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Home Care Management Associates, Ltd.

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Home Teleheath Systems: A Primer

Technological Development:

This subsumes four separate progressions: (1) the development of the diverse telecommunications and computer technologies used to provide home tele-health services; (2) the introduction of sophisticated electronic devices for measuring patient physiological parameters in-home; (3) the development over the past decade of electronic devices for administering drug and other therapies in-home: and (4) the increasing level of familiarity, comfort, and enthusiasm among providers all of these technological innovations.

The HTH Continuum

HTH spans "first responder" or "medical alert" systems to interactive care management systems. HTH systems cluster along a continuum of increasing complexity and technical sophistication.

1. Personal Emergency Response Systems (PERS):

This is an automated dialing system ("base unit") which can transmit one or more coded messages to a remote monitoring station when activated by the user or by a sensor (e.g., air temperature, smoke or fire). User activation is by means of a small, battery-powered transmitter that may be worn around the neck or on the wrist. The transmitter can send discrete signals (e.g., police or ambulance) to the base unit which initiates a toll-free call to the monitoring station, which in turn attempts to verify the emergency with the user and then contacts the appropriate emergency service in the userís community. Some base units are speaker phones and permit the monitoring station to stay in contact with the user until local help arrives. PERS is an in-home emergency service. It enables aged and disabled individuals to stay in their residences without caregivers and reduces hospitalization by facilitating early emergency treatment and transport.

2. Monitored Medication Dispensing Systems (MMDS):

This is a programmable device for scheduled dispensing of medications which alerts an off-site monitoring station of patient non-compliance by means of a coded telephone message. It consists of a medication storage compartment which holds from a one week to a one month supply of tablets or capsules. The compartment has a "lock out" feature to prevent access. The userís daily regimen is programmed by the provider. The dispensing device may simply release the designated scheduled dosage or it may display patient instructions on a small LED screen (e.g., a reminder to a diabetic to "take your insulin"). A common feature is an visual message and/or audio alarm or signal that alerts the user that it is time to take the required medication(s). When the patient does not take the medication the system notifies a monitoring station, which may call and give a "reminder" or an on-call nurse who will contact the patient.

3. Medical Device Monitoring Systems (MDMS):

This configuration permits off-site monitoring of in-home medical devices such as oxygen concentrators and drug delivery systems by a telephone connection which periodically transmit reports on device functioning and patient usage. "Tele-infusion" is an example of this type of system. The infusion device is linked to a telephone line. Solution administration and device operation can be monitored at a remote location. Troubleshooting can be done "on line." This minimizes in-home interventions and increases patientí involvement in care and therapy. In other applications a monitoring device can be attached to a concentrator or a ventilator. These systems may be free-standing in terms of telecommunications capability or may have a "hardwire" or "wireless" connection to a PERS unit which provides the telecommunications capability.

4. Therapy Tele-Management Systems (TTMS):

This is a dedicated configuration involving the on-line real-time continuous monitoring of a single specific in-home therapy administration which would automatically track the patientís signs and adjust volumes and flows as indicated. One in-home oxygen conservation device has the ability to track the patientís oximetry on a real-time basis. If the system measures a rise in the patientís blood gas above a predetermined level it can reduce the flow of oxygen. When the patientís levels drop the system will adjust the oxygen flow accordingly. Systems of this nature need only a telecommunications link to find a place on the home tele-health continuum.

5. Patient Tele-Monitoring Systems (PTMS):

This is involves the input of patient data at scheduled intervals to a device that either has telecommunications capability or attaches to a standard telephone. An application is to monitor asthmatics and other respiratory patients. Spirometry is performed by the patient in-home to measure Peak Expiratory Flow (PEF) and Forced Expiratory Volume for one second (FEV1). A typical unit provides a digital display of the results for the patient and transmits the data to monitoring station (which transmits the print-out by fax to the provider and physician) or directly to the provider which relays the read-out to the physician. Other applications involve telephonic sphygmomanometer for monitoring blood pressure and pulse and a telephonic stethoscopes to ausculate heart, lung, and bowel sounds.

6. Tele-Video Patient Management Systems (TPMS):

This is a video-phone configuration involving a standard television set, a digital color video camera, and a touch-tone telephone set to create an in-home video-conferencing capability for voice communication and the exchange of low resolution images of the patient and provider staff. They may use standard or ISDN telephone lines. They may also incorporate a wide range of instruments for measuring patient clinical parameters on-line.

Source:

Home Tele-Health Systems: A Guide for Home Care Providers
Springfield, PA: Home Care Management Associates, Ltd., 1998

Copyright 1998 Home Care Management Associates, Ltd.

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A Home Telehealth Glossary

The tele-health industry draws on many fields and uses terminology, phrases, and acronyms that may be unfamiliar to the newcomer. The following definitions are offered to facilitate learning and to use with the tele-health literature. We have included terms relevant to the emerging home telehealth field from telecommunications, telemedicine, and elsewhere. It is non-technical and meant to be suggestive rather than definitive. Terms will be added on an ongoing basis. We welcome suggestions or corrections.

Index

A B C D E F H I K L M O P R S T U V W

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Definitions

Acoustic Data Transmission - Sending voice or other sounds via telephone lines, video cable, or other media.
ADSL (Asymmetric Digital Subscriber Line) - Use of phone company upgrades to increase data transmission capacity of existing copper wire lines.
Alarm - An audio tone (sometimes accompanied by a visual signal) issued by a tele-health device to alert the user of a scheduled event or an emergency.
Algorithm - Mathematical coding scheme for compressing audio or video signals to permit transmission over less costly lower bandwidths.
Analog - Signifies the transmission of information in continuously varying units.
Auto-dialer - Component of a PERS or other device enabling it to dial programmed telephone numbers in response to an alarm or other event.
Auxiliary Equipment - Devices configured to a tele-health system to improve image quality, provide image storage, and permit image manipulation or distribution.

Index

Base Unit (AKA Base Receiver] - See receiver.
Bandwidth - Capacity of a medium to transmit data per unit of time. The higher the bandwidth the greater the transmission capacity.
Back-up Power Supply - External rechargeable battery power source capable of operating a PC and peripherals for a short period in the event of a loss of primary electrical service.
Base Unit - The main component of a personal emergency response system housing the speaker phone, auto-dialer, and other circuitry.
Battery Back-up - Replaceable or rechargeable power source capable of operating a PERS or similar system for up to 24 - 48 hours.
Bit (Binary Digit) - Basic unit of information used by computers for data entry, transfer, and storage. Telecommunications transmission rates are usually expressed in terms of bits.
Board - A printed circuit component.
BPS (Bits Per Second) - The number of data bits transferred second between two telecommunications devices.
Broadband - Signifies a telecommunications network able to transmit data, video, and voice over a broad radio frequency spectrum; a high capacity communications medium.

Index

Card - A small printed plug-in circuit board containing an entire circuit that can be changed to upgrade or modify a device's functions.
Carrier - The basic continuous frequency signal transmitted over telephone line to transfer data.
CATV (Community Antenna Television) - Local cable-based video network also capable of providing telephone service.
Central Station - See monitoring center
Chip (AKA Microchip) - An integrated circuit (IC) consisting of electronic components and their connections on silicon or similar material.
CHIN (Community Health Information Network) - Utility providing on-line access to dispersed patient records or information at provider sites.
Coaxial Cable - (AKA Coax) A telecommunications medium able to handle wide bandwidths and resist interference.
Component Video - A method of color video transmission that produces high image quality with better resolution and color than composite video.
Composite Video - A method of color video transmission that conserves bandwidth but is subject to interference and poorer image quality than component video.
Compression - Use of a mathematical algorithm to reduce the size of data, audio, or video transmissions for greater speed or use of lower bandwidths.
Configuration - How software, hardware, or a system as a whole is set up to operate or function; a particular combination of devices.

Index

Dedicated Line - See Leased Line.
Demarc (Demarcation Point) - Site (i.e., jack or panel) in a building where the telephone company's responsibility ends and the customerís begins.
Digital - Signifies information transmission in discrete, uniform units.
Digital Camera - Captures still or moving images digitally for ready transmission or storage via computer.
Dip (Dual In-line Package) Switch - A tiny switch on a circuit board providing a means of selecting or setting device functions.
Distribution Amplifier - Device used to transmit a single video transmission to several locations or devices.
Download - Transfer of programming instruction, patient education information, or other files from the provider to the home tele-health system.
DTMF (Dual Tone Modulated Frequency) - Refers to the tones used by touch-tone telephones.
Duplex - Data communications capable of simultaneous two way transfer.
Duplex Audio - Two way simultaneous audio or voice communication.

Index

Encryption - Encoding information to assure security prior to transmission.

Index

FDA 510K - Food and Drug Administration (FDA) approval.

Index

Half Duplex - One way at a time audio or voice communication.
Hard Wired - Permanent or semi-permanent connection of an electronic device to a telecommunications port.
Home Tele-Health (HTH) - The use of telecommunications by a home care provider to link patients or customers to one or more out-of-home sources of care information, education, or service by means of telephones, computers, interactive television ,or some combination of each.

Index

IATV or ITV (Interactive Tele-video) - A form of video conferencing involving simultaneous audio transmission and video display between two or more sites.
Interface - The exchange of information between two devices or the connection that makes such an exchange possible.
ISDN (Integrated Services Digital Network) - A telecommunications standard permitting the simultaneous transmission of data with voice and video- permits higher data transmission speeds (64 - 128 Kbps) than POTS.

Index

KBPS (Kilobits per Second) - One thousand bits per second.

Index

Leased Line - (AKA "dedicated line") A continuously open (no dial up) point-to-point line used exclusively for a telecommunications link between two systems for a flat monthly charge that does not vary with usage.
LED (Light Emitting Diode) - A semi-conductor diode that lights when a current is passed through it to indicate that a device is receiving or sending a signal.
Line Splitter - Device used to give second line access to a single port modular phone jack for installation of a tele-health system.

Index

MBPS (Megabits per Second) - One million bits per second.
MHz (Megahertz) - 1 000 KHz; used to express transmitter frequency.
Monitored Medication Dispensing Systems (MMDS) - A programmable device for scheduled dispensing of medications which alerts an off-site monitoring station of patient non-compliance by means of a coded telephone message.
Monitoring Center/Station - A remote central telecommunications facility that receives, processes, and responds to incoming alarm signals and other coded messages from home tele-health systems (AKA a Response Center).

Index

On Line - Signifies that a telecommunications devices is connected to another such device or means of transmission
Off Line - Signifies that a telecommunications device is not connected to another such device or means of transmission.

Index

Patient Tele-Monitoring Systems (PTMS) - A configuration involving the input of patient physiological data at scheduled intervals to a device that either has telecommunications capability or attaches to a standard telephone for transmission.
Pendant - Mini-transmitter worn by user around the neck.
Peripherals - Devices connected to a tele-health system to expand its capability.
Personal Emergency Response Systems (PERS) - An automated dialing system which can transmit one or more coded messages to a remote monitoring station when activated by the user or by a sensor (e.g., air temperature, smoke or fire).
Point of Care - Site of tele-health care delivery, e.g., the home.
Point of Use - Site of review or evaluation of an incoming video or other file or transmission of data or information.
Point-to-Point - Describes system connection or communication linkage (e.g., home to agency).
Port - A point of connection between two devices; a network entry/end point.
POTS (Plain Old Telephone System) - The standard analog public telephone network that can carry voice and data transmission- typically permits data transmission at 33.6 Kbps.
Programmable - System feature permitting the provider to effect on-site or remote changes to the operating routine of a device or system.

Index

Real Time - Signifies the near simultaneous sending and receiving of data, audio, and/or video with only a fraction of a second delay.
Receiver - Component of a PERS or other HTH system which receives coded signals from a transmitter (e.g., pendant) for transmission to a monitoring center by means of an auto-dialer.
Resolution - Signifies the degree of image or graphic detail that can be displayed on a monitor.
RJ11 Modular Jack - Registered Jack; the common modular connector used for faxes and modems and household telephones.

Index

Soft Keys - A limited function keypad permitting the user to enter a preset range of information to a device.
Split-Screen Generator - Device that enables the display of two or more video images from different sources on a single monitor.
Standard Television Set - Household TV used to receive video via POTS or CATV; such tele-health configurations usually use a touch-tone phone for audio transmission and alphanumeric data entry by means of the keypad.
Store-and-Forward - Capability of a system to capture to memory incoming video or graphic images for later retrieval and analysis, comparison, or transfer.

Index

T1 - A widely available leased line option commonly used with IATV telemedicine systems.
Tele - Prefix meaning "distant." Used to describe delivery of services to individuals remote from the source, e.g., tele-pharmacy, tele-psychology, teleradiology, or tele-nursing.
Tele-conference - An interactive, real time conversation, usually involving parties linked by a telecommunications medium (e.g., speaker phones and microphone amplification systems balancing audio input).
Telecommunications - Communicating voice, video, and/or from a distance using telephone, cable, Internet, microwave, or radio.
Telemedicine - the use of telecommunications for the purpose of transmitting or exchanging medical data and delivering medical assessment, diagnosis, or care.
Tele-patient - A individual "seen" or "visited" by means of a tele-health system; also used to distinguish an individual who is appropriate for tele-health program participation as well as one oriented to use such a system in-home.
Telephony - Transferring voice and or/data by telephone, fax, Internet, or data transfer using telephone technology and optical cables.
Tele-Video Patient Management Systems (TPMS - A video-phone involving a standard television set, a digital color video camera, and a touch-tone telephone set to create an in-home video-conferencing for voice communication and the exchange of images of the patient and provider staff.
Tele-visit - An in-home encounter using telephone-only technology to gather and transmit patient information.
Therapy Tele-Management Systems (TTMS) - A dedicated configuration involving the on-line real-time continuous monitoring of an in-home therapy administration which automatically tracks the patientís signs and adjust volumes and flows as indicated.
Transmitter - Small battery-powered device capable of sending coded signals short distances to a receiver in a tele-health device. May be worn as a pendant or on the wrist. Some systems also use wall-mounted user activated transmitters.

Index

Upload - Transfer of stored patient data from the in-home tele-health system station to the provider or host system.

Index

Video-phone - A stand-alone in-home video camera and telephone combination that permits interactive audio/video communication over POTS or ISDN.
Video Conference - Live video image display and audio/voice transmission between two or more locations.
Video Switcher - Device that receives and distributes incoming transmissions to a selected location.
Video Visit - An in-home visit via an IATV-based home tele-health system.

Index

Wireless - Signifies the use of radio, microwave, or infrared signals by a variety of telecommunications devices (e.g., cellular telephones) to transmit information without the use of wiring or cabling.
Wireless Installation - Requires no new or additional wiring or cabling; uses existing available electrical and or telecommunications connections.
Workstation - Used to describe the configuration of telecommunications devices in the home and in the providerís office.

Index

Source:

Home Tele-Health Systems: A Guide for Home Care Providers
Springfield, PA: Home Care Management Associates, Ltd., 1998

Copyright 1998 Home Care Management Associates, Ltd.

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Some Telehealth Resource Links

Telemedicine and the Law (Arent Fox)
Legal and legislative issues and articles
American Telemedicine Association
Definition of "telemedicine" and other resources
T.I.E. Home Health Data Base
Telemedicine Information Exchanges's HTH files on equipment, costs, etc.
Telemedicine Virtual Symposium
Telemedicine & Telehealth Networks' Message Board on home health and more
A Telemedicine Glossary
From the Association of Telemedicine Service Providers web site
"Med Web" Telemedicine
Emory University HSC Library's mega link directory

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