Tele-what? At last informed journalism on telehealth.

 Check out the op-ed piece by one of my favorite bloggers Neil Vershel in the Columbia Journalism Review titled Tele-what?

I have known Neil for a few years, first met him at MedInfo in San Francisco in 2004 if my memory is correct, and have caught up with him over the past 6 years on my visits to HIMSS and other ehealth events in the USA. Most impressively he made the long trek over to Australia in 2007 to attend MedInfo in Brisbane and after that the Third International Conference on Information Technology in Health Care: Socio-technical Approaches in Sydney. Few bloggers and journalists make the effort to find out what is happening outside their direct sphere and the internet. Neil does!

Neil’s piece was a response to a Los Angeles Time piece published late last year in response to an article in the New England Journal of Medicine which looked at the results of a “telemonitoring” randomized control trial run by Dr Sarwat Chaudry from Yale University.

First let me emphasise that I am a very strong believer in the use of evidence based medicine. My old medical school at the University of Sydney was a big proponent of EBM and throughout my career I have been as obsessed with the evidence of efficacy and efficiency as any other clinician. But one of the very important things you learn when studying EBM is the need to evaluate the evidence and compare it to your clinical situation. Unfortunately the NEJM paper was so far removed from good practice of “telemonitoring” of heart failure patients in 2010 so as to be clinically useless to me, and I suspect all my peers.

Yes I work for Care Innovations, the new Intel GE joint venture that is developing solutions for just such situations. Yes we have a great solution in this space, as do some of our competitors. But what is important are the models of care that are developed as a result of these new technologies, not just the gadgets themselves.

The study by Chaudry and his colleagues used Interactive Voice Response technology, something that was pretty cool a few years ago when it first came out. The problem with the model was that it required the patient to pick up the phone, go through an IVR script and report their results to the system, which the clinician then reviewed and responded to. Of interest is the fact that by the end of the 26 week study 45% of the patients on the “telemonitoring” arm had stopped using it!

The problem is that the model of care was not patient centered or participatory. It was a throwback to the bad old days of when you gave the doctor information and they told you what to do. Only in this case the clinician was an electronic voice on the end of a phone that you had to call. A more progressive model of care would have gathered the information directly from the devices, displayed that information to the patient in a relevant way, given them access to information about their condition and what their results meant in the context of their condition, delivered the relevant information to the clinicians, and enabled the clinicians to respond in a reasonable amount of time in a way that was relevant to the patient. Some would be happy to get an email or a text message; others would like to speak to a real person. The beauty of modern technology is that all those models of care can be provided with technology you can buy today.

Patient centered care is about developing models of care that are relevant to an individual patient, and one thing you learn early in your clinical career is that all patients are individuals with their own needs and wants. Squeezing them all in to a one size fits all system that actually removes the human element of communication and collaboration is not the solution. The good news is that based on the work in the Chaudry paper we can no go forward and develop new models of care that utilize new and evolving technologies and compare them to the baseline of Chaudry’s paper on 2010. It is a first step, but healthcare innovation means we need to keep developing new ways of using the technology to make the lives of our patients better.