Telehealth involves incorporating care beyond traditional clinics and hospitals, and into two more domains: (1) at home, (2) in the community. Thomas Nesbitt, MD MPH, at the University of California, Davis, spoke at UC Davis’s most recent monthly Health IT seminar covering the future of telehealth. I covered some of the questions concerning telehealth in my earlier post; here, I’ll cover some of the challenges he touched upon during his talk.
At home, telehealth can potentially manage chronic diseases better. We are used to seeing health professionals during sporadic one-time episodes. Care management models are migrating towards more frequent patient contact and regular physiologic management.
This can make things like managing hypertension more accurate. Some patients might forget to take their meds for awhile, so they “spiff themselves up” beforehand to make it appear as if they were more compliant before a doctor’s visit. Or perhaps they get “white coat hypertension,” becoming more nervous while in the doctor’s office.
Telehealth can instead monitor blood pressure on a more frequent basis to have a more accurate picture of a patient’s day-to-day blood pressure.
Sensors like this SecuraPatch Sensor can help track heart rate, respiration rate, falls, stress, skin temperature, activity, caloric burn, and even body posture. It’s nearly the size of a Band-Aid but does a whole lot more!
Projects from the VA in the mid-2000’s, dedicated medical devices and peripherals for iPhones (and, I hope, Android devices), and even pills with embedded chips (as previously covered by Stephen Colbert in Cheating Death) demonstrate how telehealth can work at home.
But we’ll have to tackle issues like:
- How much intrusion patients will allow into their lives?
- How can we create chronic disease management models in smaller practices — not just big practices like Kaiser?
- How can we manage the deluge of data and make it something patients & doctors can use?
In the community, telehealth can help physicians to treat patients beyond their local areas.
In fact, projects allow specialists to do great consultation work in underserved communities. Otolaryngologists can evaluate middle-ear disease in the Alaska Federal Health Care Access Network with otoscopes operated by high-schoolers. Opthalmology, dermatology, and even psychiatry are evaluating patients in clinics and hospitals where specialists aren’t available. We could even do virtual reality remote physical therapy — something Jay Han, MD, a physiatrist at UC Davis, is already involved in!
This saves money by reducing the need for waiting rooms, staff, and exam rooms, all of which essentially duplicate a primary care office.
We’re heading towards more portable, cheaper devices that can transmit information over the Internet for specialists, like iPhone-based otoscopes, Lippman bluetooth stethoscope with recording capabilities, Livecor electrocardiogram pads on the iPhone, and even portable ultrasound devices.
Issues that need to be addressed include:
- What kind of providers can assist at these remote sites? Pharmacists? High schoolers?
- How sustainable are these new technologies? Will they work together?
- How can they be incorporated into the Accountable Care Organization (ACO) model and the Primary Care Medical Home (PCMH) models?
Dr. Nesbitt’s talk really excited me about where healthcare is heading. These new technologies should help break down time-consuming communication barriers (e.g. fax machines, telephones) and make healthcare more accessible, affordable, and exciting for individual folks.