Telemedicine has been a ‘whiz-bang’ concept for some time. I remember working with AT&T right after their breakup from the baby bells (almost 20 years ago). We were working on the initial stages of a telemedicine system they would market. (The real issue was there were insufficient/inaccurate devices upon which we would initially rely.)
But, each year more and more devices are developed, broadband is coming more mainstream (affording faster and real time data transfer), so telemedicine is no longer ‘the future’. One of the biggest ways we can minimize our national healthcare costs is to employ such techniques to preclude hospitalizations.
Right now, there are several studies directed at keeping congestive heart failure (CHF) patients out of the hospital. [CHF is the leading cause of readmission to the hospital (25% return within 30 days of the event); there is data purporting that some 40% of these are not necessary.] Key metrics (vital signs such as weight, blood pressure, among others) need to be conveyed to a case manager or nurse. Warning signs can be detected before the patient needs to visit the emergency room- saving money and keeping the patient in a better emotional state.
Companies such as Humana and Anthem (WellPoint) are beginning to monitor these key metrics; video links are also used, when merited, to allow for nurse intervention. Intel is involved with a different clinical trial (Aetna is the co-sponsor) to determine how hospitalization events can be minimized when using remote monitoring systems.
For those patients who have defibrillators, their heart function data can be monitored. A small study (1400 patients) recently showed that in-hospital evaluations were reduced by 45%, as a result of this sort of monitoring;.
New sensors for pulmonary arterial pressure can be employed to transmit data. Changes can be detected, leading to intervention before a hospitalization is merited. (This study is ongoing; there seems to be a significant reduction in hospitalization (30%) among the 500+ patients involved in this study.)
Part of these studies will be to develop means of patient education. When the blood pressure cuff is not properly employed, wrong results ensue. Similarly, patient weight must be consistently determined- the donning of shoes can alter the weight notation.
With our health care costs climbing by 5 to 10% annually, we need to include more than just CHF patients in our telemedicine efforts.
