Chest 2000 Jan;117(1):148-55

Internet-based home asthma telemonitoring: can patients handle the technology?

Finkelstein J, Cabrera MR, Hripcsak G.

Department of Medical Informatics, Columbia University, New York, NY, USA.
finkelj@bu.edu

STUDY OBJECTIVE: To evaluate the validity of spirometry self-testing during home
telemonitoring and to assess the acceptance of an Internet-based home asthma
telemonitoring system by asthma patients. DESIGN: We studied an Internet-based
telemonitoring system that collected spirometry data and symptom reports from
asthma patients' homes for review by physicians in the medical center's clinical
information system. After a 40-min training session, patients completed an
electronic diary and performed spirometry testing twice daily on their own from
their homes for 3 weeks. A medical professional visited each patient by the end
of the third week of monitoring, 10 to 40 min after the patient had performed
self-testing, and asked the patient to perform the spirometry test again under
his supervision. We evaluated the validity of self-testing and surveyed the
patients attitude toward the technology using a standardized questionnaire.
SETTING: Telemonitoring was conducted in patients' homes in a low-income inner
city area. PATIENTS: Thirty-one consecutive asthma patients without regard to
computer experience. MEASUREMENT AND RESULTS: Thirty-one asthma patients
completed 3 weeks of monitoring. A paired t test showed no difference between
unsupervised and supervised home spirometry self-testing. The variability of FVC
(4.1%), FEV(1) (3. 7%), peak expiratory flow (7.9%), and other spirometric
indexes in our study was similar to the within-subject variability reported by
other researchers. Despite the fact that the majority of the patients (71%) had
no computer experience, they indicated that the self-testing was "not
complicated at all" or only "slightly complicated." The majority of patients
(87.1%) were strongly interested in using home asthma telemonitoring in the
future. CONCLUSIONS: Spirometry self-testing by asthma patients during
telemonitoring is valid and comparable to those tests collected under the
supervision of a trained medical professional. Internet-based home asthma
telemonitoring can be successfully implemented in a group of patients with no
computer background.