I was reading a news report this weekend about a report RAND Corporation published on Pearl Harbor Day (sponsored by Royal Philips Electronics).  This reporting covered a survey of 100 health professionals and advocates in six countries- China, France, Germany, Singapore, the UK, and the USA- asking the question:  Can home healthcare monitoring help improve health care delivery in their countries.   In a nutshell- their answer is there is neither proof of cost-effectiveness nor of their ability to be readily adopted. The problems, as RAND sees it, are that insurance companies will not cover the practice, patients don’t understand the technology, and the support structure is lacking.

Remote health technology offers the ability for seniors to age in place (because they can be “monitored”), rather than be institutionalized.  It could possibly save money because remote monitoring would involve a higher multiple of patients per professional than our conventional model.  It is conceivable that one physician (with a trained paraprofessional force) could monitor 10,000 individuals, a high multiple of our current practices.

The largest employer of such techniques is the Veterans Administration (VA), which employs remote monitoring to enable veterans to manage chronic heart failure, hypertension, and diabetes.  Their program (Care Coordination/Home Telehealth  [CCHT]) has involved about 50000 patients employing devices such as videophones, biometric devices, digital cameras, and telemonitoring devices.  They published a report two years ago ( of 17025 subjects, 95% male over the age of 65) describing the technology’s ability to reduce the days hospitalized by 25%, along with a 19% reduction in hospital admissions; the average annual costs run well under $ 2000.

The problem is that this presents nothing new.  In the very early 1980’s, we were part of a “think tank” looking a new technologies that the “new AT&T” could develop and market.  [Remember that AT&T was to be split up into “Baby Bells” and a long distance/Bell lab entity then.]  Among our seven final candidates was teleheath delivery systems.  There were two problems then- a dearth of reliable devices and technology and an antipathic regulatory environment.

Almost two decades later, we were working with an entrepreneur (Ellee, you know who you are) who wanted to provide services for the elderly (primarily in Florida).  The goal was to be paid by the children of the retirees to monitor their elderly parents each morning and night.  Phone calls would be made via videophone, coupled with the use of one or two rudimentary devices available (because that’s all there was then, too) to insure their parents were doing ok.  The key was to use automatic dialing and computer technology, to keep the costs low- and to not rely upon insurance reimbursement for profitability.  And, now, an even more basic system is provided by ADT.

This is not to say that there are not valuable telehealth services afforded patients.  Such technology are primarily used  in rural areas and Indian reservations, but the regulatory environment needs radical adjustment for these concepts to thrive.  State governments resent the use of out-of-state medical professionals (who are not licensed [taxed?] by their authorities].  The Federal government questions the reliability of the devices.  Insurance companies do not generally reimburse for these services.

It’s clear that there are enough devices to satisfy the health care need.  And, there will be even more developed for this market if CMMS (Centers for Medicare and Medicaid Services), HHS (Health and Human Services) and the FDA (Food and Drug Administration) provide clear support and guidelines for the technologies involved.  We need to let people get their basic health information shared with their health practitioners on a routine basis.

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