title: Detecting deterioration in patients with chronic disease using telemonitoring: navigating the 'trough of disillusionment'.
abstract: OBJECTIVE
  To examine the evidence base for telemonitoring designed for patients who have chronic obstructive pulmonary disease and heart failure, and to assess whether telemonitoring fulfils the principles of monitoring and is ready for implementation into routine settings.
  
  
  METHODS
  Qualitative data collection using interviews and participation in a multi-path mapping process.
  
  
  METHODS
  Twenty-six purposively selected informants completed semi-structured interviews and 24 individuals with expertise in the relevant clinical and informatics domains from academia, industry, policy and provider organizations and participated in a multi-path mapping workshop.
  
  
  RESULTS
  The evidence base for the effectiveness of telemonitoring is weak and inconsistent, with insufficient cost-effectiveness studies. When considered against an accepted definition of monitoring, telemonitoring is found wanting. Telemonitoring has not been able so far to ensure that the technologies fit into the life world of the patient and into the clinical and organizational milieu of health service delivery systems.
  
  
  CONCLUSIONS
  To develop effective telemonitoring for patients with chronic disease, more attention needs to be given to agreeing the central aim of early detection and, to ensure potential implementation, engaging a wide range of stakeholders in the design process, especially patients and clinicians.
authors.affiliation: Department of Primary Care and Public Health, Clinical Epidemiology Interdisciplinary Research Group, Cardiff University, Cardiff, UK. elwyng@cardiff.ac.uk
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Alex R
authors.initials: AR
authors.lastname: Hardisty
authors.forename: Susan C
authors.initials: SC
authors.lastname: Peirce
authors.forename: Carl
authors.initials: C
authors.lastname: May
authors.forename: Robert
authors.initials: R
authors.lastname: Evans
authors.forename: Douglas K R
authors.initials: DK
authors.lastname: Robinson
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Bolton
authors.forename: Zaheer
authors.initials: Z
authors.lastname: Yousef
authors.forename: Edward C
authors.initials: EC
authors.lastname: Conley
authors.forename: Omer F
authors.initials: OF
authors.lastname: Rana
authors.forename: W Alex
authors.initials: WA
authors.lastname: Gray
authors.forename: Alun D
authors.initials: AD
authors.lastname: Preece
mesh_terms: D002908:Chronic Disease; D004059:Diffusion of Innovation; D018450:Disease Progression; D006282:Health Personnel / Q000523:psychology; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D036301:Qualitative Research; D019114:Remote Consultation / Q000379:methods; D013686:Telemetry / Q000379:methods*; D006113:United Kingdom