Stanley Finkelstein, Ph.D.

Professor
612-625-6406
stan@umn.edu

Research Interests

Patient monitoring systems: home monitoring for transplant patients, telemedicine in chronic disease management, cardiovascular risk factors-arterial compliance, decision support systems, patient adherence, data visualization.

Dr. Finkelstein is an electrical engineer whose research utilizes engineering principles to develop monitoring systems for chronic illnesses. In one of his projects he is investigating the vascular impedance (resistance, compliance) properties of the arteriovascular system. He and his colleagues in the study, including Dr. Jay N. Cohn in the Cardiovascular Division, Department of Medicine, have developed techniques to indirectly assess two measures of arteriovascular compliance: One is capacitive compliance, which is related to the ability of the system to store volumes of blood (cardiac output); the second is oscillatory or reflective compliance primarily related to the stiffness or compliance of the smaller vessels and contributes to the development of reflected pressure waves and resonances in the system. The investigators are looking at how these properties differ between healthy humans and those with cardiovascular disease, such as hypertension or congestive heart failure, as well as diabetes. For example, studies indicate that these compliance measurements can be used in the treatment decisions for people classified as borderline hypertensive by standard blood pressure cuff measurement. They have developed the technology into a noninvasive, easy-to-use method for assessing the arterial vascular compliance status in a clinical setting.

Finkelstein and another group of colleagues in Pulmonary Medicine, Nursing, and Biostatistics have developed a home monitoring system for lung and heart-lung transplant patients to assist in detecting infection and rejection at the earliest possible stage. Using an electronic spirometer and diary system, patients are able to take measurements reliably at home. Spirometry, vital signs, and symptom information are recorded daily in this electronic, paperless diary/spirometer instrument and transmitted by telephone to the study database for weekly review and evaluation. Patients can assist their medical team by providing information that is helpful for predicting an infection or rejection episode. The system can facilitate the detection of adverse health trends earlier than is now practical by regular clinic visits, so that patients can be treated before serious complications develop. In addition to instrumentation and telecommunications concerns, project investigators are developing methods to improve patient adherence to home monitoring, provide effective data visualization tools for clinicians evaluating the large data sets generated by home monitoring, and implementing decision support systems to assist the clinical team in assessing patient status from home monitoring data.

Dr. Finkelstein and colleagues in the Division of Health Informatics have developed and implemented telemedicine applications for chronic disease management, with a focus on telemedicine from the home (telehomecare). The telehomecare virtual visits utilize videoconferencing, Internet access, and physiological monitoring to provide skilled nursing care to homebound patients; the home health care nurse at the clinical site and the patient at home interact using telemedicine technology.  Both nurses and patients give these visits high marks in terms of satisfaction, technical quality, and clinical utility.  Telehomecare can be a cost effective way to increase access to care utilizing monitoring and telecommunications technology. Project investigators are exploring new monitoring tools to follow a broader range of disease entities, as well as utilizing broadband services as they become available in rural areas to provide cost effective access to health services to a traditionally under-served population.

Recent Publications

• Sabati N, Snyder M, Edin Stibbe C, Lindgren B, Finkelstein SM. Facilitators and barriers to adherence with home monitoring using home spirometry. AACN Clinical Issues  12:178-185, 2001
• Arnett DK, Glasser SP, McVeigh G, Prineas R, Finkelstein S, Donahue R, Cohn JN, Sinaiko A. Blood pressure and arterial compliance in young adults: the Minnesota Children’s Blood Pressure Study. Am J Hypertension 14:200-205, 2001
• Finkelstein SM, Speedie SM, Lundgren JM, Demiris G, Ideker M. TeleHomeCare: virtual visits from the patient home. Home Health Care Management and Practice 13:219-226, 2001
• Demiris G, Speedie S, Finkelstein S. The nature of communication in virtual home care visits. Proc Amer Med Informatics Assoc  135-138, 2001.
• Beltran A, McVeigh G, Morgan D, Glasser SP, Neutel JM, Weber M, Finkelstein SM, Cohn JN.  Arterial compliance abnormalities in isolated systolic hypertension.  Am J Hypertension  14:1007-1011, 2001
• Demiris G, Speedie S, Finkelstein SM. Change of patients perceptions of telehomecare. Telemedicine J. and e-Health 7:241-248, 2001
• Demiris G, Speedie S, Finkelstein S. Considerations for the design of a Web-based clinical monitoring and educational system for elderly patients. J Am Med Informatics Assoc 8:468-472, 2001
• Finkelstein SM, Speedie SM, Demiris G, Hoff M, Lundgren JM. Telemedicine in home healthcare. Proc State of the Science Conference on Telerehabilitation and Virtual Reality, pp. 94-97, October 2001, Washington DC
• Lindgren BR, Snyder M, Sabati,N, Adam T, Pieczkiewicz D,  Finkelstein SM. Health locus of control and adherence with home spirometry use in lung transplant recipients. Progress in Transplantation  12: 24-29, 2002
• Veen M, Finkelstein SM, Speedie S, Lundgren JM. Patient satisfaction with telehomecare. Proc 24^th Annual International Conf EMBS (2nd Joint EMBS-BMES Conf) 24: 1845-1846, 2002
• Mullan B, Snyder M, Lindgren B, Finkelstein SM, Hertz M. Home monitoring for lung transplant candidates. Progress in Transplantation 13:176-182, 2003
• Grey E, Bratteli C, Glasser SP, Alinder C, Finkelstein SM, Lindgren BR, Cohn JN. Reduced small artery but not large artery elasticity is an independent risk marker for cardiovascular events. Am J Hypertension 16: 265-269, 2003
• Demiris G, Speedie S, Finkelstein S, Harris I.  Communication patterns and technical quality of virtual visits in home care. J Telemedicine and Telecare 9:210-215, 2003
• Finkelstein SM, Speedie SM, Demiris G, Veen M, Lundgren JM, Potthoff S. TeleHomeCare: quality, perception, satisfaction. Telemedicine J and e-Health  10: 122-128, 2004
• Pieczkiewicz DS, Finkelstein SM, Hertz MI. The Influence of Display Format on Decision-Making in  a Lung Transplant Home Monitoring Program – Preliminary Results.  Proc Eng Med Biology Soc Conf, 25: 3653-3656, 2003
• Finkelstein S, Speedie S. The return of the house call. Minnesota Physician 17: 1, 10-11, 2004
• Duprez D, Kaiser D, Whitwam W, Finkelstein S, Belalcazar A, Patterson R, Glasser S, Cohn JN. Determinants of radial artery pulse wave analysis in asymptomatic individuals. Am J Hypt 17:647-653, 2004
• Troiani JS, Finkelstein SM, Hertz MI. Incomplete event documentation in medical records of lung transplant recipients. Prog Transplantation  15: 173-177, 2005 
• Finkelstein SM, Scudiero A, Lindgren B, Snyder M, Hertz MI. Decision support for the triage of lung transplant recipients based on home monitoring spirometry and symptom reporting. Heart & Lung 34:201-208, 2005
• Karl BC, Finkelstein SM, Robiner WN. The design of an Internet-based system to maintain home monitoring adherence by lung transplant recipients. IEEE Trans Information Tech Biomedicine, 2005 (in press)
• Finkelstein SM, Speedie SM, Potthoff S. Home telehealth: a way to provide quality care at lower cost.  MN Physician 19: 22-23, 2005