That’s because some promoters of home monitoring technology believe doctors will carefully scrutinize each EKG or blood sugar reading and use the information to tailor perfect regimens for their patients. This is not how medicine works.
Looking at thousands of EKG tracings won’t add much value either. In fact, putting all that information into an electronic medical record (EMR) only makes it more difficult for doctors to identify other, more vital pieces of information. Instead, doctors need to understand which of a few possible patterns are happening to determine the appropriate course of action.
Dr. Pearl’s prescription is for smartphones to embed telehealth monitoring capabilities at a price point slightly above the current cost, but less expensive than stand-alone devices like the iBG blood glucose monitor and AliveCor’s heart monitor. That data would be processed through apps that record and trend that data. When the trend (or rule) moves outside the norm, the phone prompts the patient to notify their doctor. The advantages according to Dr. Pearl is that the smartphone alternative is less expensive, easier to use and especially that the information remains under the control of the patient and perhaps–just perhaps–outside of FDA. (This also avoids the possibility of Patient State of Denial.)
The smartphone-embedding-device in its nascent form can be seen in the Samsung Galaxy S4’s SHealth [TTA 15 Mar] and some of the capabilities of Jawbone UP and Fitbit. However, why Dr. Pearl doesn’t extend the alerts to the doctor (as a decision-support tool) is an integration gap that may be simplified with a system that would take the alert and put it properly into the patient’s EHR and PHR. That approach is currently being developed/trialled by Partners Healthcare (Boston Globe 29 July and TTA 25 June] albeit on all data. Good points made in his article, but we will see how the bubble floats on the breeze.
Your Editor notes that AmbioHealth incorporates remote behavioral monitoring–yes, good ol’ telecare but not by either name!–into its system. Motion detectors to determine home activity, entry/exit door and window monitoring, and rules-based (not algorithmically determined norms over time) alerts–sound familiar?
* The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.