1. Duckett, Kathy BSN, RN

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Q: I have a remote telemonitoring program for my patients with heart failure, but I'm not gaining any traction with the program because my staff is unsure when to put in the telemonitoring equipment. Do you have any suggestions?


Remote telemonitoring has been shown to be effective in reducing rehospitalization and promoting self-management skills in patients with heart failure (Bashshur et al., 2014; Clarke et al., 2011; Giamouzis et al., 2012; Martin-Lesende et al., 2013). Although patients with heart failure have shown improved outcomes when telemonitoring is used, one of the biggest challenges for many home healthcare agencies is identifying the patient population who will benefit from telemonitoring. The criteria for patient admission vary among programs. There are successful programs that include everyone posthospitalization with either a heart failure diagnosis or an exacerbation of heart failure (Hoban et al., 2013), programs that also include patients who were hospitalized for symptoms related to heart failure without requiring a recent hospitalization for heart failure (Hall & Morris, 2010), and programs that delineate specific patient, disease, and technology criteria (Canady, 2008; Duckett, 2014). The important guideline for patient selection is to ensure the patients selected are based on the program goals and the ability of the patients to use the equipment selected (Duckett).


Although patient guidelines are important they cannot be so onerous that they are difficult for clinicians to remember. Choosing the right patients for the telemonitoring program is vital, but there may be additional elements at play for the lack of traction to your telemonitoring program. In addition to choosing the correct patient population, successful telemonitoring programs have several elements in common; the technology is easy to use for the patient, the program is easy to implement for the staff, there is a specific program in place with clear procedures and outcome expectations, and there is accountability at all levels for the success of the program. The successful telemonitoring program includes a designated program manager and must be integrated into usual and customary practice for the home healthcare agency.


Evaluating all aspects of your telemonitoring program will help you identify if there are underlying causes for lack of program adoption. If your program is having difficulty gaining the traction you believe it should have, patient selection may be the issue; however, there may be other programmatic issues in place that should be addressed.




Bashshur R. L., Shannon G. W., Smith B. R., Alverson D. C., Antoniotti N., Barsan W. G., ..., Yellowlees P. (2014). The empirical foundations of telemedicine interventions for chronic disease management. Telemedicine Journal and e-Health, 20(9), 769-800. doi:10.1089/tmj.2014.9981 [Context Link]


Canady L. M. (2008). Implementing a home telemonitoring program. Home Healthcare Nurse, 26(4), 231-236. Retrieved from[Context Link]




Clarke M., Shah A., Sharma U. (2011). Systematic review of studies on telemonitoring of patients with congestive heart failure: A meta-analysis. Journal of Telemedicine and Telecare, 17(1), 7-14. doi:10.1258/jtt.2010.100113 [Context Link]


Duckett K. (2014, September 21). Virtual home care: Remote monitoring of patients [Webinar]. Lorman Education Services. [Context Link]


Giamouzis G., Mastrogiannis D., Koutrakis K., Karayannis G., Parisis C., Rountas C., ..., Triposkiadis F. (2012). Telemonitoring in chronic heart failure: A systematic review. Cardiology Research and Practice, 2012, 410820. doi:10.1155/2012/410820 [Context Link]


Hall P., Morris M. (2010). Improving heart failure in home care with chronic disease management and telemonitoring. Home Healthcare Nurse, 28(10), 606-617. doi:10.1097/NHH.0b013e3181f85d14 [Context Link]


Hoban M. B., Fedor M., Reeder S., Chernick M. (2013). The effect of telemonitoring at home on quality of life and self-care behaviors of patients with heart failure. Home Healthcare Nurse, 31(7), 368-377. doi:10.1097/NHH.0b013e318291fd56 [Context Link]


Martin-Lesende I., Orruno E., Bilbao A., Vergara I., Cairo M. C., Bayon J. C., ..., Recalde E. (2013). Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial). BMC Health Services Research, 13, 118. Retrieved from[Context Link]