Intel jumps into telehealth

Intel is launching hardware and software for remote patient monitoring –basically little computers with video conferencing and an ability to interface with remote monitoring devices such as blood pressure machines, glucose monitors, and scales. The Wall Street Journal (Intel Takes Step Into Home Health Care) makes it sound enticing:

Intel and other computer related companies see big opportunities in health care, hoping to address inefficiencies that will become more costly as patients and caregivers get older. Allowing more people to receive care at home can save billions of dollars, the company says.

Meanwhile, later in the article says:

Who pays for such advances is another issue. Medicare, which covers many elderly patients, hasn’t yet been willing to reimburse patients or caregivers using remote monitoring systems, said Marc Holland, research director at… IDC. “Unless and until Medicare gets on the bus, it will be slow going,” he said.

These technologies always sound great: better outcomes, lower costs, and higher quality of life through technology. But results to date have not lived to the promise. Here are some of the mundane problems that have slowed the field down:

  • Many patients (especially the elderly) have trouble using even seemingly simple devices. Increasing the number of buttons from 1 to 2 on a device can cause compliance to drop by more than 20% because people get confused
  • A lot of patients don’t want to be monitored, at least not enough to actually use the devices. Some examples:
    • Even getting a heart failure patient to step on a scale on a routine basis is difficult
    • Medicaid patients have been known to sell their devices on eBay to buy food (or whatever)
    • Some patients leave the Fedex that the device arrives in unopened on their kitchen table for weeks until a relative comes to help them out
  • Financial return on investment is elusive. Despite big claims by remote monitoring companies, many of these programs actually increase costs. The devices and administration are expensive and there’s no reduction in hospitalization compared with cheaper approaches, such as disease management without all the technology. A popular trick is for remote monitoring companies to compare their well-controlled patients with completely unmanaged patients rather than with those in a cheaper but effective program
  • There’s a good reason Medicare and private insurance companies don’t pay for remote monitoring: trials they’ve done show that costs go up with remote monitoring, not down.

Over time devices and systems will get better and cheaper and effectiveness will improve. Right now monitoring can pay off only for some heart failure patients and some patients who’ve been recently discharged from hospitals.
For now we’ll have to look for cost savings elsewhere.

November 12, 2008

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