The Hospital has a long history as a teaching institution and currently maintains 95 agreements with numerous colleges and universities to train medical, nursing and allied health students. The Hospital operates eight residencies — seven for graduate physicians in Internal Medicine, Obstetrics/Gynecology, Pathology, Psychiatry, General Surgery, Nuclear Medicine, and Pediatrics – as well as one in General Practice Dentistry.
Danbury Hospital is one of several affiliates within Danbury Health Systems. Another affiliate is the Danbury Visiting Nurse Association Inc.
About Danbury Visiting Nurse Association, Inc.
The Danbury Visiting Nurse Association is a private non-profit and an affiliate of Danbury Health Systems. The VNA optimizes the health and well being of people in Northern Fairfield County and surrounding towns by employing the most advanced knowledge about the cause and prevention of disease, illness management and health maximization. The agency provides skilled nursing care; home health aides; medical social work; speech, occupational and physical therapy; maternal child/health care; specialty clinicians in respiratory therapy, cardiac care, wound care, diabetes care, pain management, and home infusion therapy. In addition, the Danbury VNA is the area leader in community health services providing educational seminars on health topics, blood pressure screenings, flu clinics, and health services to the uninsured and underinsured through the Wellness on Wheels Van.

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