A new report from consulting firm CSC provides a taxonomy of this burgeoning field, which it calls "teleservices."
The four main branches of teleservices, the CSC report says, are:
-- Telecare: Home monitoring to alert caregivers about emergencies such as falls and potential patient issues such as patients not rising and walking around in the morning.
-- Telehealth: Health tracking tools and asynchronous monitoring devices capable of triggering caregiver support when health status indicators go out of normal range.
-- Telecoaching: Tools designed to facilitate patient self-management and patient education. This type of service can help patients manage chronic conditions more effectively or help at-risk patients avoid developing more serious conditions.
-- Telemedicine: Delivery of real-time consultations, diagnoses and treatments through audio- or videoconferencing with a clinician. These sessions are usually scheduled in advance rather than in response to emergencies.
[ The U.S. healthcare system has dug itself into a large hole. But IT Can't Fix Complex Healthcare Problems. ]
According to an inMedica study cited by the authors, more than 300,000 patients are already being remotely monitored each year for congestive heart failure, COPD, diabetes, hypertension and mental illness. An additional 140,000 post-acute-care patients and 80,000 ambulatory patients were also monitored last year. By 2017, it's projected, about 1.8 million patients worldwide will receive regular treatment through remote services.
While this doesn't seem like a lot of patients, Clive Flashman, a coauthor of the report and a global healthcare industry strategist with CSC, told InformationWeek Healthcare that the inMedica study focuses only on the telehealth aspect of teleservices. In the U.K. alone, he said, 80,000-100,000 people are using telecare services, which are not included in the inMedica estimate.
Meanwhile, evidence of the effectiveness of teleservices is increasing. The CSC report cites studies of telehealth programs for heart failure that showed them to be effective in reducing hospitalizations and mortality. In another study, 80% of patients who used telehealth-based psychotherapy reported that their depression was "much improved," compared to 55% of the control group.
A recent trial that wasn't mentioned in the report showed that remote monitoring of patients with hypertension, combined with feedback from pharmacists, helped control that condition. Seventy-two percent of patients in the intervention group were able to control their blood pressure, compared with 57% of those who received usual care only.
While most studies of teleservices have shown a positive impact on care, the CSC report acknowledged that the evidence of return on investment is mixed. "Experts agree that the best approach to evaluating an initiative is one that takes into consideration not just clinical effectiveness and cost-effectiveness, but also factors such as service, utilization, patient satisfaction and patient-reported outcomes."
Flashman added that one reason for the uncertainty about ROI is that "the studies haven't been done at scale." Cost savings are evident in in large-scale implementations such as those of the U.S. Department of Veterans Affairs (VA) and the U.K.'s National Health Service, he said. The VA has seen savings of more than $1,000 per patient from telemedicine. NHS achieved cost savings by lowering hospital costs and unplanned admissions, he added.
The report stated that teleservices are important to care coordination. But physicians don't necessarily view remote monitoring data, which typically goes to call centers or nurse care managers. Asked whether it would help to integrate remote monitoring data with an electronic health record, as Partners Healthcare recently did, Flashman responded, "The question is how much data do doctors want to see."
Many physicians are afraid of being inundated by the data, he pointed out. "They might want to see data at a granular level, or they may just want alerts. Or they might want to go to a portal and get a unified view of the patient without logging into multiple systems."
That said, he agreed that access to the information must be integrated into the workflow. But this must be built into a "care pathway" that provides doctors with the data they believe is relevant.
"This has to be a prescribed service, in the same way that you'd prescribe a drug or refer a patient to an orthopedist," he said. "This is not a piece of technology; it's technology enabled, but it's a clinical service. And it has to be integrated with your existing services. When you do that, it's integrated in the workflow."