As health care costs escalate, medical and technology providers are pooling resources to create affordable, cutting-edge solutions for patients recovering

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

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

“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:


  • QRS Diagnostic,

  • Texas Children's Hospital,