Efficacy

With the idea of network failure aside, remote monitoring devices across the spectrum offer great effectiveness that is on par with the same basic measurements taken at the actual physical location of the hospital or clinician’s office (Shandle, 2008). In some ways, it is actually a more effective mode of patient monitoring because it offers clinicians a glimpse of how the patient functions outside of a managed setting. For instance, a diabetic patient while in the care of nursing staff each day is expected to thrive as his or her dietary intake is closely measured and scrutinized, remote monitoring means that the patient is at home and might fall into negative patterns of unhealthy behavior. Seeing the effects of this behavior will alert the nurses or care providers that more education regarding certain lifestyle choices is in order and will help them develop the larger course of care in the context of these behaviors.

Cost
In one study that analyzed patients with chronic heart conditions, “telemonitoring [remote monitoring] over a 6-month period generated $355 in savings per patient, or a net gain of about 15% compared to traditional in-home care” (Pare et al., 2006). However, this same same research went on to note that the “financial advantages of the program could have been more pronounced had it not been for the cost of the technology that effectively erased a good portion of the savings” (Pare et al., 2006). Like all new technologies, however, the cost when new is quite high and is not affordable to the general public. As these technologies, through a top-down filter, gradually make their way into more homes as a result of supply and demand cost cutting, the benefits and savings of lessened office visits and other related medical cost incursion will be more prominent.

The fight has been on to secure coverage and reimbursement for the use of remote monitoring technologies. Currently, with the Medicate Remote Monitoring Access Act of 2008, which is alive in California, more attention is being drawn to the sky-high costs of healthcare for treating chronic conditions in the clinical setting and how these could be dramatically offset if many of the monitoring aspects of continued care could be done without costly visits and use of equipment in the hospital or specialist’s office.

Social Impact

Mass implementation of remote monitoring technology for those with chronic conditions will result in paradigm shift in the ways patients view their role in their own healthcare and how they understand the physician/patient and nurse/patient relationship. Until the advent of remote monitoring technologies, patients were entirely in the hands of the nursing and healthcare staff and had little responsibility outside of following recommendations. What remote monitoring does is involve a unprecedented dual relationship between the patient and his or her healthcare team, which may lead to results where patients feel more involved, thus more inspired to take a greater role in symptomatic and preventative treatments. This will also involve a large change for all healthcare staff, not only as they learn how to interpret the results of remote monitoring, but as they learn how to manage these large amounts of patient data. Currently, 65-70% of all U.S. physicians practice in groups of less than 10 doctors…these smaller providers still struggle to establish an IT-based medical records system” (Shandle, 2008, p. 26) thus there needs to be a greater internal and external (society) acceptance of these technologies in order for the maximum benefit to be derived.

Summation of Technology Assessment

Technologically speaking, remote monitoring offers great promise in terms of large-scale cost reduction and efficiency and will allow for patients, even those in rural areas, to have remote access to excellent care that they might not receive otherwise. There are daunting challenges ahead for remote monitoring technologies, especially as they relate to communications and network infrastructure. While there are already structural fail-safes to complete “blackout” of wireless and satellite networks, other issues about the safety if the worst occurs or if data corruption happens must be considered. This is an emerging field that encompasses several ranges of technology aimed at several different chronic conditions.

Ethical, Legal, Regulatory, Quality Discussion

The presence of technology, whenever it takes over what has hitherto been seen as an essentially human-based operation, causes controversy and speculation. In the context of care, however, these issues are magnified since this is supposed to be one area of life in which face-to-face contact is essential to communicate personal matters. As one scholar notes, “Certain features of the electronic medium, that it can be curiously nameless, faceless, depersonalized, and seemingly anonymous, pose clear challenges to a relationship that is supposed to be marked by care, compassion, and face-to-face interaction” (Friedman, 2004, p. 382). These are valid concerns, although it should be noted that these technologies are not replacing human care giving completely, they are simply addressing some of the most basic and routine elements of it. “In response to concerns about privacy, liability, and cost, companies are creating new methods of secure online communication to facilitate electronic patient-physician non-visit care” (Friedman, 2004, 379). Patients in remote monitoring situations use the telephone and internet to communicate with their healthcare team, who have the ease of instant access to fresh data about that patient’s current state.
In addition to concerns about the human element being replaced by technology, there are also some valid issues raised about privacy of data. In such a large stream of patient data with highly sensitive information about nearly every aspect of one’s life, this is a guaranteed matter for utmost security. Currently, most of the collocation devices and facilities specialize in handling secure data in much the same way they do with financial institutions and remotely stored government documents. This issue will require constant vigilance and the hiring of full-time software and network security experts to maintain.

Analysis and Summation

The future for remote monitoring technology is bright and the diverse range of services it offers both patients and healthcare providers is staggering. It is expected that the existing “telehealth wave will be quickly followed by a second, in which highly sophisticated sensors attached to and implanted in the body will communicate over body-area networks. The focus will shift from providing lifestyle modifications to delivering just-in-time life-saving information to physicians” (Shandle, 2007, p. 25). In other words, it is expected that these technologies will soon, once accepted into the mainstream, transmit emergency data to hospitals, rather than the steady transmittal of general vital statistics or heart monitoring results. This could completely revolutionize triage units in hospitals as they would have instant access to the patient’s overall condition before arriving, thus allowing for a swifter and more focused response.

“In 2003, the United States alone spent $1.7 trillion on health care, with more than 75 percent of these costs directed toward the treatment of patients with chronic diseases” (Blount et al., 2007, p. 94). Remote monitoring offers a relatively safe, effective, and stable way to reduce the number of patient trips to the hospital and allows them the comfort of staying at home and not incurring massive medical costs for relatively minor symptomatic issues that arise due to chronic conditions. While there are many elements of remote monitoring that require attention, especially in terms of data security and privacy and the stability of connections for both transmitting and storing patient data, this is a promising technology guaranteed to revolutionize the way patients and healthcare providers alike view their conditions and professions respectively

Related Articles

The Need for Health Care for All

The Fragmentation of the Healthcare Profession

 

References

Al-Ali, A., Al-Rousan, M., & Ozkul, T (2005). Implementation of experimental communication protocol for health monitoring of patients. Computer standards & interfaces . 28, 523-560.

Blount , M. et al. (2007).Remote health-care monitoring using Personal Care Connect. IBM Systems Journal. 46, 95-144.

Friedman, L. (Ed.). (2004). Cultural Sutures: Medicine and Media. Durham, NC: Duke University Press.

Pare, G., Sicotte, C., St. Jules, D., Gauthier, R., & Liebert, M. (2006). Cost-Minimization Analysis of a Telehomecare Program for Patients with Chronic Obstructive Pulmonary Disease. Telemedicine and e-Health. 12.

Shandle, J. (2008). Remote medical monitoring A new telehealth age dawns. Electronic Engineering Times, no. 1545, 24-26.

Stachura, Max (2008). Telehomecare and Remote Monitoring: An Outcomes Overview. Retrieved November 22, 2008, from Advanced Medical Technology Association Web site: http://www.advamed.org/NR/rdonlyres/2250724C-5005-45CD-A3C9-0EC0CD3132A1/0/TelehomecarereportFNL103107.pdf