Signs of a home monitoring bubble?

click to enlargeSuddenly home-based remote monitoring is very warm, if not hot. The news of investments at all levels–from Medtronic’s purchase of Cardiocom [TTA 12 Aug] to a $525,000 third angel round investment in AmbioHealth (which this Editor doubts would have been on MedCityNews’ radar a year ago)–sounds like home telehealth is finally, finally gaining traction with investors, which have been more attracted to hospital-based and fitness monitoring. But is it the right type of traction based on reasonable expectations? We were among the first to point out in 2010 in positing the FBQs* that where the data goes, how it’s being used and who’s taking action on it was critical. Now Robert Pearl MD in Forbes is also examining the new song of home RPM and finding a few off notes (or to mix metaphors, finding a pan of fool’s gold):

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.

and

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.  

Categories: Latest News, Opinion, and Soapbox.

Comments

  1. Kevin Jones

    We’re all aware that physicians do not want to review daily glucose readings. A more efficient and effective care model is evolving where health readings are transmitted to case managers who provide telephonic support to the patient and, when necessary, coordinating with the patients’ primary care physician when readings are outside of pre-established thresholds. Recent clinical studies have shown the effectiveness of this model. Ambio enables a significantly lower intervention cost for this model which enables it to be used economically to keep larger populations healthy.

  2. Donna Cusano

    Kevin, thank you for your response from Ambio. Case managers (or in Paul Otellini’s formerly of Intel’s words–which I think were Eric Dishman’s–army of virtual care clinicians discussed in these pages back in 2009) are a great idea, but perhaps now not necessary except for the most acute situations. (and it is not one case manager per person) Automating alerts and flagging the individual out of norm is a lot more doable, flexible and yes, economic. Who pays for the case manager? Open question–and the physician/health system also needs to trust the case manager system.

    Did Ambio develop the telecare (activity/residence monitoring) on its own or are you using another system?

  3. Kevin Jones

    The case manager model typically has 50-150 patients per case managers. For diabetes, they would be Certified Diabetes Educators who are skilled at coaching and motivating patients to manage their diabetes. The level of interaction is typically brief weekly calls, plus calls as needed when alert conditions occur. Hypertension is less complex and requires somewhat less interaction. This model matches the skill level and cost of the case manager to what is needed by the patient. It is more clinically effective when the case managers coordinate with the patient’s primary care provider. “Who pays” are payers who want to invest in preventative care to reduce the overall healthcare costs for their populations. That includes self-insured companies, Accountable Care Organizations and Medicare/Medicaid who are increasingly using a capitation payment model and leaving it up to the provider organization to manage patients’ health, including when to use preventative care.

    Ambio developed the activity/residence monitoring product on its own by modifying sensors often used in home security systems and adding proprietary wireless technology and functionality to enable the sensors to send alerts both when something happens that was not expected, and when something does not happen that was expected – e.g., if there is no movement in the bedroom by 9am. Alert conditions can be customized for each user.

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