1. Please list publications in peer-reviewed journals showing
cost-effectiveness of wireless monitoring systems for homecare
patients. These patients have illnesses which require supervision
(e.g. Diabetes Mellitus, congestive heart failure (CHF), chronic
obstructive pulmonary disease (COPD). Note: I am not looking for
patient-activated, wearable emergency alarm systems, but automated
systems which record wirelessly when the patient enters certain rooms,
lifts up medications bottles, etc. so that the patient's movements can
be tracked and the caregiver/ homecare agency notified when the
required events do not take place (e.g., entering the bathroom at
least twice daily).
 
2. Please list and compare wireless monitoring systems for homecare patients. 

3. For each monitoring system, please obtain three references of
homecare agencies or other institutional users currently using their
system.

Thank you.

---

Clarification of Question by dangardner-ga on 07 Aug 2006 22:55 PDT

Item 2: Please list homecare wireless monitoring systems. No need to compare them. 
Item 3: No need to obtain references.

Hi dangardner,

This is a fascinating area of study. Thank you for asking this
question and giving me the opportunity to look into it for you.

Here are some studies dealing with this issue.

"Assessment of activity of elderly people using a home monitoring system."

Chan M, Campo E, Esteve D.


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15729100&dopt=Abstract

---------------------------------------------
This one studies the effectiveness of sensors that include heart rate,
along with motion sensors.

"Vital sign monitoring for elderly at home: development of a compound
sensor for pulse rate and motion."

    * Sum KW,
    * Zheng YP,
    * Mak AF.

Rehabilitation Engineering Center, Hong Kong Polytechnic University, Hong Kong.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16282652&query_hl=3&itool=pubmed_docsum



-------------------------------------

http://bmj.bmjjournals.com/cgi/reprint/324/7351/1434

"Systematic review of cost effectiveness studies of telemedicine interventions"

Pamela S Whitten, Frances S Mair, Alan Haycox, Carl R May, Tracy L
Williams, Seth Hellmich.

Department of Telecommunications, Michigan State University, East
Lansing, MI 48824-1212, USA, b Department of Primary Care, University
of Liverpool, c Department of Pharmacology, University of Liverpool, d
Centre for Health Services Research, University of
Newcastle-upon-Tyne, e School of Primary Care, University of
Manchester


-------------------------------------
http://www.ncl.ac.uk/chsr/publications/publication/16954

"A review of telemedicine cost-effectiveness studies 2000"

F.S. Mair;A. Haycox;C. May;T. Williams

Journal of Telemedicine and Telecare
-------------------------------------

http://www.cis.gsu.edu/~uvarshne/papers/IJMC3.pdf

?Using wireless technologies in healthcare?, Int. J. Mobile
Communications,. Vol. 4, No. 3, pp.354?368.

Upkar Varshney

-------------------------------------

This one incorporates monitoring of vitals but also uses location
sensors for tracking when patients have gone out of a certain
acceptable range.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15319047&dopt=Citation

"Home telehealth reduces healthcare costs."

Noel HC, Vogel DC, Erdos JJ, Cornwall D, Levin F.

VA Connecticut Healthcare Systems, West Haven, Connecticut, USA.

-------------------------------------

http://jhi.sagepub.com/cgi/content/abstract/11/4/309

"Economic analyses for ICT in elderly healthcare: questions and challenges"

Vivian Vimarlund

Economic Information Systems, Department of Computer and Information
Science, Linköping University, S-581 83 Linköping, Sweden,
vivvi@ida.liu.se

Nils-Göran Olve 
-------------------------------------

http://iospress.metapress.com/(kgxjtpvbzvwm0aenlrkxtbnh)/app/home/contribution.asp?referrer=parent&backto=issue,150,182;journal,5,15;linkingpublicationresults,1:300379,1

"Cost-effective Ambulatory Monitoring"

Pantelis Angelidis and Markela Psymarnou 

-------------------------------------

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15824728

"The Frail Elderly Community-Based Case Management Project."

    * Duke C.

Patient Care Services Administration, Pitt County Memorial Hospital,
Greenville, North Carolina, USA.

-------------------------------------

This paper does touch on how the overall costs of healthcare can be
lessened with early detection.

http://courses.ats.rochester.edu/surveys/futurehealth/workshop/articles/Morris2.pdf

"Embedded assessment: Overcoming barriers to early detection with
pervasive computing."
M Morris, SS Intille, JS Beaudin 
Proactive Health

-------------------------------------

This is an old-school paper that does focus on some of the economic
benefits, but is more outdated than the other papers.

http://www.williamson-labs.com/elderly-main.htm

"Automated Activity Monitoring for Elderly Home Care"
last Printing Nov 18,  1992
By Glen A. Williamson

-------------------------------------

This is not from a peer-reviewed journal, but it seems to be a very
extensive project conducted by the University of Illinois at
Urbana-Champaign called the "Assisted Living Project." They touch on
the cost savings that remote monitoring can have.

http://lion.cs.uiuc.edu/assistedliving/technical.html

In addition, the researchers involved have published related articles in journals:

http://lion.cs.uiuc.edu/assistedliving/publications.html

-------------------------------------

Systems for wireless monitoring.

Here are some selections of systems for wireless monitoring. There are
only three on the market. I could find references for QuietCare; the
other two companies have been contacted and I will clarify the
question with that information when I receive it.

QuietCare-- has highest market share and is well-established
HealthSense-- also appears to be brand new
Lusora-- brand new and does not have high market share 

QuietCare by Living Independently Group Inc.
http://www.sensorsmag.com/sensors/article/articleDetail.jsp?id=360124

Setup:
Wireless monitors set up baseline of daily activities, and any
differences are sent out to designated workstation, phone or pager.
Installation costs about $200 and does not involve any wiring of the
structure. Ongoing monitoring costs about $2 a day. The technology was
invented at Drexel University and licensed by Living Independently
Group for worldwide use.

used by:
1. Ecumen of Minnesota, with over 100 facilities in Minnesota, Iowa
and Wisconsin communities
2. Sunrise Senior Living
"Today, Sunrise operates nearly 350 communities in the U.S., U.K. and Canada."
http://www.sunriseseniorliving.com/about/SunriseHistory.do
--presently being used in 18 rooms in Brighton Gardens in Florham
Park, NJ and plans are being made to roll it out to every other
location
http://www.quietcare.com/documents/AL_Director_10-24-2005-1.pdf

3. Agewell HomeCare LLC, Edina, Minnesota
http://www.agewellhomecare.com/

"QuietCare is an early detection and early warning system that
provides caregivers with 24/7 information and alerts about the safety
and well-being of elderly or other at-risk individuals, while
maintaining their privacy and independence. This proven system uses
discreet wireless activity sensors that are positioned throughout a
person's residence to learn his/her normal pattern of daily living,
such as meal preparation, interaction with medications, and bathroom
use, as well as the person's morning wake-up time and overall
activity. The system remotely identifies potential medical
emergencies, such as possible bathroom falls, and automatically alerts
caregivers to these situations, thereby permitting them to provide
early intervention. QuietCare also provides alerts when the
temperature in the person's residence is dangerously high or low.
QuietCare is currently used by individuals in their homes, assisted
and independent living communities, and homecare agencies."

Pricing--
http://www.quietcare.com/pricing.html

QuietCare - $2.67/day

    * 24 hour a day, 7 day a week tracking
    * Alerts and web-based reports for viewing and response by family,
friends, or professionals
    * Round-the-clock attention to potential emergencies for quick human response

QuietCare Plus- $2.99/day

    * 24 hour a day, 7 day a week tracking
    * Alerts and web-based reports for viewing and response by family,
friends, or professionals
    * Round-the-clock attention to potential emergencies for quick human response
    * Full Personal Emergency Response (PERS) pendant service.

---------------------------------

HealthSense.

http://www.healthsense.com/healthsense/

"eNeighbor? (electronic neighbor) is a complete in-home monitoring
system designed to provide security for seniors in a non-intrusive
manner. With eNeighbor, both seniors and caregivers alike have
security and peace of mind knowing that the at-risk senior's
well-being is constantly monitored, and access to help is available at
all times. The system operates utilizing wireless sensors that detect
a variety of daily living activities. If a change in daily living is
detected that is out of the ordinary, help will automatically be
called upon. In addition, with the eNeighbor wearable sensor, seniors
can call for help on their own when necessary."

Includes:
emergency pendant
sensors detecting motion, door openings, refrigerator openings,
leaving and entering

eAlert AssistedCare specifically for assisted living homes--

http://www.healthsense.com/healthsense/prod-main-assisted.html

"Designed for assisted living residences, eAlert? AssistedCare? offers
continual monitoring of residents around the clock. Occupants can feel
secure knowing that help is available at all times even if they are
unable to call for it themselves, and staff can have peace of mind
knowing that they will be alerted of a need for help.

How the system works
Small, wireless electronic sensors are placed in strategic areas of
the assisted living residence. These sensors monitor typical daily
living activities of the occupant. The sensors are non-intrusive?no
cameras or audio devices are used?thus maintaining the occupant?s
privacy and integrity."



---------------------------------

Lusora Inc.

http://www.lusora.com

Setup:
Wireless internet, wifi, connection for those with an always-on
broadband internet connection. For those with no broadband, it can
dial in every two hours and works similarly to QuietCare. Images can
be viewed via Lusora's secure website. Alerts-- text message, call or
email-- can be sent if something happens that is considered out of the
ordinary. It also includes a Lifeline-style pendant for emergencies.

Economist article:
http://www.lusora.com/articles/economist_jun09_05.html

Cost:
$250-300 for installation, monthly $30-40

http://www.quietcare.com/documents/WJS_Article_Keeping_Tabs_121205.pdf

http://www.lusora.com/faq.html

"Lusora's first two product, a personal alert device, is designed to
allow the elderly to live independently in their own homes. These and
other sensor devices can be programmed individually through a Web
interface to monitor the unique habits of the elderly living in their
own homes.
How does the system work?
LISA is an intelligent wireless set of products that uses radio waves
to communicate with a range of sensors in the home. These sensors are
mounted on key access points such as doors and windows, as well as key
monitoring points, such as medicine cabinets, refrigerator doors etc.
and are also integrated into light switches. All the sensors
wirelessly report to the LISA Hub using radio waves. The hub in turn
connects to the Lusora Platform using standard a telephone lines. The
system stores data remotely on a secure web site. Each of the wireless
sensors can be viewed, maintained and configured using a simple web
interface."

-------------------------------------

Search terms:
telemedicine cost-effectiveness
journal of telemedicine
wireless monitoring elderly cost pubmed
elderly telehealth cost
elderly telemonitoring cost efficiency
elderly location monitoring
rfid monitoring elderly
elderly wireless sensor
sunrise senior living klaassen
healthsense elderly

If you need any more help or clarifications, let me know and I'll be glad to help. 

Cheers,
--keystroke-ga

---

Request for Answer Clarification by dangardner-ga on 11 Aug 2006 01:22 PDT

Keytroke-ga,
Thanks for the helpful info. 

Will you please check out the vendors below, whom I found by searching
for "Remote Patient Monitoring"?  I'd like info on features, pricing,
and current customers.

Thanks so much. 


http://www.carematix.com/

http://www.continuaalliance.org/home

http://icarehealthmonitorin.reachlocal.com/

http://www.sjm.com/devices/device.aspx?name=Housecall+Plus%26%23153%3B+Remote+Patient+Monitoring+System&location=us&type=10

http://www.medical.philips.com/main/products/telemonitoring/products/motiva/

http://www.adtwellhealth.com/

(end)

---

Clarification of Answer by keystroke-ga on 18 Sep 2006 22:26 PDT

Hi dangardner,

I'm sorry I didn't respond to this clarification request earlier! I
simply didn't see it before now. Thank you for your patience. Here is
what I have researched on these vendors.

http://www.carematix.com/

"The core product is a wireless monitoring system for vitals like
blood pressure, pulse, temperature, weight etc. The system consists of
RF enabled devices that communicate with a hub somewhere in the home."

"Once the hub receives the reading, it is pushed via a phone/PC to the
Internet server where it is added to the users chart. The user or care
giver can now track the relevant data, graph it, monitor trends,
annotate it for variances, set alert criteria and receive alerts.
Users or caregivers can easily monitor the basic wellness parameters
like blood pressure, pulse, temperature, weight and sugar level."

From these descriptions, it does not seem to me that Care Matrix would
meet your needs of a system to monitor a patient's movements.

---

http://www.continuaalliance.org/home

This group might work for your needs. According to its website:

"Around 9:00 a.m., a prompt appears across the TV screen reminding
Carol to take her blood pressure, which she does with a
wireless-enabled blood pressure cuff that is sitting next to her easy
chair in the den. Each morning around 10:00 a.m., Michelle, Carol?s
daughter, receives a text message on her cell phone that says ?Mom?s
okay? ? meaning that systems throughout her mother's home were able to
determine that she got out of bed, she used the bathroom, her weight
had not dramatically shifted, she took her pills correctly, the gas on
the stove is off, and her blood pressure is stable."

Features include:
    *  Assistance with daily health and monitoring tasks
    * Medical reminders
    * Activity prompts
    * Monitoring and early warning using bio-sensor data collection
    * Automated dietician
    * Emergency response
    * Real-time alerts and communication

The Continual Health Alliance seems like a very good company when it
gets started up, but I see no specific items listed on the website and
it mostly seems to be trying to enlist businesses in partnerships to
come up with new products at this point. I don't think that they are
actually selling products yet, but ideas, from what I can tell of
their website.

---

http://icarehealthmonitorin.reachlocal.com/

This ICare system seems to be freely available, available in CVS
pharmacies, but  it is mostly a blood pressure and vital signs
monitor, not real time actions as you so desire.

---

http://www.sjm.com/devices/device.aspx?name=Housecall+Plus%26%23153%3B+Remote+Patient+Monitoring+System&location=us&type=10

This system seems to be geared more towards doctors. It allows doctors
to conduct tests on the patient with the patient still at home. It is
more far-reaching than simple vital signs monitoring.

"The Housecall Plus system makes it possible to monitor parameters and
settings on the ICD, clear diagnostics and evaluate the following:
real-time electrograms, surface ECGs, delivered therapies and stored
electrograms. The complete diagnostics available are equivalent to a
full, in-office programmer-based interrogation, without programming.
While the system does not eliminate the need for visits to the
physician's office, it can minimize follow-up visits, indicate when a
patient should be seen, and help avoid unwarranted trips to the
emergency room. Housecall Plus Remote Patient Monitoring System
supports the Atlas® and Epic? ICD families, including the Atlas® HF
and the Epic?+ HF ICDs."
---

http://www.medical.philips.com/main/products/telemonitoring/products/motiva/

"The Motiva interactive healthcare platform uses broadband television,
along with home vital sign measurement devices, to connect patients to
their healthcare providers and medical support system. Our goal is to
turn the home TV into the patient's own personal healthcare channel or
"virtual health coach.""

This also measures vital signs and provides interaction with families,
but no information on where the patient goes or what they do during
the day. The TV probably could be programmed to set up alerts telling
them to take pills or go to the bathroom, however.

---

http://www.adtwellhealth.com/

This is the only one of these devices that fits your parameters of a
physical monitoring system.

http://www.adt.com/resi/programs/Performics/CSPaidSearch/Quietcare/

"    *  QuietCare consists of five small, wireless motion sensors
placed in strategic locations throughout the home, such as the
bedroom, the bathroom, and areas where medication is stored.
    * ADT receives system alerts and takes action as needed.
    * It gives loved ones a way to stay in touch when they can't be
there in person.
    * The QuietCare system is unobtrusive, maintains privacy and
requires no effort by those it helps protect.
    * The system reports daily activity to a private Web page that can
be viewed by loved ones and professional caregivers who can take
action to help avoid medical emergencies."

Pricing information is not given on the website but here is the
contact form to inquire about pricing on the device:

http://www.adt.com/resi/programs/Performics/CSPaidSearch/#LeadForm

Again, I'm very sorry for the delay in responding.


--keystroke-ga