Health care's telemonitoring evolution revolution

David Linden, professor of neuroscience at Johns Hopkins University, gave a recent commentary on the human brain that has an analogue to health care information technology. "In evolution, you never build something new if you can adapt something you've already got," Linden said. "It's the ultimate tinkerer and the ultimate cheapskate."  He was referring to the fact that what makes humans brilliant is not that we have amazing brains so much as that we have such huge brains. The design of our essential processing hardware, in fact, was borrowed from jelly fish some 600 million years ago. Our wiring isn't efficient, but it has lots of backup, and over time has adapted to changes in the environment. What does this have to do with health care IT?

We often bemoan the fact that health IT is a cobbled-together system: Different departments may use different systems within a single hospital. Hospitals may have different IT protocols than other entities within a larger health care organization. Your family doctor may still have a paper-based system, and none of these systems are guaranteed to talk to each other. That's partially why we are experiencing health care IT evolution, not a revolution: We simply can't install an all encompassing, totally interrelated health information sharing network at the drop of a hat. Instead, we build small fixes and patches for specific needs. Solving smaller problems while consistently moving away from the vision of a single, interrelated network.

Telemonitoring, however, offers a great example of piggy-backing on existing technologies that are ubiquitous and proven reliable. For example, using cell phones or the internet to feed regular vital sign readings or other health metrics to the electronic medical record back at your doctor's office. This can provide a constant flow of information to a clinician managing a chronic condition, without necessitating excessive office visits. In many cases, systems automatically alert clinicians when certain thresholds are reached. But do such systems enhance health? Recently, the first ever study of asthma telemonitoring found positive results, and now a review by the prestigious Cochrane Collaboration has found more evidence of effectiveness.

After reviewing 25 peer reviewed studies involving some 9500 patients tracked for between 3 and 18 months, the reviewers found that telemonitoring effectively reduced death from heart failure from a rate of 154 to 102 per 1000. In some of the studies, reductions in mortality were accompanied by improvements in quality of life, and reduction on health care costs.