Case Studies

• Due to a combination of language barriers, hearing deficits and dementia, the patient repeatedly denied symptoms of edema, but consistent readings from AMC's telehealth scale and blood pressure device indicated otherwise.
• The patient was brought in for further evaluation and an acute renal issue was identified.
• He was immediately scheduled for surgical intervention, after which his blood pressure stabilized.
• The patient was discharged from home care with goals met.

• She was given a blood glucose meter, a scale and a blood pressure device.
• The RN telehealth coordinator was able to provide effective nutrition education based on the blood glucose patterns that emerged from the daily readings.
• The coordinator also used telemonitoring data to strategically schedule clinic appointments to adjust medications and help the patient work with her clinicians to take ownership of her care and manage her diabetes.
• After these interventions, her HgA1C was reduced from 14.3 to 9.5, which is equivalent to a blood sugar decrease from more than 418mg/dl to 261mg/dl.

• Daily information transmitted from AMC system showed incremental but steadily increasing blood pressure, most likely a result of the latest medication change.
• Medications were adjusted accordingly, thereby preventing further complications of an already complex situation.
• The complexity of the case was contributing to the patient's anxiety, and the patient stated that having the daily readings from the blood pressure and blood glucose devices provided constant reassurance that her symptoms were not as severe as she imagined.

• The patient was discharged to home care and AMC telemonitoring was ordered.
• Low BP readings began to come in to home care, but the physician believed they were most likely anomalies. Nevertheless, the RN was able to use subsequent daily blood pressure readings to confirm to the physician that a pattern of low blood pressure (diastolic consistently <50) had indeed been established.
• Medications were decreased, after which the patient's blood pressure stabilized.
• The RN indicated that having the daily data made all the difference, as the patterns of low blood pressure would not have been obvious from intermittently scheduled face-to-face clinical encounters.

• Her blood pressure appeared stabilized upon the initial visit of the homecare RN, and next visit was scheduled to take place a week later. AMC blood pressure telemonitoring was initiated.
• The telemonitoring device soon began transmitting high blood pressure values, but the RN questioned the accuracy given her findings on the first visit. She suggested that these readings were a result of device malfunction, but agreed to meet AMC technicians at the patient's home.
• Upon arrival at the home, the patient was ashen and clearly clinically decompensating. The RN confirmed the high blood pressure manually and discovered that the daughter had not filled the patient's blood pressure medication prescription.
• An emergency room trip was prevented, and the patient was immediately issued AMC's medication management system to ensure medication compliance.

• The patient worked with the clinician to understand the significance of the biometric values and to be aware of symptoms.
• Upon alarmingly elevated readings and corresponding symptoms, the patient went to the ER on his own initiative.
• At the ER, the patient presented his AMC login card to the physician.
• The ER physician was struck by the wealth of available information including medical history, physician and emergency contact numbers, recent readings, active and inactive meds and flowcharted results.
• Immediate clinical intervention was started and the patient was transitioned to home care after contact with the patient's primary care doctor.
• The ER physician credited the information provided by the AMC system for helping to make the correct diagnosis and appropriate interventions unlike the majority of patients who arrive at the ER with no accompanying information.

• The physician initiated a regimen change and ordered AMC telemonitoring.
• Subsequent readings indicated that the patient was not responding to the new regimen as anticipated and the home care RN scheduled a home visit.
• The RN discovered a discrepancy between the medication listing on the AMC Web portal and the medications found in the home, with dangerous contraindications identified.
• The RN worked with the patient and physician to clarify an appropriate regimen, (removing the inappropriate meds from the home), and later readings confirmed stabilization of vital signs.
• Both the RN and physician articulated that had they not had this web-based patient record through AMC, the discrepancy would not have been discovered.

• Discharge department arranged for AMC telemonitoring upon arrival home.
• RN took baseline BP reading of 100/60, and scheduled next home visit to take place 5 days later.
• Two hours later after the baseline assessment, the telemonitoring devices were installed and immediately began transmitting alert readings of 81/52, which were verified repeatedly.
• 911 was called by the telehealth coordinator and the patient's physician was notified
• Within 3 hours of the RN's baseline assessment, the patient was back in the hospital and was not discharged again until stabilized.
• The telehealth coordinator stated that had they waited for the next home visit to assess vitals the patient would likely not have survived

• Patient was set up for AMC telemonitoring which included a BP device and a scale.
• Homecare field RN made an initial visit, made sure that the patient knew how to use the telehealth unit, instructed her in signs and symptoms to report and scheduled her next visit to take place in 3 days.
• The next day the telehealth RN coordinator viewed the patient's results and found that the pt's weight was 2 lbs above her baseline taken the day before.
• Field RN was contacted and made a visit that day. The patient told her she was a "short of breath" but didn't want to bother the nurse because she knew she would be seeing her in a just a few days.
• RN contacted the physician from the home, the diuretic was increased and the next day the patient's weight was back at baseline.
• An ER visit and most likely a hospitalization were averted.

• A baseline glucose reading upon enrollment was 346 and the patient was immediately placed on AMC telemonitoring, with the patient instructed to send readings multiple times a day - before and after meals - to assess her diet's role in her disease. Subsequent evaluation determined that insulin and not diet was likely required to stabilize the patient, but repeated calls to the physician brought no response.
• Patient was hospitalized with glucose of 480, was stabilized and discharged with insulin.
• Physician now agreed to cooperate with the homecare diabetes team, and together, with quotidian data from the telemonitoring system, they have been able to keep the patient's glucose stable at between 80-180 and the wound has healed.
• By using the telemonitoring effectively, homecare staff not only were able to determine the most effective approach to bring the patient's blood sugar under control, but the case's severity would have dictated far more visits to the patients' home had telemonitoring data not substituted for many in-person readings.

• Soon after discharge, the patient collapsed at the cardiologist's office with very low BP
• Cardiologist was able to stabilize the patient in the office, and upon learning that the patient has telemonitoring set up at home, recommended home monitoring instead of rehospitalization after suspending all cardiac Rx, save Lasix every other day.
• Cardiologist worked with the telehealth RN, using trending analysis from AMC telemonitoring to slowly reintroduce Rx and keep the patient stabilized at home.
• Patient's BP remained stable for the duration of the episode, and there were no re-hospitalizations.