Abstract
The Informatics for Diabetes Education And Telemedicine (IDEATel) project is one of the largest civilian telemedicine projects in the country. It incorporates a variety of home telemedicine and remote monitoring technologies, including synchronous and asynchronous physiologic monitoring, videoconferencing, secure messaging and web-based resources. In addition, the telemedicine components are tightly coupled to Columbia University Medical Center Electronic Medical Record (CUMC-EMR). The system incorporates both vendor and internally developed components. It is currently in use by over 600 patients and a variety of clinicians at two large academic medical centers.
Context
The Informatics for Diabetes Education and Telemedicine Project (IDEATel) has enrolled over 2100 subjects enrolled since late 20001,2. These subjects were randomized either to usual care by their primary care provider, or to an intervention of adjunct diabetes case management and education employing telemedicine intervention delivered directly to subjects homes.
Features
The intervention subjects received a home telemedicine unit (HTU) (American Telecare, Inc.), which consisted of a web-enabled specially-configured “personal computer” with a dial-up modem connection to an existing POTS line. The HTU has four components: (1) a video camera and microphone for videoconferencing with nurse case managers at the Berrie Diabetes Center at Columbia University or Joslin Diabetes Center at SUNY Upstate Medical University; (2) a home glucose monitoring device and a blood pressure cuff which are connected to the HTU for uploading readings; (3) the ability to access patients’ own clinical data and send message at a project specific web portal; and (4) the capability to access educational websites, including one created for participants of IDEATel by the American Diabetes Association.
A major goal of the technical implementation was the seamless integration of the project specific telemedicine systems with existing clinical systems through the use of well established standards, in particular HL7.2 The IDEATel project was one of the first systems to allow patients to electronically upload data directly into a hospital EMR without a gatekeeper.
Deployment
The IDEATel system originally went live in December 2000. Currently over 600 HTUs are in active use. Since initial deployment, a second generation of HTU has been developed and will be demonstrated along with the integrated clinical systems. Interim evaluation has shown has shown improvements at one year of follow in the main prespecified clinical outcomes of HgbA1c, blood pressure level, and low-density lipoprotein (LDL) cholesterol level net of changes in the control group3.
Acknowledgements
The research described in this paper was supported by the Centers for Medicare and Medicaid Services Cooperative Agreement (95-C-90998).
References
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