Air Care

As health care costs escalate, medical and technology providers are pooling resources to create affordable, cutting-edge solutions for patients recovering in their homes. A prime example is a joint venture involving QRS Diagnostic, Terry Respiratory, Respironics and Houston’s Texas Children’s Hospital to provide quality support for pediatric lung-transplant patients.

TCH serves young lung-transplant patients from Texas, Louisiana, Arkansas, Missouri and other states in the region. The ability to send those children home with accurate post-operative care, no matter where they live, and to monitor them directly — yet remotely, via a direct hook-up to the hospital’s pulmonary function lab — is proving to be an important part of successful recuperation.

The story begins with George B. Mallory, M.D., associate professor of pediatrics at Baylor College of Medicine and director of the lung-transplant program at TCH. Before coming to Houston, Mallory had developed the transplant program at St. Louis Children’s Hospital, where he was responsible for 130 pediatric lung-transplant patients. After surgery, those patients were sent home with a conventional spirometer for testing the volume and velocity of airflow from their transplanted lungs.

“Decreased pulmonary function is an early, and critical, indicator of possible transplant rejection, and careful, detailed, ongoing surveillance of lung health is one of the keys to a good outcome,” Mallory says.

“We did not have a direct automated way to get the actual numbers and monitor flow-volume curves remotely, so we asked families to send us written logs of the test results,” he continues. “One of our disappointments in St. Louis was poor adherence to our requests for daily spirometry after we sent our patients home.”

Determined to find a better way in Houston, Mallory contacted Houston-based Terry Respiratory, a provider of high-end, home respiratory services for infants and children, and asked for help.

“From the start, Dr. Mallory and I understood the essential attributes of an ideal solution,” says Terry Hull, CRT, RCP, and Terry Respiratory’s director of operations. “We had to have an accurate spirometer that would be convenient and easy for kids and their families to use at home. And, it had to support real-time [applications] and remote access to the test results so TCH could monitor patients’ lung function at any time, no matter how far from Houston they lived.”

Based on a recommendation from Murrysville, Pa.-based Respironics, a business partner and primary distributor of spirometry devices for Plymouth, Minn.-based QRS Diagnostic, Hull found the perfect tool for successful monitoring. QRS’ SpiroCard is a medical device that slides into the PC card drives of personal digital assistants, notebook computers and hand-held PCs. With its digital storage capacity for test results, the device allows the host equipment to work as a full-function spirometer to provide clear, concise and accurate pulmonary function testing while digitally storing hundreds of test results.

David Blanco, a pulmonary diagnostic lab technician working with Mallory at TCH, tested SpiroCard side-by-side with his laboratory spirometer, and the results proved “dead-on accurate,” Mallory says.

In July 2002, Terry Respiratory, Respironics and TCH explored how to deploy the device to enable remote access to test results. “I knew we could use SpiroCard with Office Medic software from QRS to collect and then store and manage the test results. The proverbial light bulb clicked on when I realized we could put SpiroCard and Office Medic on a notebook PC with pcAnywhere (a remote computer access solution from IT company Symantec),” Hull says. “That would allow the nurses and respiratory therapists at TCH to access the kids’ results via a modern modem connection at any time, and [the patients’] geographic distance from Houston would not be a problem.”

Refinement of the set-up even allows the lung-transplant patients to collect their own data for transmittal. Prior to leaving TCH, they receive SpiroCard and a notebook PC as well as training to ensure they use the device correctly.

“We access the results right from our center,” Mallory says. “Out of our first five kids using at-home monitoring, four — three of them using [the SpiroCard system] and one using a different system — have shown excellent proficiency, and their parents have proven to be worthy of helping the kids, if needed.”

Use of the system has proven liberating to the children and their parents and, according to Mallory, assures medical staff, patients and families that recovery is going well.

“It’s amazing to see the kids’ faces light up the first time they use SpiroCard, because these kids have struggled just to breathe, have dreamed of living a normal life and have spent so much time in doctors’ offices and hospitals,” Hull says. “After having their lung function tested so many times in clinics and hospitals, they immediately realize that SpiroCard gives them personal control and freedom. The doctors can monitor their lung function without [the kids] having to leave home yet again … and they value the freedom of just being out and away from the hospital.”

The next step is to get insurance providers to reimburse the remote monitoring. Hull has created a packaged solution that includes the SpiroCard device and Office Medic software; a Compaq Evo notebook computer; set-up and testing of the computer with SpiroCard and the software; a year’s supply of pre-calibrated, disposable mouthpieces; lifetime support of the system; and all processing of payer approvals. The cost: $6,500 to $8,500 for the complete package.

“Having spent some $200,000 to $300,000 to care for kids prior to transplant and for the transplant itself, the additional cost for home-based spirometry and remote monitoring is a modest, incremental investment for payers,” Hull says. “Plus, it eliminates the need for many follow-up office visits and repeat visits to the hospital pulmonary function lab.”

So far, Mallory’s results confirm the importance of at-home monitoring in terms of health and cost savings — indicators that should impress health insurers.

“It is too soon to tell about acceptance by the insurance providers, but one of the strongest arguments you can make with a company that has not had experience with this kind of equipment is [that] we have a track record, and one that seems to be working well,” Mallory says. “One of our kids with a six-month checkup is doing so well and we are so pleased with the communication that we eliminated the nine-month checkup, which is easily a savings of $4,000 in testing. I can argue in theory that it is cost-effective, and I like to think we will be successful with the insurers.”
— David Aquilina contributed to this article.

To learn more about the companies and organizations involved in this project, visit the following Web sites:

• Respironics, www.respironics.com
• QRS Diagnostic, www.qrsdiagnostic.com
• Texas Children’s Hospital, www.texaschildrenshospital.org