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Simulated case management of home telemonitoring to assess the impact of different alert algorithms on work-load and clinical decisions

Gyllensten, Illapha Cuba; Crundall-Goode, Amanda; Aarts, Ronald M.; Goode, Kevin M.


Illapha Cuba Gyllensten

Amanda Crundall-Goode

Ronald M. Aarts

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Dr Kevin Goode
Research Systems Project Manager / Business Analyst


© 2017 The Author(s). Background: Home telemonitoring (HTM) of chronic heart failure (HF) promises to improve care by timely indications when a patient's condition is worsening. Simple rules of sudden weight change have been demonstrated to generate many alerts with poor sensitivity. Trend alert algorithms and bio-impedance (a more sensitive marker of fluid change), should produce fewer false alerts and reduce workload. However, comparisons between such approaches on the decisions made and the time spent reviewing alerts has not been studied. Methods: Using HTM data from an observational trial of 91 HF patients, a simulated telemonitoring station was created and used to present virtual caseloads to clinicians experienced with HF HTM systems. Clinicians were randomised to either a simple (i.e. an increase of 2 kg in the past 3 days) or advanced alert method (either a moving average weight algorithm or bio-impedance cumulative sum algorithm). Results: In total 16 clinicians reviewed the caseloads, 8 randomised to a simple alert method and 8 to the advanced alert methods. Total time to review the caseloads was lower in the advanced arms than the simple arm (80 ± 42 vs. 149 ± 82 min) but agreements on actions between clinicians were low (Fleiss kappa 0.33 and 0.31) and despite having high sensitivity many alerts in the bio-impedance arm were not considered to need further action. Conclusion: Advanced alerting algorithms with higher specificity are likely to reduce the time spent by clinicians and increase the percentage of time spent on changes rated as most meaningful. Work is needed to present bio-impedance alerts in a manner which is intuitive for clinicians.


Gyllensten, I. C., Crundall-Goode, A., Aarts, R. M., & Goode, K. M. (2017). Simulated case management of home telemonitoring to assess the impact of different alert algorithms on work-load and clinical decisions. BMC Medical Informatics and Decision Making, 17(1),

Journal Article Type Article
Acceptance Date Dec 9, 2016
Online Publication Date Jan 17, 2017
Publication Date Jan 17, 2017
Deposit Date Mar 10, 2017
Publicly Available Date Mar 10, 2017
Journal BMC medical informatics and decision making
Electronic ISSN 1472-6947
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 17
Issue 1
Article Number ARTN 11
Keywords Health Policy; Health Informatics
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Publisher URL
Additional Information This is a copy of an article published in BMC medical informatics and decision making, 2017, v.17 issue 11.


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© The Author(s). 2017 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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