Post CES reflection on role of technology and Alzheimer's.
Boston, mid-May, 2016
It's another health tech day and Mayo Clinic concludes a study. So who knew? Telehealth monitoring is not effective at keeping patients out of the hospital! So reports a new study from those who (repeatedly) study these things. Does that bode ill for telehealth marketers, who fervently hope that pending re-hospitalization penalties would energize a long-lived but relatively small market. Use of telemonitoring equipment, the study concluded, should continue to be limited to studies. And oh, by the way, doctors need to 'learn how to do something with all of that data!' Yeah, no kidding. Apparently, knowing nothing about the patient's condition except for 'routine' primary care visits with doctors ($$) and specialists ($$$), we learn that with only 205 elderly patients from Minnesota, half (103? 102?) were chosen to be monitored by the now-defunct Intel Health Guide, reborn last year in a GE-Intel spinoff as the Care Innovations Guide.
Being monitored is a risk to one's health. Here's how the Mayo Clinic study apparently worked: It was comprised of "five to ten minutes of measurements taken daily and [participants] also talked with nurses over the phone and could video-conference with them if they needed help." Among those monitored, there were more deaths, in comparison to those who continued with their regular face-to-face see-the-doctor routine. Would you conclude that there is a correlation, unexplained, between telehealth monitoring and risk of death? Or perhaps you said to yourself, maybe we have seen this one before. Might one wonder about the resemblance of this study to the 2010 Yale study (also deemed an indicator of the 'failure' of telehealth) in which patients were required to telephone in their results? Oh, right, there's that 'tele' in telehealth. We certainly wouldn't connect it to the VA study of 2008 that demonstrated improved outcomes for patients whose 'non-institutional' care was coordinated and supported by telehealth technologies used by the (thousands) of participants and which the VA, no surprise, continues to deploy.
Duh, could there be a slight difference in reimbursement? Meanwhile, the wireless health market will reach $38 billion by 2016 (!!!) with 45% of the share coming from the US in 2011. Oh, but they must still be talking about fitness, fertility tracking and white noise generation. These do not require a prescription from your doctor, who is facing a 'cash crunch' and apparently in the Medicare realm may be motivated to encourage repeat visits, which may not be 'convenient' for the patient. Exactly. So what can encourage the doctor to refer or deploy a telehealth device? Many believe that fear of patient readmission to the hospital is a near-term enabler. These readmission incidents are being counted in reports now being generated to prepare for looming October 2012 penalties. But was there a specific recommendation of telehealth as an admission-avoidance tactic? Read this summary: "Essentially, the Act authorizes subsidizing some of the cost hospitals will incur in their efforts to reduce readmission rates.The program is to include patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by appropriate healthcare professionals." So the hospital and doctors can rely on people to keep Mr. Smith and Mrs. Jones from readmission within the 30-day period, using home visits, phone calls, and whatever else. So does anything fundamentally change? Not until the reimbursements are rearranged in favor of telehealth, as is underway in Australia, for one. Why would a doctor, outside of a doomsday study funded at Mayo Clinic, Yale or wherever, be really serious about making telehealth work?
Excessive use of telemonitoring studies could do more harm than good. There are plenty of technologies out today that could help in the care of frail and at-risk seniors, whether in a hospital, in a skilled nursing facility, or in assisted living. You can search for them on this site and many others. They include bed sensors that suggest to a nurse that a patient be turned to avoid bedsores, wireless devices that enable a wandering patient (even en route to the bathroom) or resident to be tracked, remote and home monitoring technologies, self-care devices, including telehealth-enabled blood pressure cuffs, weight scales and fall detectors, that patients and residents could be trained to use before a repeat emergency room visit is required. Insurance companies -- giants like Humana, for example -- along with hospitals, Medicare, and everybody else are also in the yet-another-research-study mindset before committing themselves to inclusion of telehealth technology in their strategies. With everyone waiting for the Godot of studies to end all studies, medications are routinely mismanaged, patients fall out of bed, changes in vital signs are missed, and risk reduction and preventive treatments continue to depend on the labor of an ever-scarcer population of skilled people who deliver most of that care face-to-face. Can it be that so many other aspects of our lives are dramatically altered when a technology is introduced (books, travel, communication, car safety) and yet we continue to stumble along in a paper-and-person and nearly technology-free health system?