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Fragmented thinking (gov and industry) hobbles healthcare technology enablement

Devices, devices, everywhere. I guess I just don't get telehealth-related technology 'progress' -- it seems like two steps forward in one area and a few backward somewhere else. On the one hand, there will be 15 million mobile and wireless telehealth devices by 2012, says an ABI July 22 research report, devices that will be jabbering away with information about our chronic disease measurement readings. Kind of exciting, especially for those who may be home-bound or live a long (or traffic-jammed) distance from the doctor's office. But who's going to monitor their readings? Oh yeah, the current health providers (aka today's doctors and nurses in hospitals and standard practice settings).

Yay - states recognize 'tele' in healthcare -- one state at a time. In other telehealth news, New Hampshire and Wyoming passed legislation this spring that ended the requirement that health insurers only reimburse for face-to-face visits. That's good. Meanwhile, in January a medical malpractice insurance company issued guidelines for doctors when using the telephone and e-mail ('check your spelling and grammar and never use all caps').  Okay -- these are signs of progress. But you gotta pause and sigh. Let's imagine the progress of one state at a time deciding that their state has a shortage of doctors and an overabundance of driving distances ('windshield time').  Now let's imagine that wording in each state (as in New Hampshire) requires that tele-anything fit into 'current scope of practice', avoiding anything 'experimental'. Fifty states may take a few years. And a doctor responding to a call in New Hampshire better not be trying to diagnose a patient in Wyoming with different state licensing requirements.

Consumer moves forward, despite the industry. Meanwhile, back at the alternative medicine ranch, US consumers are now spending $34 billion per year on homeopathic remedies, acupuncture, and practitioner visits not covered by health insurance (CDC and NIH survey). And a telephone/e-mail doctor consulting service like TelaDoc has grown from 300,000 to 1 million subscribes within 18 months. But of course, we all believe the commonly accepted theory that consumers won't pay for healthcare delivery outside of the insurance reimbursement system.  And so one insurance reimbursement scenario at a time will be assessed.

What care will we expect as we age? Meanwhile aging-in-place baby boomer and senior consumers will exercise their power to stay out of the car when possible -- even in short-haul traffic zones, and especially for the 72% of today's non-emergency care visits to the doctor and ER (per the AMA). They will seek and switch to a telephone-prescribing, e-mail responding (spelling and grammar checked!), online chatting, remote monitoring, video conferencing, alternative-medicine-aware set of providers.

Who will provide it? These will include nurses, EMT-trained response services, walk-in clinics, and consultative pharmacists to help them deal with their diabetes, renew a prescription, respond to changes in their blood pressure.  As we get smarter about what exists to help us, we will understand that solving multiple physical ailment issues is not going to be left up to risk-averse insurance companies, states, federal programs, and yes, to doctors. Yeah, sounds crazy, I know.

But who knows, maybe all of the above, plus a way to lower the cost of malpractice insurance and improve prescription coverage nationwide, will be in the latest health care bill before Congress.



You have hit the nail on the head again. The technology, care, management and delivery SYSTEMS, and funding must march forward in lock step or very little real change can occur, despite great ideas and products.
And it must match the reality of the processes of aging- chronic and progressive.
That is a tall order. Many recognize the breadth of the problem, few are taking a large enough view to see how coordination is a requirement for the solution.

You have put your finger on an important topic here, Laurie. Viva the consumer-driven revolution! Steve

I think government is generally not interested in facing the aging issue in general. The task is too great, and politicians only look to the next election. Industry, on the other hand, is profit driven and will constantly look for ways to solve problems (so long as there's money to be made).

Right now many seniors are far from relatives and live isolated in homes they own. They need friendship and care. My wife is an RN at a doctor's office and talks to patients about their medicine one the phone. Some need simple companionship and use doctor's office visits to meet this need.

We need to really get with it in terms of helping people stay at home and get the care they need. Technology will be coming in quickly to help in health matters. I hope I can help.