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March 16, 2005
Dr. Jeffrey Spaeder is an instructor at Johns Hopkins, and one of his main projects is TeleWatch, which monitors patients with chronic heart failure remotely, anywhere in the world.
How did you start at Hopkins?
Dr. Spaeder: I came here initially as a medical student. Aside from a brief training in Pittsburg and in St. Louis, I have been at Johns Hopkins since graduating from medical school. I did my internal medicine residency training here, and then I was the first NIH Johns Hopkins cardiology fellow. I actually spent two years down at the National Library of Medicine during that fellowship working on medical informatics projects, and I started as faculty when I graduated from that fellowship.
What is your current line of research?
Dr. Spaeder: I am an instructor in Cardiology here at Johns Hopkins, and my research involves developing novel ways of utilizing technology to manage large patient populations with chronic illnesses.
What kind of patients are you working with?
Dr. Spaeder: I started off mainly treating patients with heart failure and other chronic cardiovascular illnesses, which are the most common causes of hospitalization for patients of age 65 in America. This is a problem that is going to continue to become bigger as the population ages.
What we primarily do is develop ways to monitor patients remotely in their homes or away from the hospital and try to combine the remote monitoring of these people with the detection of either inadequate therapy or early clinical deteriorations of the clinical condition. We combine that with validated interventions, which can result in either improving outcomes or reducing the need for hospitalizations.
How important is telemedicine for your work?
Dr. Spaeder: Telemedicine is the center of my research. I think it going to become increasingly important in the way of managing patients. There are just too many patients who have these chronic illnesses, and logistically it is going to become increasingly difficult, if not impossible, to deliver the type of monitoring these patients require.
Telemedicine is going to become more important as the complexity of illness and the complexity of treating patients increase as we get new medications that have different types of side effects. I think that Telemedicine is certainly central to my research, and I think it’s going to become increasingly important in the future.
What is the TeleWatch system?
Dr. Spaeder: The kind of remote monitoring we have been researching for the past four and a half years resulted in the development of a telemedicine system called TeleWatch telemedicine system, which is accepted by the FDA for use at the clinical management of patients. We have performed several studies both at medical institutions as well as in collaboration with Johns Hopkins healthcare, and through this system we have enrolled close to 700 patients in the system since the summer of 2001.
TeleWatch is a voice-interactive, two-way, telemedicine technology that only requires the patient to have access a push button telephone. We ask the patients a variety of questions, which we have validated and tested in focus groups, as well as based on our clinical experience. We ask patients to self-collect important physiologic information, and we ask them a variety of symptom questions, and with these questions the system automatically evaluates the information for any abnormal changes in the patients, either in their symptoms or in their physiologic information. Then, we alert the proper healthcare providers who are monitoring the system if it detects any abnormalities in these patients.
In this way we can monitor large patient populations very efficiently and we can focus our resources, and the care of our nurses and physicians only on those people who are having problems with either inadequate therapy or who are having early clinical deteriorations. It is a way to increase the number of people that we manage, increase the efficiency of our healthcare personnel, and it also results in patients anecdotally feeling more in control of their illness and of their symptoms.
How do the patients react to the system?
Dr. Spaeder: Because we haven’t published the study yet I cannot say the exact figures, but I can say that the patients use the system very regularly, so they obviously like using it, based on how regularly they use it. Also, the feedback we get from them is very high. We find that a significant number of patients believe that the system either helps them take care of their condition better or that they feel like they are in better control because somebody is monitoring them.
The fact that it is a telephone-based system which is easily accessible from a variety of places also makes it easy for the patients to use. They don’t have to worry about any complicated equipment in their home. They feel very comfortable with the system, and even elderly patients who we thought would be somewhat reluctant to use this technology have accepted it very well.
Who initiates the monitoring, the system or the patient?
Dr. Spaeder: We instruct the patients to call in a regular basis, depending on the severity of their illness. We know who has and has not called into the system, so if somebody has not called in we make the call. Most of the time, however, it is patient initiated, and again the fact that such a high percentage of patients are calling on a regular basis is strong evidence that the patients are really accepting this technology.
Could you share with us a story of how the system has improved patients’ lives?
Dr. Spaeder: Yes. There is one patient I would like to talk about because not only this technology is improving the quality of care we are delivering to our patients, but we also have evidence that it decreases hospitalization, and decreases cost.
There is one story that I particularly like, about an elderly gentleman from the Baltimore area who was an avid sailor, until he had a large heart attack, and was left with severe heart failure. He was admitted multiple times because of this heart failure, and he was so concerned about having another episode that he never went out on his sailboat late, which was his pride and joy, but had had so many heart failure admissions, that he never spent a night on his sailboat again, even though he used to love to go on sailing trips up and down the Chesapeake Bay. That is, until he got enrolled in the system.
He felt so comfortable with the way that the system monitored his symptoms, and he liked that someone was looking at his numbers on a daily basis, and he felt so much more in control of his health, that the summer after he enrolled in the system he went out and spent a week sailing up and down the Chesapeake Bay on his boat. Every morning he would sail into cell phone range, call in his information and sail back out, several hours later. Unfortunately he died over that winter, but at least the system gave him the ability to go out and do something that he enjoyed and that he felt comfortable with.
We also have stories of people leaving for the holidays to go see children and grandchildren far away; things that they have not done in the past because they were concerned about having a deterioration of their health while visiting other people. However, with this system they could keep in contact with the healthcare professionals back home; they had no problems, and were more active. So, not only we are seeing improvements in outcomes, but we are also seeing improvement in quality of life.
So, do patients have the ability to call when they are away from home?
Dr. Spaeder: We designed the system to be as flexible as possible, so that anywhere in the world where patients have access to a push button telephone, they can access the system.
What kind of population are you working with right now?
Dr. Spaeder: We are working with patients that have chronic cardiovascular illnesses, although we are expanding now to diabetes, obstructive lung disease and potentially some other chronic diseases also.
Is it going to play a role in preventive medicine?
Dr. Spaeder: I think there is certainly the potential for some preventive health uses. Things like weight loss, for instance. However, it will depend upon a provider, either a healthcare organization or insurance company making a commitment to invest in these types of conditions where the payoff of that prevention might be years or decades away. We are certainly interested in doing that, but unfortunately in the past people have not shown interest to make that kind of investment.
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