Internet-Based Home Asthma Telemonitoring*

Can Patients Handle the Technology?

Finkelstein, Joseph MD, PhD
Cabrera, Manuel R. MD
Hripcsak, George MD

*From the Department of Medical Informatics (Drs. Finkelstein and Hripcsak), Columbia University, New York, NY; and the Division of Pulmonary Medicine (Dr. Cabrera), Columbia Presbyterian Medical Center, New York, NY.

This work was supported by New York State Center for Advance Technology grant Computerized Pulmonary Monitoring Center and by National Library of Medicine training grant LM07079.

Manuscript received March 12, 1999; revision accepted July 23, 1999.

Correspondence to: Joseph Finkelstein, MD, PhD, Doctors Office Building, Suite 1102, 720 Harrison Ave, Boston, MA 02118; e-mail: [email protected]

Chest 117(1):p 148-155, January 2000.

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%), FEV₁ (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.