The cost of treating chronic disease in Canada can be greatly reduced with remote patient monitoring, according to research presented at a healthcare technology forum in Toronto earlier this year. Joseph Cafazzo, an engineer and lead at the Centre for Global eHealth Innovation at the Toronto General Hospital/University Health Network, noted that the legacy of technology's impact on chronic disease management hasn't been a good one. "There is a recognition that technology doesn't always serve patients well," he explained. "The tools we have are not as good we say they are, and we need to spend more time on evaluation of technologies."Cafazzo has high hopes though that technology can help reduce the cost of providing healthcare to people with chronic diseases. During the conference, he talked about the potential cost savings realized through remote patient monitoring in relation to the treatment of diabetes, particularly since the numbers of cases more than doubled from 1995 to 2005. A recent study, he noted, found that only 15% of diabetics were able to maintain adequate blood pressure levels. With this in mind, Cafazzo and colleagues set out to help create a better management system. But after reviewing literature on telemedicine and the management of diabetes, it became clear that they needed certain principles integrated into the system: the technology didn't interrupt clinician's day-to-day workflow; it was easy-to-use for patients; and the price tag wasn't too high.Moreover, the cost of devices and peripherals needed to be affordable for the remote monitoring to be adopted beyond a pilot project, added Cafazzo. "The costs need to be about $300 to $500 rather than $3,000 to $5,000 for this to be widespread," he said. "You should be able to buy the devices at stores like Wal-mart or Best Buy."Because affordability was a guiding principle in the design of the project, the investigators opted to use cell phone technology instead of a PC for transmitting patient data to an application server, explained Cafazzo."What was surprising is that we didn't find widespread use of the Internet for accessing health information in our focus group," he said. "There was not sophisticated use of the PC, so we decided we could not rely on patients using a PC on a regular basis in the project."The mobile phone was the most obvious choice to build a home blood pressure monitoring system," said Cafazzo. "We found patients to be less intimated by a mobile phone than by a PDA. When you look at the computational power of a mobile phone, it's extremely powerful. It has as much computational power as a PC did five years ago."Patients took readings with a blood pressure monitor, and then blood pressure readings were transmitted to an application server. From there, a written report was generated and faxed through to the care provider. Since physicians were loath to take part in the project because they weren't being financially compensated for their time, researchers were careful to minimize interruptions in their workday by having results faxed to physicians."Physicians were cynical about patients complying with this," said Cafazzo. "In addition, we saw it as a barrier if physicians had to go onto a PC to retrieve the data, so we made sure it was delivered to them via fax, respecting the existing workflow in family doctor offices. The design in most family doctors offices has been the same for the last two decades."To ensure robust adherence to the project, investigators left automated reminder messages on patients' voicemail, letting them know when they hadn't transmitted their readings."We took our cue from telemarketers in sending these reminders," said Cafazzo. "Some patients were annoyed at the reminders, but ultimately this improved adherence."Researchers found that 35% of patients met adequate blood pressure control after participating in the study.Patients' perceptions of the remote monitoring system were positive as well with 15 out of 20 indicating they wanted to continue to use the system after the project. About 18 out of 20 said they thought the blood pressure reports aided them and their doctor in deciding how best to treat hypertension. A total of seven out of 20 subjects said they would pay for the system to use it, and three indicated they would use it if the Ontario Health Insurance Plan covered the cost.The investigators conducted a similar project in the northern Ontario town of Chapleau and are currently analyzing results. In that project, investigators also solicited blood sugar readings from participants who were equipped with glucometry kits as well as blood pressure monitors. Similarly, they were asked to measure their readings and transmit the data via a mobile phone.A remote monitoring pilot project for kidney dialysis is also taking place, according to Cafazzo. Conventional dialysis requires that patients come into hospital about three times per week, with sessions lasting three to four hours of treatment. Home treatment is designed to be nocturnal, occurring while patients sleep. This remote monitoring project involves a much more complex design than the measurement and transmission of blood pressure alone though. All vital signs are being monitored, meaning a camera is set up in the patient's bedroom, and a bloodline disconnect monitor exists to alert investigators if any blood is spilled during treatment.If such a project can be done on a greater scale, the financial savings would be highly significant, noted Cafazzo.