Home telehealth: the future of home care
Shereene Z. Idriss
The following article summarizes some of the major
points made in the new book, Home Telehealth: Connecting Care within the
Community, edited by Richard Wootton, Centre for Online Health,
Queensland, Australia, Susan L. Dimmick, adjunct associate professor,
University of Tennessee Health Sciences Center, Memphis, and Joseph C.
Kvedar, M.D., founder and director, Partners Telemedicine, Harvard Medical
In recent years, home care has faced a number of
challenges that have led many to question how healthcare will be efficiently
and effectively delivered in the future. The combination of increased
healthcare spending, provider shortages and an aging population has put
homecare at a crossroads, where change has become a rapid necessity. That
change is evident with the creation of a virtual model of care known as home
telehealth — delivering state of the art hospital care in the home without
interrupting the routine of everyday life, widely known today as connected
This new model of connected health is available through the
application of available consumer technologies to enable such services as
remote monitoring, activity monitoring, and the delivery of disease
management and wellness programs. By implementing this new system of care in
the management of chronic diseases and wellness programs, we are already
seeing many valuable benefits. For example, treatment outcomes and patient
care are improving.
As a result of this success, we will continue to see
marked improvement in the management of chronic diseases, along with a
decrease in the overall annual expenditure via connected health programs. In
addition, as advancements in information technologies continue to be
introduced, connected health is becoming more readily accessible to a wider
population base, hence diminishing the effects of provider shortages.
With an annual expenditure rate exceeding
billions of dollars worldwide, the management of chronic diseases has proven
to be the biggest challenge for both patients and healthcare providers. A
remote monitoring system, such as a home based management program for
chronic diseases, will improve healthcare outcomes and the cost
effectiveness of care.
One excellent example of a disease management program already being
implemented, and that has so far proven to be successful, is the use of
connected health in the monitoring of heart failure patients. Two
technology-enabled approaches are being used for better managing patients at
risk for heart failure: one via the telephone, and the second via
In the first approach, a nurse replaces the in-house visit with a weekly
telephone call, during which the nurse reviews the patient’s status, and
counseling and educational support are offered to the patient. The challenge
that has surfaced with this system is the reliability of patient self
A second program, using telemonitoring, has demonstrated a reduction in
mortality without utilizing healthcare resources, which has been achieved
using available consumer electronics. Daily measures of body weight and
blood pressure are recorded via sensors, which transmit the data wirelessly
to an interface unit in the patient’s home. The information is then
transferred to central servers for further evaluation by the patient’s
healthcare provider. Patients can connect with their healthcare provider
through email, and some offer videoconferencing capabilities so that
patients and physicians can hold direct teleconsultations. An additional
component to telemonitoring is the ‘Smart System Design’ enabling
knowledge-based optimizing algorithms, which facilitate and improve decision
making by capturing and recording data trends.
There is some concern about the ‘medicalization’ of the home setting, and
much work is underway to improve the technology and remote interactions
between patients and healthcare providers. To that end, researchers have
developed ‘wear and forget’ sensors that fit into patients’ lives, such as a
physiological adhesive monitoring patch. However, it is important not to
lose sight of the bigger goals of remote monitoring. Transitioning from an
institution-centered model of care to a patient-centered system, by
empowering the patient to better manage their own care, will aid in
improving treatment outcomes and patients’ quality of life, while reducing
overall healthcare costs.
monitoring is not confined to remote monitoring of chronic diseases. It also
includes a broad spectrum of activity monitoring. For instance, it would
allow healthcare providers, family members or caretakers to measure the
physical activities of elderly patients, either actively or passively, via
two monitoring systems.
The first consists of a sensor, worn by the individual at all times, that
records the patient’s vital signs and motor functions. The measurements
obtained are transmitted wirelessly, in real time, and are very accurate and
precise since movement is as natural and unrestricted as possible. However,
such a system is not practical for long term monitoring because carrying the
sensor becomes a burden over time.
The second monitoring system uses a more passive approach. It senses a
person’s presence in a room by motion detectors installed throughout the
living quarters, such as infrared, light, magnetic and temperature sensors.
Movement patterns are then analyzed for unusual behavior. This activity
monitoring system, with very little cost associated with its maintenance,
would be appropriate for long term monitoring of vital signs and movement,
and can reduce anxiety among elderly patients and family members. However,
as with the worn sensors, certain disadvantages have surfaced as well. For
example, a lack of privacy, the inability to detect the patient’s true
health condition, confinement to spaces and difficulty in detecting
immediate emergencies, have all been reported.
concerning activity monitoring of elderly patients include fall monitoring,
which aides in the prevention, detection and prediction of falls.
Since the implementation of telehealth in the home setting,
many consumer technologies have been integrated in the management of health
and wellness. The use of telephones, cellular phones, the Internet, and even
non-communicating devices such as digital cameras and sensors, have had an
impact in re-shaping the image of home telehealth and wellness programs. By
constantly ‘being connected,’ patients are more involved in the
decision-making process regarding their treatment and overall health
In one study, telephones featuring a smart feedback system,
were used to provide education and counseling as part of a smoking cessation
program. This lifestyle management system, also known as Telephone-Linked
Care (TLC), had overall positive responses from the users who, with time,
had formed personal relationships with the technology.
Other services are being offered via mobile telephones. For instance, for
diabetic patients, mobile telephone-based messaging services remind patients
to take their medications. Moreover, generalized access to broadband
services in industrialized nations has rendered the Internet a common
gateway to information regarding health issues.
Expanding on this service, several academic centers, such as Harvard
University, are incorporating both the use of the Internet and digital
cameras, to offer online electronic consultations. One of the first areas of
medicine to utilize e-consultations is dermatology, where patients
electronically transmit photos of their condition, taken with a digital
camera, to their healthcare provider for review.
To further underscore the importance of connected health and the use of
technology in providing quality patient care in the home, we are seeing
technology companies, employers, payers, providers and others coming
together to shape the future of telehealth.
For example, the Continua Health Alliance is the definition of a modern
day ecosystem. Continua has brought together leading technology, healthcare
and fitness companies to better address the need for proactive involvement
of patients in their healthcare needs through the application of consumer
technologies. One major initiative of the Continua Alliance is the
development of technology standards for a wide range of interoperable
devices from fitness equipment to heart monitors and weight scales, that
will help individuals best manage their health.
The United States and
European Union are two dominant markets for the use of connected health in
homecare service. Within the United States, over 260 million people have a
land line connected, over 190 million are cell phone users, and
approximately 200 million are Internet users. The European Union has roughly
an equivalent number of people connected to land lines, but prevails over
the U.S. with more than 300 million cell phone users and 230 million
This represents a tremendous opportunity to further expand and implement
connected health programs, taking advantage of the technology already in
place in most countries.
The impact of telehealth on the delivery of care
appears to be very promising. Patient empowerment, cost reductions, improved
efficiencies and quality of care are benefits to be gained through its
implementation in the home setting. So far, advancements in home telehealth
have been focused primarily on disease management centered on the elderly.
Nonetheless, a wide array of management programs, such as asthma control,
can also be implemented within the pediatric population. With chronic
diseases affecting such a broad patient population base, many have come to
believe that the future of disease prevention and management lies within the
realm of e-visits.