Developing an improved framework for telemonitoring heart failure patients

Telemonitoring can help manage patients with heart failure, but evaluating its true impact can be difficult. In response, researchers examined previous studies to establish criteria, which were divided into six classes: dimensions: clinical, economic, user perspective, educational, organizational, and technical. Findings were published in the Journal of Medical Internet Research.

The team first listed criteria previously used in published works for noninvasive heart failure telemonitoring, describing how telemonitoring is used and organizing them into a standardized evaluation framework.

“Telemonitoring interventions are complex: They involve many different actors with different backgrounds, they use technical devices and they change the usual process of care,” stated first author Troskah Farnia, MSc, with Sorbonne Universités in Paris, and colleagues. “They can impact healthcare on many levels: patient access to care, health and quality of life, patient and care provider education, family and care provider workload, organization of the patient care pathway, healthcare costs and more. A comprehensive telemonitoring evaluation framework therefore needs to be multidimensional.”

Articles included in the analysis were published from January 1990 to August 2015 and were collected from MEDLINE, Web of Science and EMBASE. Only original reports using noninvasive heart failure telemonitoring evaluations in English were eligible.

A total of 128 articles were reviewed and researchers identified 52 criteria classified into six dimensions. Clinical and economic impacts accounted for 70 percent of studies while educational, organizational and technical impacts were included in less than 15 percent. User perspective was the most frequently covered dimension while telemonitoring was in its development stage, but the focus changed to clinical and economic impacts in later stages of development.

“Comprehensive telemonitoring evaluation frameworks should cover all six dimensions and help users choose the appropriate dimensions and evaluation criteria depending on the phase of their telemonitoring project lifecycle and the perspective of telemonitoring actors or external stakeholders they want to adopt,” concluded Farnia and colleagues. “Our next goal is to build such a framework for noninvasive HF telemonitoring, deliberately emphasizing the technical, organizational, and educational dimensions that have been neglected by previous telemonitoring assessment studies. We will test this framework on an ongoing HF telemonitoring project.”