What Will You Do With All That Telemedicine Data?

Neil Chesanow

Disclosures

December 18, 2014

In This Article

The Rise of the Machines

More and more devices can remotely monitor patients and wirelessly transmit data on their state of health to monitoring clinicians around the clock. Such devices are increasingly being approved by the US Food and Drug Administration (FDA) as safe and effective.

But the growing prevalence of monitoring devices is starting to make many doctors nervous as they contemplate how they will deal with all the data they may receive. And if you work in an environment where reimbursement will increasingly be based on outcomes—a hospital, a practice owned by a hospital system, an accountable care organization (ACO), or a patient-centered medical home (PCMH)—this dilemma may affect you sooner than you may think.

The remote monitoring market includes blood management and function monitors, cardiac event and function monitors, neurologic event monitors, and respiratory function monitors, among others. Blood pressure cuffs, cardiac event recorders, ECGs, EEGs, EMGs, EOGs, fetal heart monitors, glucometers, cardioverter defibrillators, nasal airflow sensors, pacemaker monitors, pulse oximeters, spirometers, thermometers, ultrasounds, and weight scales, to cite just a few, are now available in wireless versions.

Monitoring Performed Primarily by Patients

Many physicians fear that once remote patient monitoring becomes the standard of care, they will be deluged with patient data that they will then need to evaluate and, in some cases, act on in a timely fashion, when there already aren't enough hours in the day.

Several methods exist to prevent data overload. In one scenario, patients monitor their own data and assume responsibility for taking corrective measures. Or patient data can be wirelessly beamed to a device vendor, which monitors the data and notifies a doctor only when necessary. Or the data can be sent to an independent testing facility that will do the required physician notifications. Or the data will be transmitted to a hospital system, which will alert the monitoring doctor if there is cause for concern.

The first two methods are likely to predominate, predicts cardiac electrophysiologist David Lee Scher, MD, clinical associate professor of medicine at Pennsylvania State University in Hershey, Pennsylvania, and chairman of the Healthcare Information and Management Systems Society (HIMSS) Mobile Health Roadmap Task Force.

With patient self-monitoring, patients use such devices as glucometers, blood pressure cuffs, and weight scales that mate with smartphone or computer apps to wirelessly transmit and store measured data points, Dr Scher explains. These are "closed-loop systems," he says, meaning that "patients treat themselves based on the data," which can also be wirelessly shared with a monitoring clinician.

For example, says Dr Scher, Glooko™ offers a device that attaches to a nonwireless glucometer to give it wireless capabilities.[1] It enables synching of blood glucose data on a companion smartphone app, integrates food and lifestyle data, has a patient education component, and allows for real-time connection between patients and providers. On the provider end, another smartphone app wirelessly receives and displays date of birth, diabetes type, average glucose reading per day, standard deviation, and individuals who may soon be at risk for multiple patients at once.

"The advantage of this operational model is that you don't have to navigate the healthcare system to do it," Dr Scher says. "It actually promotes patient self-treatment with regard to motivation and behavior issues. The disadvantage is that you always have the potential for irresponsible patient response or monitoring. Elderly patients, for example, or people with mental health issues, may not be the best ones to do this without caregiver support."

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