System offers clinics daily CHF monitoring

Automated data prevent hospitalizations

While third-party monitoring of congestive heart failure (CHF) patients is better than no monitoring, a new technology offers a way to bring it in-house with potentially impressive quality outcomes.

Mary Jo Macklem, RN, nurse clinician in the CHF Clinic of the Park Nicollet Clinic in Minne-apolis, uses the system, Cardiocom, for daily patient feedback. "We can quickly review [patients’] current weight, symptoms, medications, and trends on the screen and know specifically who needs our assistance."

By using the Cardiocom CHF management program, at $50 a month per patient, health care organizations can eliminate outside monitoring fees of at least $150 a month per patient, according to Daniel Cosentino, president of Cardiocom, based in Excelsior, MN. Daily monitoring also offers a high probability of preventing hospital readmissions, which average about $7,000 per episode. (See QI/TQM, January 2000, cover story.)

Cardiocom entered the commercial market in October 1999, and already it’s been installed in health care systems around the country, Cosentino says. Patients welcome the ease of use and the closer ties with their nurses. Soon, the company will expand the program to include blood-pressure and pulse-rate monitoring.

The basis of the system is a Telescale placed in the patient’s home. It connects into an electrical outlet and the phone jack. Equipped with a computer chip, the Telescale transmits the patient’s weight to the clinic’s computer via the phone line. It also sends the patient’s answers to 12 questions regarding key signs of an impending CHF crisis. Some of the questions cover medication compliance, shortness of breath, and decreased urine output. It takes patients roughly two minutes to step on the scale, dial the clinic, and answer the wellness questions. They have their choice of communication modes: voice or a numeric or Braille key pad.

"Clinicians only spend time with patients who need it the most," Cosentino says. "The daily monitoring is better than random calls that can miss patients who are headed for a crisis."

Patient data reaches the provider within 30 seconds. The system records the data and alerts staff about patients requiring intervention. It compiles customized reports to mesh with the user’s existing record-keeping system. Routine reports include:

• individual patient summaries;

• trend reports on the clinic’s CHF patient population;

• hospital and emergency room admissions.

Macklem uses Cardiocom for patients with the highest risk of readmission. "Most of them are elderly people who had compliance issues or who have bad vision and could not see a regular home scale. Before we introduced Cardiocom, they would not have weighed themselves every day. If they only weighed themselves once a week, they could have gone into a crisis before they weighed themselves again."

The initial concern at Park Nicollet centered on the patients’ acceptance of and compliance with daily monitoring. As it turned out, "Most of the patients are thrilled with the Telescale," says Macklem. "Some even say it’s like having a home visit by us each day. We can catch a change in symptoms before a crisis develops. When we call the patient, we have the footwork done."

The ease of use that patients enjoy extends to providers as well. She says the system was up and running within a few days after the phone lines were installed.

Cost details

Users pay $50 per month for each patient monitored. The minimum is 100 patients, or $5,000 a month. Here’s what the fee covers:

1. Cardiocom software with free upgrades as they become available. The software can be integrated into the provider’s existing network. Data are generated in a Microsoft Access database and are compatible with other commonly used software packages.

2. A computer with accessories, including the required modems, a 17" color monitor, a re-writable and recordable CD-ROM drive, and a laser printer. As the patient population increases, additional modems and memory are provided.

3. A Telescale for each patient in the program. Shipping fees for the scale are extra. The amount varies. Sometimes the delivery goes directly to patients’ homes. Other providers request bulk shipment to a hospital or clinic for distribution to patients.

4. Installation and on-site training. One condition prospective users need to consider is that Medicare does not reimburse for the monitoring, Cosentino acknowledges. "But we’re working on that."

Need More Information?

For CHF patient monitoring, contact:

- Mary Jo Macklem, RN, Nurse Clinician, CHF Clinic, Park Nicollet Heart Center, Meadowbrook Medical Building, Suite W200, 6490 Excelsior Blvd., St. Louis Park, MN 55426. Telephone: (612) 993-3509.

For details on Cardiocom automated patient feedback systems, contact:

- Daniel Cosentino, Cardiocom, LLC, 20640 Linwood Road, Excelsior, MN 55331. Telephone: (888) 243-8881. E-mail: dlcosen