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Tele-what?

As a journalist who for the last decade has covered the use of information technology in health care, I’m rather disgusted at some of my brethren in the mass media. I’m none too happy with the medical establishment, either. Both seem hopelessly stuck in the past, refusing to look beyond the status quo. And the public suffers because of it.

This fall, for example, the Los Angeles Times and other news outlets covered a Yale University study that sought to determine whether or not “telemonitoring” heart failure patients recently discharged from the hospital would reduce heart attacks or readmission. The study, published in the New England Journal of Medicine and presented at a November meeting of the American Heath Association, concluded that that telemonitoring, which involved patients calling in their weight measurements and health symptoms after being discharged, made virtually no difference in the outcome. The Times called the trial “a good, commonsense idea that simply didn’t work out.”

Was it, really?

Keeping in touch with one’s physician on a frequent basis after being hospitalized for heart failure is a fine idea, as is monitoring one’s weight. But, as happened in the Yale study, patients generally don’t stick with the program. One in seven study participants never called their doctors, while just 55 percent of patients were making at least three calls per week six months after discharge.

“We had a lot of faith and hope that providing increased information could improve outcomes,” study leader Dr. Sarwat I. Chaudhry of Yale told the Times. “Obviously that wasn’t enough.”

Of course it wasn’t enough. Chaudry was relying on an old form of technology, namely the telephone. Worse yet, he counted on patients to make the calls.

Calling this “telemonitoring” and “telemedicine,” as the Times did, represents twentieth-century thinking. Instead of blindly complimenting the good intentions of an experiment that was, in fact, almost bound to fail, the Times should have been asking about more modern forms of telemedicine, such as active monitoring from portable sensors that take readings in real time, just like telemetry equipment in hospitals.

There’s a new generation of sensors designed to be worn around-the-clock by patients with chronic diseases like heart failure or diabetes. Many of these devices are wireless-enabled for easy connection to a home network or to a cell phone, and automatically send alerts to caregivers or on-call nurses whenever there’s an abnormal reading. The right sensor can detect a heart murmur or dangerous change in body temperature, for example, before the wearer even notices something might be wrong. And all the patient has to do is make sure it’s on. There are no calls to make and no readings to write down. Sure, this technology is pricey, but if it keeps people with chronic diseases and post-operative patients out of the hospital, it just might pay for itself—and offer users a better quality of life. Several health insurers and private institutions have studies underway hoping to prove this theory.

A Spanish study, presented at the European Society of Cardiology’s Heart Failure Congress in Germany last June, showed that a home-based, active-monitoring system, plus remote access to healthcare providers over broadband Internet connections, reduced hospitalization rates by 63 percent, cut inpatient days by nearly 75 percent, and significantly boosted quality of life for patients with heart failure. A similar remote-monitoring program at the Henry Ford Health System in Detroit decreased hospital admissions by 36 percent over a six-month period, while producing a more than 2-to-1 return on investment. A Department of Veterans Affairs hospital in Clarksburg, W. Va., has slashed inpatient hospitalization days and visits to the emergency room with wireless monitoring of patients with diabetes, congestive heart failure, pulmonary disease, or hypertension.

Skeptics such as Forbes magazine’s health editor, Robert Langreth, may call remote patient monitoring “overhyped” because the Yale trial and one other study from Germany “show, shockingly, that better communication may not be enough.”

The problem with assessments like Langreth’s is that he’s comparing apples to oranges. Cutting-edge forms of telemonitoring collect real vital signs in real time, then automatically transmit that data to an electronic medical record or alert a caregiver in case something is abnormal. All the patient has to do is wear or step on the device and make sure everything is turned on. There’s no transcribing of readings and no manual calls to be made.

That’s the promise of telehealth, telemedicine, telemonitoring or whatever “tele-” phrase you prefer. Here’s a good, commonsense idea for reporters: Think about the technology you see pretty much everywhere but the hospital or doctor’s office—on smartphones, in video game consoles and even at the self-service check-out at the grocery store that knows if you’ve bagged the item you just scanned. And start asking the health-care organizations you cover why they still rely on old-fashioned telephones and fax machines.

Neil Versel is a professional healthcare IT journalist. He has been covering healthcare IT since 2000, across a wide range of publications including his blog, Meaningful HIT News with Neil Versel.

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Kimberly S.LyndseyMargalit Gur-ArieMD as HELLBruce Recent comment authors
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Kimberly S.
Guest

Telehealth was created to save money and to try to keep people out of the hospital. Medicare is now even covering some telehealth services. Wound care is one area that telehealth has really shown to be beneficial. Chronic wounds create a lot of hospital follow up appointments, debridement (surgery), and home health care services. In people with limited mobility this can be a tough diagnosis to be compliant with. With telehealth a physician can monitor a wound daily and decide if it is getting better or worse or needs further treatment before it gets to the point of long hospitalizations… Read more »

Lyndsey
Guest

So glad to see some more news on this subject, even if it is about studies using what could now be considered “antiquated” monitoring techniques. At least we are talking about it! As someone in her 20’s I would prefer monitoring using auto-transmitted technologies. I almost expect to have it by the time I need it (hopefully in the much distant future). The world of tele-whatever holds tons of value, and I’d like to see a study where the use the most up-to-date monitoring as you suggest Neil. We put together a podcast on the subject this month that your… Read more »

Bill Crounse, MD
Guest

Great post, Neil. The health industry has too many pilots and not enough implementations even when the pilots show promising results. Of course, the current reimbursement system with its perverse incentives to maintain the status quo and reward the “old ways” of doing things is largely responsible for the stagnation.

Bill Crounse, MD

Neil Versel
Guest

This originally ran in Columbia Journalism Review, which is why it is geared toward reporters who cover health care. http://www.cjr.org/the_observatory/tele-what.php

Christopher Cassidy
Guest

Great Post! It seems to me that the focus on prevention needs to be the greater focus. If 600m people are actively using a social network, how is it not possible to use this technology to enable motivating tools?

Bruce
Guest
Bruce

Christopher Cassidy asks a good question: If 600million people are actively using a social network, how is it not possible to use this technology to enable motivating tools?
As a hospital-based bedside nurse for more than 20 years I will say that the healthcare community—hospitals, doctors, HMOs, insurers, etc.—should not depend on phone calls FROM patients. Either utilize self-reporting, wireless devices and broadband networks to report patients’ data, as Neil suggests, or a healthcare rep. needs to phone the patient.

MD as HELL
Guest
MD as HELL

HIPAA. Government is in the way.

Neil Versel
Guest

So you’re saying get rid of HIPAA and just make it a free-for-all with people’s health data? Fantastic.

MD as HELL
Guest
MD as HELL

I am not saying that. I am saying that is what will prevent anyone from promoting individual healthcare data exchange via social media.

But protecting “people’s health data” is overrated. If they wish to share, they may share. I will not be sharing data I collect and interpret and customize without compensation.

Margalit Gur-Arie
Guest

MD as HELL, if your ED or urgent care is using an EHR, you may already be “sharing” more than you know…. Check the fine print.

Bruce
Guest
Bruce

Yes it is. Yet, people deserve to have their medical information protected (along with lots of other information that isn’t as secure as it ought to be). HIPAA, as I know personally, being a nurse, was government’s over-wrought attempt to protect individuals’ medical info. For now, it may be that having more than less protection is an acceptable price to pay.
Besides, HIPAA is government’s response to peoples’ desire for privacy protection. I choose not to say it’s government’s fault; that’s too simplistic for me. HIPAA should be revamped and reformed.

BobbyG
Guest

J.D. Kleinke has a set of YouTube’d presentations (a Medco audience) in which he addresses HIPAA. His take, IIRC, was that the privacy stuff was an 11th hour legislative staff afterthought add-in.

http://www.jdkonline.com/videos.html

It’s a long set of 5 YouTubes, close to an hour in the agrregate

MD as HELL
Guest
MD as HELL

HIPAA was cover for concealing HIV.

BobbyG
Guest

See “The Connected Patient: charting the vital signs of remote health monitoring”

http://www.chcf.org/%7E/media/Files/PDF/T/PDF%20TheConnectedPatient.pdf