Telemonitoring is a specific form of "telemedicine," which is the use of telecommunication to provide health care at a distance. That can include sending images, video (e.g., for dermatology consults in rural areas), or person-to-person discussions such as via Skype. Remote monitoring devices and companies are proliferating rapidly since many individuals have sophisticated computers with Bluetooth and WiFi capabilities with them all the time—i.e., smartphones. These may be linked with biologic monitors such as watches with HR monitors, dedicated blood pressure monitors, or even biologically integrated sensors in the skin or deeper tissue to transmit information.
I imagined the ability to monitor for biologic parameters such as heart rate and temperature in high-risk patients after chemotherapy to improve neutropenic fever care. This might be helpful after outpatient stem cell transplants. Also, remote monitors could evaluate adherence to oral medications on or off study. Other applications might be monitoring well-being, pain control, nausea, or other patient-centered outcomes to improve the continuum of care.
Mayo Telemedicine Study = no drop in readmissions, ED visits
I was alerted to an interesting study on telemonitoring by the following tweet (HT @medskep): RT @jessiegruman: Telemonitored pnts: no drop in readmissions, ED visits. Time to re-think breathless marketing? [study. Arch Int Med]: bit.ly/Io30wQ
In the study by Takahashi and colleagues, "A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues to Prevent Hospitalizations and Emergency Department Visits," published in the Archives of Internal Medicine (online April 16, 2012), the authors found that "Among older patients, telemonitoring did not result in fewer hospitalizations or ED visits."
The manuscript noted that, "Efficiently caring for frail older adults will become an increasingly important part of health care reform; telemonitoring within homes may be an answer to improve outcomes." The study was a randomized controlled trial in patients older than 60 years at high risk for rehospitalization. The 205 study participants were randomized to telemonitoring or usual care. Telemonitoring was accomplished by daily biometrics, symptom reporting, and video conference.
As noted in the AMA Medical News: “‘We’re trying to change our care model for sick and older people, and we know this technology’s been out there, and the question is: Will it help?’ said Paul Y. Takahashi, MD, MPH, lead author of the study. ‘We went into it with the thought that this would provide some assistance. . . . It didn’t help at all.’”
The study was performed by a great team with a leader (Paul Y. Takahashi, MD, MPH, was my attending when I was a resident at Mayo) who understands the potential to merge medicine and technology. The study was performed at a well-recognized center that is engaged in innovation. What went wrong? I don't think this study "kills" the concept of telemonitoring. However, it is cautionary that technological innovation cannot solve all problems in human medicine. Just as anti-VEGF therapy didn't cure all cancer, new technology has great potential, but may need additional effort or fine tuning of population, etc. I think this and future prospective studies will provide more real data as opposed to the theoretical speculation of how this remote monitoring might help.
What are your thoughts?