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.