TELEHEALTH DEVICES THAT PROVIDE REAL-TIME MONITORING TO PATIENTS WITH CARDIOPULMONARY DISEASE IN THE HOME: THEIR ROLE IN THE DELIVERY OF PHYSICAL THERAPY SERVICES. William E. DeTurk*1; Craig Lehmann2; Barbara W. DeTurk3 1. Physical Therapy, Stony Brook University, Stony Brook, NY; 2. School of Health Technology and Management, Stony Brook University, Stony Brook, NY; 3. Home Care Division, Metro Therapy, Inc, Hauppauge, NY UNIQUE: Telehealth monitoring systems represent the latest technological innovation in the delivery of health care to chronically-ill homebound patients. They connect the patient in the home to the home care agency or clinic via a telephone-mediated or wireless (Bluetooth) network. To date, there has been a small but growing number of home care physical therapists interacting with these devices. Physical therapists should be aware of their utility and performance characteristics, and should be prepared to interact with them in order to better serve the patient. The physical therapist is in a unique position to utilize peripheral measuring devices like electronic stethoscopes, ECG transmitters, and sphygmomanometers during treatment. Comparison of real-time exercise data to resting data using telehealth may optomize the care of patients with congestive heart failure (CHF). PURPOSE: The purpose of this presentation is to introduce telehealth monitoring systems. The components of a typical telehealth system will be described. One monitor and three peripheral measurement devices will be described. Their use in the management of a patient with CHF will be presented. FOUNDATION: Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, and patient and professional health-related education. It is being increasingly utilized in the home environment, especially in rural areas that may be underserved, and in large healthcare systems like the Veterans Health Administration. There were over 90,000 teleconsultations in 1998. Perceived benefits include cost effectiveness, quality of care, efficiency, and ease of use. Candidates for telehealthcare include those with chronic disease. The patients most often treated in the home are those with CHF. Physical therapists treating these patients may encounter telehealth devices. Their presence in the home requires that the physical therapist understands how they are used, and perhaps interact with them during treatment sessions. The addition of exercise data will assist the physician in making decisions regarding the efficacy of medications designed to control CHF during both rest and exercise (activity) states. DESCRIPTION: There are several telehealthcare systems being marketed. Typically a monitor placed in the home serves as a command center, and also provides an array of customizable features. These features may include two-way messaging, two-way, real-time video conference calling, automatic notices that remind the patient to take their medications, and the ability to take high resolution photographs of skin lesions and body parts. The monitor also receives data from peripheral measurement devices like an electronic stethoscope, ECG event transmitter, digital sphygmomanometer, and digital weight scale. These devices are particularly useful in the management of patients with CHF. Acquired data from these devices are digitized and transmitted over the patient's regular telephone line, and then uploaded to either a central server or a secure web site. At this point the patient's health status can be accessed at any time by healthcare providers who have the access code. Heart and lung sounds can be played directly off the web page using a resident media player. ECG data presents as a tracing of serial ECG complexes, and blood pressure is displayed as a graph. Data from these devices can be displayed in graph form plotted out over time, a feature that allows identification of change in patient status. Frequency response, reliability, and validity for the electronic stethoscope, and ECG event transmitter have been found to be suitable for clinical applications in patients with heart disease. OBSERVATIONS: Telehealth devices have been shown to reduce the incidence of emergency room visits and re-hospitalizations. The use of telehealth monitoring devices in the management of homebound patients with CHF is particularly beneficial. The digital weight scale can aid in the assessment of fluid retention and concomitant weight gain. The electronic stethoscope can record heart and lung sounds. The presence of an S3 heart sound is often a harbinger of impending CHF; The presence of pulmonary crackles indicates a failing left ventricle with back-up of fluid into the lung fields. Finally , patients with CHF may complain of shortness of breath, a symptom that can be identified with a pre-programmed set of questions that the patient is prompted to respond to. All of these findings in patients with exercise-induced CHF are cause for concern and should prompt immediate medical response. A case study of a home-bound individual with CHF who goes into acute exacerbation will demonstrate how telehealth was used to identify and treat the sudden change in this patient's status. CONCLUSIONS: Telehealth is still an emerging technology, but one that is being increasingly utilized in the home care environment. Home care physical therapists are exposed to a growing number of patients with telehealth systems in place. Their presence provides a window of opportunity for therapists to add exercise data to resting data being acquired by the patient. This may be particularly important for those patients with CHF who are on medications designed to control CHF at rest and during activity states. The interaction between physical therapists and patients who have telehealth devices placed in the home requires further study. FUNDING SOURCE: None. KEYWORDS: CHF, Home Care Services, Telehealth, Telemedicine Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.