Tuesday, August 18, 2009

Another study documenting savings from remote monitoring
– how many more do we need before change is made?

A study just published by the Journal of Medical Internet Research (J Med Internet Res 2009;11(3):e34) looked at the use of home-based telemonitoring on a group of patients using mobile phones. The study, conducted in Austria, was based on a group of 120 randomly selected CHF patients divided into a control and “tele” group. The results were predictable, “home-based telemonitoring using mobile phones improves outcome in CHF patients and reduces both frequency and duration of heart failure hospitalizations.”

Other research studies have reached similar conclusions. A study published last year about the use of remote monitoring in the Veterans Administration documents a 19% reduction in hospital admissions and 25% reduction in the days of care. A systematic analysis of telehomecare studies published last year (Telemedicine and e-Health November 1, 2008, 14(9): 896-904. doi:10.1089/tmj.2008.0009), concluded that total cost, cost per patient and cost per visit were all reduced by telehomecare.

So, with this growing string of academically sound research studies documenting significant savings from the use of remote monitoring, why haven’t governments and payers leaped at the use of such services? The well-worn conclusion, especially by researchers, is that more research is needed. However, a load of other healthcare policy decisions have been made based on considerably less documentation and much less experience.

One problem appears to be the age-old silo mentality that resides with governmental budget and private insurance analysts as well as separate department administrators.

For example, much of the savings from remote monitoring appears as reduced use of hospitals and emergency rooms. However, achieving such savings means a small investment in home telehealth services, traditionally pigeonholed within “home care” or “home health visits” by departments. Many analysts and administrators of those departments only see home telehealth as increasing costs. They don’t recognize or care about savings accrued in other areas.

It is the “that’s not my department” view that has retarded the use of telemedicine in many areas.

All of us who care about telemedicine and see what a difference it can make need to be aware of this issue. As health reform in this country as well as other countries is implemented, we need to explain that the benefits of telemedicine spread throughout the health care system. It can fundamentally change the way health care is provided and positively affect many different areas.

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