Casting a Critical Eye Toward Telehealth

October 6, 2011 “Telehealth adds a new paradigm in healthcare, where the patient is monitored between physician office visits. This has been shown to significantly reduce hospitalizations and visits to the Emergency Room, while improving patient’s quality of life,” explains…

October 6, 2011

“Telehealth adds a new paradigm in healthcare, where the patient is monitored between physician office visits. This has been shown to significantly reduce hospitalizations and visits to the Emergency Room, while improving patient’s quality of life,” explains the Wikipedia entry on telehealth.

The thing is though, not everyone in field agrees that telehealth delivers on its promises.

An article on telehealth, for instance, published in Technology Review outlines the views of Harlan M. Krumholz, a Yale cardiologist who is openly skeptical about the technology’s prospects.

Krumholz takes on the notion that telehealth could represent a way to help cut healthcare costs or otherwise transform care. He partnered with another cardiologist, Sarwat I. Chaudhry, to oversee a study on the use of telehealth technology in the care of 16000 patients that were hospitalized for heart failure. Published in the New England Journal of Medicine, the study found that remote monitoring had no benefits.

Critics of that study, which include telehealth-sponsor Intel, criticized the study’s methodology, and point to a number of other studies that seem to indicate a number of benefits for home healthcare.

On LinkedIn, the Technology Review article is being discussed in the Wireless Health group and has thus far spurred 135 comments. Several of the commenters agree that evidence for telehealth’s efficacy is lacking. They then point out that though there is enormous potential in this space.

Our sister site, Medical Electronics Design, mentions the aforementioned Technology Review article and another article, also published on that site, which faults the reimbursement system for slowing remote monitoring’s adoption. In a blog, Jamie Hartford asks: “Do we need more studies to show that mobile health gets results? A reimbursement system that rewards its use? More patients demanding it? More doctors pushing it? More innovation from developers?”

Hartford summarizes by saying that we need a combination of all of the above. It seems like many people agree that, at least at present, the real benefits of telehealth are uncertain. Maybe telehealth can revolutionize the field, but how are we going to know that it will? Where will the funding for clinical studies come from with reimbursement for the technology being the challenge that it is?

Al Shar, Ph.D., M.A., vice president of information technology for the Robert Wood Johnson Foundation believes that we have crested the “Peak of Inflated Expectations” and are on track to hit what the so-called “Trough of Disillusionment” in the Gartner hype cycle (see the image at left from his blog. That blog, by the way, is well worth checking out).

My (current) take on telehealth is that it’s only a matter of time before it makes good on some of its promises to redefine care. It may be overhhyped at the moment, but as a growing segement of the population is burdened with chronic disease, they are going to want new ways to deal with those problems that don’t involve more visits to the doctor. For telehealth to catch on, remote monitoring has to be as non-intrusive in patients’ lives as possible. Think of the Ron Popeil phrase: “set it, and forget it!” Most patients are not going to want to work with technology that is a hassle to use that becomes something of a daily burden to them. At the risk of sounding trite, most people want to maintain their independence and the perceived freedom to choose their daily routine.

Another important consideration: the view that a patient is “discharged” from a hospital after a catastrophic event such as heart failure will likely begin to change in years to come, owing, in part, to programs such as the one at Baylor Hospital, which considers release from the hospital as an another stage of patient monitoring and not the end of it. As a result of implementing that philosophy, the hospital has the lowest readmission rates in the country for heart failure.

Brian Buntz