Someone misses the point again.
Remember my column last week, in which I took telephone-based telemedicine to task--and also chided the Los Angeles Times for referring to this approach as a "a good, commonsense idea that simply didn't work out"? One of the leaders of the Yale University study in question is not only defending his research, he says that his work and another study from Germany shows that "telemonitoring" is overhyped.
Subbing for Robert Langreth on Forbes magazine's "Treatments" blog, Yale cardiologist Dr. Harlan Krumholz argues that telemonitoring strategies need to be subjected to the same scientific rigor as drugs and medical devices are. Fair enough. "We need to be skeptical of small studies and poor quality studies," Krumholz writes. "We need to understand how to employ technology to improve outcomes. Studies with negative results can help us avoid wasteful efforts. We need to invest in knowing what we are achieving by strategies that are in current use." Also good points.
The problem is, his study--similar to the "very high quality" one from Germany, also presented at an American Heart Association meeting-- may, as Krumholz writes, "reveal no benefit to the telemonitoring system over 6 months in reducing hospitalizations or deaths. Nothing. No group of patients benefited. No secondary outcome showed promise." But, as I pointed out, those forms of monitoring are passive.
What's more surprising is that his opinion is under the sensationalized headline, "Why Remote Patient Monitoring Is Overhyped." The intro paragraph, written by Langreth, refers to more modern, active monitoring technologies than just asking patients to check in by phone. "Telemonitoring of patients with chronic conditions is a hot concept in the tech world. Companies like Intel, General Electric, Philips and numerous upstarts are pursuing various gadgets that aim to provide seamless communication between patients and their doctors. The premise is that people with chronic diseases like heart failure and diabetes will do better and avoid complications if there are better means to communicate daily fluctuations in symptoms with their health providers. But two big new studies show, shockingly, that better communication may not be enough," Langreth writes.
We're talking about apples and oranges here, folks. Telemonitoring of the kind that Intel, GE, Philips and smaller "upstarts" are pushing the collection of real telemetric and other data in real time, and either automatically sending that information to a patient record or alerting a caregiver in case of an abnormal value. All the patient has to do is wear or step on the device and make sure everything is turned on. There's no transcribing of readings and no manual calls to be made.
That's the promise of telehealth, telemedicine, telemonitoring or whatever "tele-" phrase you wish to use. A Yale cardiologist really ought to know better. Then again, the medical establishment seems hopelessly stuck in the 20th Century. - Neil