Emily Seto, Health Policy, Management and Evaluation, University of Toronto, ON; Centre for Global eHealth Innovation, University Health Network, ON, Toronto, Canada Heather Ross, Department of Medicine, University of Toronto, ON; Divisions of Cardiology and Transplant, University Health Network, ON, Toronto, Canada Joseph A Cafazzo*, Health Policy, Management and Evaluation, University of Toronto, ON; Centre for Global eHealth Innovation, University Health Network, ON; Institute of Biomaterials and Biomedical Engineering, University of Toronto, ON, Toronto, Canada Kevin Leonard, Health Policy, Management and Evaluation, University of Toronto, ON; Centre for Global eHealth Innovation, University Health Network, ON, Toronto, Canada Track: Research Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Oral presentation Submission Type: Single Presentation Building: MaRS Centre, 101 College Street, Toronto, Canada Room: CR2 Date: 2009-09-18 01:30 PM – 03:00 PM Last modified: 2009-08-13

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Background: Self-care among the heart failure patient population is generally poor and most heart failure patients have low self-efficacy in performing self-care practices. Non-adherence, such as to daily weight measurements and diet, has been found to be a major cause of morbidity and preventable hospital admissions of heart failure patients. Studies suggest that as many as one third to one half of heart failure hospitalizations are preventable. Remote patient monitoring is a potential tool to avert further deterioration of a heart failure patient’s condition and to avoid the cost of re-hospitalization.

Objective: The objective of this research was to inform the design of a user-centric remote monitoring system for heart failure self-management through extensive feedback from heart failure patients and their clinicians.

Methods: Semi-structured interviews with 11 heart failure healthcare providers were conducted to elicit the system requirements and general utility of mobile phone based remote patient monitoring. Three iterative rounds of usability testing were then conducted with 20 heart failure patients throughout system development. A single round of usability testing was conducted with 9 clinicians near the end of system development.

Results: A user-centric remote monitoring system for heart failure management was developed that monitors weight, blood pressure, heart rate, symptoms, and heart rhythm. The physiological data is sent wirelessly from the medical devices to a mobile phone, which then transmits the data to the servers. Patients receive specific instructions on the mobile phone depending on their measurements to help enable self-care, such as reminders to follow their salt and fluid restrictions. In addition, the monitoring system sends alerts to both patients and their healthcare provides as required. A web-based viewer was developed for patients to review their information in logs, graphs, and summary tables. A web application was also developed for the healthcare providers to review their patients’ data and to record their clinical actions.

The usability testing provided insight into the attitudes and concerns of the patients and clinicians, as well as recommendations on how to improve the system. One of the main patient concerns was improper use of the equipment leading to false alerts being sent to their clinicians, while a major concern for the clinicians was not having the time to follow-up on the alerts. Most patients thought that they would benefit from using the monitoring system by reducing their travel to the heart function clinic, centralizing and logging their data, getting information to their physicians quickly, and keeping on top of their own condition. Feedback from the patient and clinician usability testing was particularly useful for clarifying the terminology of symptom questions and alerts, informing the required website features, and determining the workflow for using the system.

Conclusions: The feedback by patients and their clinicians enabled development of a heart failure monitoring system that met their needs, including helping patients perform self-care and providing their healthcare team with clinical decision support. To our knowledge, this is the first heart failure remote monitoring system designed using a formal, iterative, user-centered method throughout its development.