AHRQ Innovations Exchange | Expert Commentary: Daily Nurse Review of Key Health Indicators Reduces Inpatient and Emergency Department Use for Patients on Dialysis

AHRQ Innovations Exchange Expert Commentary: Daily Nurse Review of Key Health Indicators Reduces Inpatient and Emergency Department Use for Patients on Dialysis


Studies Continue to Show Value of Telehealth Technology
By Jonathan Linkous, Chief Executive Officer, American Telemedicine Association

Hundreds of studies have shown the value of using home-based devices to monitor patient health, improve clinical outcomes, and reduce medical costs. Telehealth can make patient care far more ubiquitous by letting people be involved in their own care outside the walls of a hospital, clinic, or medical office. The rationale for remote monitoring is becoming even more compelling as the cost of the technology continues its rapid decline. Given widespread access to inexpensive hand-held devices and broadband Internet access, paying for the technology is no longer the most significant part of the cost equation. In fact, the chief consideration is the need to change how care is delivered and coordinated across settings, including the home environment. In many cases, telehealth can make effective health care less labor-intensive and therefore more affordable.

These trends are reinforced by the favorable results of two innovations featured on the AHRQ Health Care Innovations Exchange. One (Daily Nurse Review of Key Health Indicators Reduces Inpatient and Emergency Department Use for Patients on Dialysis) showed a reduction in health care utilization and improved quality of life in patients with end-stage renal disease whose health status was monitored daily using remote monitoring technology. The other (Case Managers Remotely Monitor Chronically Ill Medicare Beneficiaries Each Day, Reducing Mortality and Costs) showed reductions in mortality and health care costs with remote monitoring of Medicare beneficiaries with diabetes, heart failure, or chronic obstructive pulmonary disease. Although I’m not surprised by the positive results of these studies, the findings do add to the evidence that remote monitoring can improve patient care and reduce costs. For another important example, consider the U.S. Department of Veterans Affairs, which is using remote devices to monitor the health of close to 75,000 veterans at home. This is the most widespread use of the technology anywhere, and it is yielding evidence of the value of remote monitoring.¹

New technology is making home monitoring increasingly cost-effective. The $3,500 initial cost of the remote device used in the University of Hawaii study (Nurse–Physician Infection Prevention Teams Conduct Rounds and Provide Support to Frontline Clinicians, Leading to Fewer Hospital-Acquired Infections) is easily twice the cost of similar systems using today’s technology. For example, we now have Bluetooth-enabled devices that can connect with a cell phone to transmit data and high-quality video. And with ongoing progress in human factors engineering, such equipment is increasingly easy to set up, readily tailored to individual needs, and intuitive to use. These advantages often eliminate the need for a home visit to connect devices and train the patient in how to operate them. Today, measuring health indicators and transmitting the data doesn’t have to be any more complicated for the patient than using a microwave oven. The Health Buddy system that was used in the other featured innovation (Case Managers Remotely Monitor Chronically Ill Medicare Beneficiaries Each Day, Reducing Mortality and Costs) is a very simple device, but it can clearly have a big impact.

Like most research, the work described in these two featured innovation profiles has some limitations. For example, the Health Buddy analysis didn’t factor in technology and staff costs. But we shouldn’t let our desire for perfect research be the enemy of good practice. Too often, researchers report positive findings and then conclude that more research is needed, such as in a recent large study of telehealth in the United Kingdom.² Considering the growing pool of favorable studies, we should support policy changes that will promote the wider use of proven technology. Clearly, home monitoring has great potential to make health care more effective and affordable, providing a return on investment that can exceed anything else in the field of telemedicine. As we work to transform health care in a way that focuses more on coordination of care and patient engagement, I’m optimistic that remote monitoring will play an increasingly important role.

References:

¹Darkins A, Ryan P, Kobb R, et al. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health. 2008;14(10):1118-1126. doi:10.1089/tmj.2008.0021. [PubMed]
²http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131689.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software .).

About the Author:

Jonathan Linkous is chief executive officer of the American Telemedicine Association, a membership organization that focuses on advancing health care through telecommunications technology.

Disclosure Statement: Mr. Linkous is aware of the Innovations Exchange requirement to disclose any financial interests, or business or professional affiliations, relevant to the work described in this commentary. He reported no disclosures.

Original publication: February 01, 2012.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: February 01, 2012.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.