Abstract-Information and telecommunication technologies are called to play a major role in the changes that healthcare systems have to face to cope with chronic disease. This paper reports a telemedicine experience for the home care of chronic patients suffering from chronic obstructive pulmonary disease (COPD) and an integrated system designed to carry out this experience. To determine the impact on health, the chronic care telemedicine system was used during one year (2002) with 157 COPD patients in a clinical experiment; endpoints were readmissions and mortality. Patients in the intervention group were followed up at their homes and could contact the care team at any time through the call center. The care team shared a unique electronic chronic patient record (ECPR) accessible through the web-based patient management module or the home visit units. Results suggest that integrated home telemedicine services can support health professionals caring for patients with chronic disease, and improve their health. We have found that simple telemedicine services (ubiquitous access to ECPR, ECPR shared by care team, accessibility to case manager, problem reporting integrated in ECPR) can increase the number of patients that were not readmitted (51% intervention, 33% control), are acceptable to professionals, and involve low installation and exploitation costs. Further research is needed to determine the role of telemonitoring and televisit services for this kind of patients.

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We have developed a new model for the care of chronically ill patients, based on home care supported by remote monitoring technology and telemedicine. The variables monitored included non-invasive blood pressure, blood oxygen saturation, threelead electrocardiogram, spirometry (including flow-volume curve) and respiratory rate. The telemedicine system consisted of a home-based patient unit and a management centre that received information from the home units. The chronic care management centre was installed in two hospitals, in Spain (Barcelona) and Belgium (Leuven). We expect this to result in significant cost-savings and a better quality of care.

We have developed a new model for the care of chronically ill patients, based on home care supported by remote monitoring technology and telemedicine. The variables monitored included non-invasive blood pressure, blood oxygen saturation, threelead electrocardiogram, spirometry (including flow-volume curve) and respiratory rate. The telemedicine system consisted of a home-based patient unit and a management centre that received information from the home units. The chronic care management centre was installed in two hospitals, in Spain (Barcelona) and Belgium (Leuven). We expect this to result in significant cost-savings and a better quality of care.

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