Cleveland Clinic doc calls high-tech home care 'inevitable'

Welcome to the age of high-tech house calls, courtesy of wireless technology.

"In my Cleveland Clinic practice, I work in my patients' homes, using a cellular broadband connection to the same electronic record system used by my colleagues in offices and hospitals," Dr. Steven H. Landers writes in the New England Journal of Medicine. "I learn practical information about my patients' medications, management of chronic illnesses, and nutrition, and check in on how their caregivers are coping. Patients often see the home visit as a gesture of caring, and many of my older patients express nostalgia for an era when house calls were common."

While the house call all but disappeared in the second half of the 20th century as care moved to hospitals and clinics, Landers believes five factors are shifting medicine back to the home: an aging population, widespread chronic disease, healthcare consumers pushing for more convenience, soaring costs and, yes, technology. "In San Diego, physicians arrive at patients' homes with a new version of the black bag that includes a mobile X-ray machine and a device that can perform more than 20 laboratory tests at the point of care," Landers explains.

The same issue of the New England Journal contains a study showing that a group of patients taking the blood-thinner warfarin who monitored clotting from home each week did no better than warfarin patients who went to visited a clinic once a month for testing. But Landers is optimistic, noting that self-monitoring patients did no worse than others.

"The transformation of patients' homes into central venues for healthcare may take years or decades, depending on how the national and institutional politics play out," Landers notes. "The pace of growth of these in-home services will partially depend on the extent to which payment reforms are slowed by the self-preservation lobbying of traditional provider groups and inertia in financing bureaucracies, such as the federal Medicare program."

It also could take time to develop a home-based healthcare workforce and to wean providers from a more centralized model. "Such hesitancy might pay off in the short term, but ultimately, healthcare organizations that do not adapt to the home care imperative risk becoming irrelevant. It seems inevitable that healthcare is going home," Landers writes.

For more:
- read Landers' NEJM commentary
- see this other NEJM article about home monitoring of patients on warfarin
- see this post from the Wall Street Journal Health Blog