Remote monitoring

Two tin cans and a wire -- is that common sense?  Over the hopping month of November, we learned that 500 million people will be using mHealth (mobile Health, sometimes also called wireless health and telehealth) by 2015.  But wait -- not so fast. Then came the wet blanket study from Yale -- the NY Times article described the 'disappointing results' with remote monitoring efficacy. The article quoted Eric Dishman, who "noted that the monitoring system in the Yale study relied on the patients to phone in their daily results. Many failed to do so."  So what the Yale study proved is that the use of technology with a bad process produces a disappointing result.  No kidding.  And because it was in the New England Journal of Medicine and written up in the NY Times, no doubt initiatives that are underway to extend deployment of remote monitoring of chronic disease will now be hobbled into re-justifying and explaining why their study is different, that their results (like the Veteran's Administration) are positive, blah, blah. That their forward motion is based on automatic transmission of results, automatic analysis of exceptions to baseline status, and a phone call TO the patient from a nurse. That after three months, more than 55% would still be participating because they received a benefit from being part of the study.  Now that would show common sense.

Geriatric care managers are cautious and waiting. (Warning: rant on). Last week I spoke about technology for aging in place to a room full of New England geriatric care managers (and a few home care agencies and senior housing folks as well).  When I talked about technology, particularly remote monitoring, filling the gap in hours covered by home care aides, they enthusiastically nodded in agreement. But when I ask if any are using this technology, I heard about interest, curiosity and upcoming pilot programs (no vendors picked yet), and the like. Ditto with the home care agencies represented in the exhibit area. What I didn't hear about -- confident or near-term likelihood of advocacy of a specific product.

MetLife today reminds us why aging in place, like long term care rates, will trend upward.  With MetLife's new study just out that updated nursing home, assisted living and home care rates -- it is no wonder that seniors will, whether or not it is appropriate for them, increasingly age outside the nursing home and assisted living realms. On average across the US, nursing home rates have risen 4.6% to $83,585 per year; assisted living is up 5.2% to $39,516 per year and home care aides now cost on average $21/hour.  Home care, in particular, is untenable as 24x7 coverage -- multiplying out to an impossible $183,960/year. Nursing homes have closed, assisted living facilities are not full. Given rising life expectancy, especially for women, combined with rising rates of diabetes and other chronic diseases, we seem to be approaching a conundrum of longer life and poorer choices and options. This represents both an opportunity and a dilemma for today's vendors:  the opportunity -- filling in care gaps of every type with remote monitoring, health and fitness tools, video, and wearable technology.  The dilemma -- recognition that those who will benefit most may be least able to pay for it as currently marketed and priced -- and until adoption is greater, price reductions and bundling into broader solutions is unlikely. 

Tangential to the talk: technology for an aging population. Looking through the agenda of the Connected Health Symposium in Boston, it's apparent in an agenda so densely packed with doctors (not to mention the attendees, with 26 just from Mass General Hospital) that this is not a conference about technology and aging (duh!).  And that is despite the fact that the biggest patient dilemma for both the businesses and providers packing the rooms remains the aging and very old patients who fill their offices and hospital beds and run up the largest bills at end of life.  Among the sponsors and exhibitors, these vendors stood out for me as important for serving an aging population. In alphabetical order: