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Tele-Home Care system based on Digital Video Broadcasting Terrestrial technology

Source agency:
Agenas (COTE)
Date of Submission:
07/10/2009
Date of Printing:
05/02/2012
Disclaimer:
This report is work in progress and should not be used for external distribution without permission from the originating agency. Users should be aware that reports are based on information available at the time of research and often on a limited literature search.

Technology, Company & Licensing

Technology name:
KeepInTouch system (R)
Technology - description:
The Tele-Home Care (THC) is the use of technologies based on ICT (Information and Communication Technology) to support and manage the medical assistance for patient homecare. One of the functions of THC includes remote monitoring of the patient. The patient from their home can communicate electronically with the healthcare provider and receive some services for example monitoring of his/her health. The interaction modality can vary (e.g., realtime or off-line) and can be in various forms (voice, video, voice-video) and can use various forms of communication (phone, internet etc.) [Dellifraine, 2008; Tran, 2008].
The measured parameters depend on the disease (typical parameters are glycemia, heart rate, blood pressure and body weight). When measured automatically or by a healthcare professional, the measurements are transmitted to the health centre. When this type of technology is used it is important that all the physical and procedural system’s elements are available and functioning (e.g. procedures to receive and process patient data). The present Horizon Scanning report looks at technologies using DVB-T technology to transmit and video signal as mean of interaction. For a functioning system an interactive DVB-T TVdecoder is required (the patient’s home system needs to be able to receive DVB-T signal) [Lamminen 2002; Angius 2008].

Company or developer:
TechOnYou Srl
Reason for database entry:
The use of interactive systems for homecare assistance of patients with chronic diseases has been tested yet.
A Tele-Home Care system based on digital TV could improve the benfits for patients in terms of quality of life, patient satisfaction and fulfilling treatment course.

Technology - stage in early warning process:
Assessment complete
Technology - stage of development:
Experimental - pilot or phase II
Licensing, reimbursement and other approval:
 
Technology - type(s):
Device
Technology - use(s):
Other, not otherwise specified

Patient Indication & Setting

Patient indications:
Tele-Home Care system based on Digital Video Broadcasting Terrestrial (DVB-T) technology is aimed at chronic patients, out patients after discharge from hospital, elderly people and at risk patients (patients with cardiac failure, diabetes and/or hypertension) who require monitoring within the home. Homecare assistance is aimed at those patients who require assistance at home, this includes house visits by GPs, nurses, rehabilitation and welfare service. It is graded on the specialist care required by the patient. At present there are three indications which patients need to fullfill, as follows:
- Patient with hypertension (usually with few symptoms): he/she has to came to the hospital for examination every six months. Between visits it is suggested that the patients visit their doctor’s surgery monthly, to assess the effectiveness of their antihypertension medication.
- Patient with heart failure (which is a more serious, frequently symptomatic pathology): the pathway is similar to the first indication, however the consultant would normally be a cardiologist, not a family doctor. For this type of patient it is important that the body weight is linked to an increased fluid intake which is characteristic of the disease of marks its progression or if the therapy is not sufficient a rapid intervention needs to be made.
- Diabetic patient: the control periods needed for insulin or non insulin-dependant patients is different and varies from two to three months. The patient however is able to test their own glucose levels more than once within a day period and decide depending on the results how much insulin is needed. The patient also needs to acquire data in between visits to present to the diabetic center at follow up and discuss these from one visit to the next.
Disease description and associated mortality and morbidity:
The percentage of the population who have heart disease is approximately 2%. Within the age group 65+ the prevalence rises to 5% [Tarantini, 2005]. Of these, 50% is able to measure their own levels of glycemia, blood pressure and body weight. In the age group 65+, 20% of the population has an episode of heart failure [A.V., 2003]. The percentage of case of diabetic mellitus in Italy is 6%, 27% of these are treated with insulin [www.ministerosalute.it]. In the age group 70 and above, 40% of the population are affected by metabolic syndrome (which may be an indicator of pre-diabetic risk).
This technology was developed for diabetic patients with cardiovascular complications. These patients require frequent monitoring of glycemia, heart rate, blood pressure and body weight which are usually measured by the patient, a family member or helper. These data need then to be transmitted to the doctor in charge. The system based on DVB-T can also be used to help the patient to learn about his/her disease, to look after themselves and improve their own condition and their psychological state.
Number of Patients:
 
Technology - specialities(s):
Cardiovascular disease & vascular surgery, Endocrine, nutritional and metabolic
Technology - setting(s):
Community and primary care
Setting - further information:
The technology is principally aimed at patient use within their own home. The data measured are sent by the patient to their dedicated healthcare worker, be it within the hospital or their own doctor.

Impact

Alternative and/or complementary technology:
Additive or complementary technology
Current Technology:
The major comparators are:
- Other THC systems (with similar objectives for the same type of patients);
- Conventional homecare assistance;
- Outpatient based treatment.
There are no comparative studies available which report effectiveness of the system versus the comparators.
Health Impact:
With the KeepInTouch system the patient can monitor and transmit their own glycemia, blood pressure or weight levels once a day or weekly or more frequently as required.
This system allows the specialists to have complete and updated data relevant to the disease area (e.g., hypertension and stroke).
Diffusion:
The KeepInTouch system is not yet on the market either in Italy or worldwide. The first region to use the technology will be Sardinia (Sardinia is the first region to have terrestrial digital coverage in 2008). Twenty patients will be enrolled for the test [http://www.techonyou.com/progettoASL.html].
Cost, infrastructure and economic consequences:
There are no data presently available on the cost of KeepInTouch (not yet on the market) for the national health service. The cost for the manufacturer will be mainly to sustain the design and production of the system (smart-KIT and base-KIT). Chronic patients already own devices such glucometers, while other patients have to pay for other equipment (e.g., sphygmomanometer and scales).
Presently the technology can only be used when a DVB-T connection is available. In 2012 the service will be available throughout Italy [www.dgtvi.it] and the 27 member states of the European Union [www.dvb.org]. The national health service supplies their patients with measurement instruments for some chronic diseases (diabetics). The other instruments have to be able to interface with personal computers.
New care units will have to be created (made up of one or more healthcare workers) within the hospital or surgery to monitor the data sent by all patients. The software should eliminate routine data collection. The GP needs to have a visualization system to check the data.
Ethical, social, legal, political and cultural impact:
 

Evidence & Policy

Clinical evidence and safety:
We carried out a literature search of the CRD (DARE & HTA) and EuroScan databases looked for reports in English on Horizon Scanning and rapid Health Technology Assessment. Our searches did not identify any documents on Tele-Home Care systems based on digital terrestrial technology. We looked for studies carried out over the last 10 years (January 1999 to June 2009) by searching EMBASE, Medline, and the Cochrane Library. The search found 6 potential studies which were then excluded as they were not reporting systems based on DVB-T.
Economic evaluation:
 
Ongoing research:
As we are reporting an emerging technology, we also searched grey literature, by looking for published and unpublished abstracts and presentations. In Italy, the first region to test a THC system based on DVB-T technology (in particular the KeepInTouch system) in everyday practice will be Sardinia [http://www.techonyou.com/progettoASL.html].

Ongoing or planned HTA:
 
Web link:
http://www.agenas.it/cote.html
References and sources:
Dellifraine JL, Dansky KH. Home-based telehealth: a review and meta-analysis. J Telemed Telecare. 2008;14(2):62-6.

Tran K, Polisena J, Coyle D, et al. Home telehealth for chronic disease management [Tecnology Report number 113]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2008.

Lamminen H, Lugmayr A, Niiranen S, Kalli S. Proposed model of a digital video-based home telecare system. Telemed J E Health. 2002 Winter;8(4):387-94.

Angius G, Pani D, Raffo L, Randaccio P. A DVB-T framework for the remote monitoring of cardiopathic and diabetic patients. Computers in Cardiology, 2008; 35:1001-1004.

Tarantini L.- La prevenzione nello scompenso cardiaco – ISBN 978-88-490-0127-3 – Il pensiero scientifico editore 2005.

A.V. Dati epidemiologici di riferimento - Ital Heart J Suppl 2003; 4 (11): 893-903

http://www.federcardio.it/informazioneScientifica/LineeGuida/documenti/20030269.pdf

Ministero della Salute. Epidemiologia del diabete mellito - Ministero della Salute – Giornata mondiale del diabete 2003. http://www.ministerosalute.it/dettaglio/pdPrimoPiano.jsp?id=196&sub=4&lang=it (last access 15st July 2009).

http://www.techonyou.com

http://www.techonyou.com/progettoASL.html

http://www.dgtvi.it

http://www.dvb.org/news_events/dvbscene_magazine/DVB-SCENE Issue 21 lo res.pdf

Notes:
This report is based on information available when the searches were made and does not contain data on subsequent developments or improvements of the evaluated technology. The observations made on effectiveness, safety or cost-effectiveness of the technology evaluated in the report are to be considered temporary.