Information technology

Home telehealth: the future of home care

Shereene Z. Idriss
Partners Telemedicine

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 School, Boston.

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 health.

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.

Remote monitoring

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 telemonitoring.

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 reporting.

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.

Activity monitoring

Home health 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.

Other technologies concerning activity monitoring of elderly patients include fall monitoring, which aides in the prevention, detection and prediction of falls.

Consumer Technologies

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 management.

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 internet users.

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.

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