Telemonitoring your health: The (virtual) doctor will see you (online)

Electronic medical records (EMR) are widely debated, studied, promoted, and slowly being implemented. A new review published in Deutsches Arzteblatt International looks at a related practice: Telemonitoring, or using technology to monitor patient health status from home. This ranges from a phone call to ask "how are you feeling?" to more sophisticated transmission of vital sign readings via the internet.

The German review revealed some promising findings, as well as noticeable knowledge gaps. A host of studies have looked at the monitoring of heart failure patients, mostly via telephone. Overall, monitoring reduced mortality and rehospitalization by 20% for up to 16 months after initial hospitalization. A separate, smaller review found hospitalization rates reduced by up to 40%, and mortality reductions as high as 56%. Other conditions have not received as much study. Heart failure is a good candidate for such an intervention since it is exceedingly common, and can be difficult and expensive to treat.

Cost effectiveness data lacks the consistency necessary to combine multiple studies to reach more solid conclusions. Improvements in patient quality of life could not be assessed since it hasn't been a primary endpoint in enough studies. Whether telemonitoring would receive widespread acceptance by providers has not been assessed, at least not in the US. Though only 50 to 60% of patients are willing to participate in the practice, those who do express 90 to 95% acceptance rate for the practice.

One country where telemonitoring is widely used is Denmark, widely regarded as the most wired healthcare systems on the planet. A recent report claimed that all Danish primary care providers have electronic medical records. Danish docs save themselves about 50 minutes of paperwork a day, and their economy $120 million a year thanks to their highly digitized records. Compelling stories have emerged showing patients transmitting their vitals to the doctor via the internet from the comforts of their own home. This is a tempting vision to be sure, though safe guards are needed. Along with the normal protections from hackers and other criminals, patient's need to feel that digitally sowing their health information across the fertile plains of the world-wide-web won't lead to unhealthy crops in the future. For example, will medical device and pharmaceutical manufacturers mine the data to identify your doctor for temptation with the newest (and least tested, highest priced) treatments? Will your health status, or unusual yet benign elevations in vital signs or biomarkers be used in the future to deny you access to health coverage or employment?

The Danes also have a national, government run patient registry that helps inform them about the overall health of their population. This is something that most American's, and many others as well, would likely oppose on privacy grounds. "As long as you are a healthy man, you fear for your privacy," the director of Denmark's health information reminds us, "It is when you are sick that you wish people knew what your problem was."

Photo credit: The author