Remember the cartoon The Jetsons?  In one episode, George Jetson’s son Elroy is sick and talks to the doctor through the TV. Today, patients are catching up to the Jetsons when it comes to care via telemedicine. Not only can they consult with their doctor remotely, but they also are able to be monitored and diagnosed through electronic collection and transmission of nearly two dozen physiologic parameters. Just a sample of these parameters includes weight, blood pressure, heart rate and respiratory function as well as anticoagulation parameters, glucose levels and other biomarkers.

The recent explosive growth in telemedicine can be attributed to increased patient demand and broader coverage of these services by private insurers, Medicare and Medicaid. But it is technological improvements that are really making telemedicine possible. High-speed internet networks, low-cost data storage, plus wireless and mobile technologies are supporting the growth of remote telemonitoring, which is just one application under the telemedicine umbrella.

Using telemonitoring tools, patients are able to collect and transmit physiologic data to caregivers for analysis and treatment options. Telemonitoring technology is now available for diabetes, asthma, and cystic fibrosis; however, its use with heart failure patients is showing the greatest improvements in outcomes, quality of life and resource utilization.

Approximately 5.7 million people in the United States have chronic heart disease. About 15 percent of these patients will not survive within one year of diagnosis, and more than 50 percent will not survive within five years. Heart failure patients account for more than 1.1 million hospitalizations annually. Their readmission rates within 30 days top 25 percent and more than 50 percent within six months.

“Health care expenditures related to heart failure are approximately $31 billion annually. Because of its prevalence and exorbitant costs, any strategy to improve clinical outcomes and lower costs is potentially very impactful,” said Joe Cummings, PhD, senior associate, technology assessment program at Vizient.

Tech trends in telemedicine

In the big picture, there is no shortage of manufacturers involved in telemonitoring and telemedicine. In 2017, Becker’s Hospital Review published a list of more than 220 companies, from start-ups to industry standouts that are providing a wide range of telehealth products and services.

At the heart failure-patient level, current telemonitoring options range from “wearable” technologies that capture specific data to implanted cardiac devices. Wearable technologies include watches, bracelets, necklaces, adhesive patches and/or small devices carried on the body. In addition, mobile phone-based platforms, also known as “mHealth,” include dozens of apps and associated physiologic sensors for data capture and transfer.

“Given the trend toward more and more usage of telemedicine, the question may not be, ‘should we use telemonitoring?’ but rather, ‘which parameters should we monitor?’,” said Cummings. “The right parameters are ones that can be utilized in a well-established, evidence-based treatment protocol. They should provide early warning of impending events and be measured accurately enough to be acted upon.”

Daily, at-home measurement of weight, fluid retention and blood pressure can be readily measured and transmitted and can provide an early-warning system of worsening heart function for physicians. Subsequent treatment, like initiating or changing medication doses, may then be ordered, as needed. “The intention is that remote telemonitoring and active patient management subsequently decrease the incidence of emergency care or hospitalization, and that they improve health outcomes,” said Cummings.

But how successful is telemonitoring related to managing heart failure patients?

“Conclusions from analysis of the available data for cardiac telemonitoring have been mixed, but a number of recent studies have noted generally positive results,” said Cummings. “In general, there are more studies reporting positive results from cardiac telemonitoring than those that show no effect on outcomes.”

Cummings also noted that conclusions may be confounded due to patient compliance issues and telemonitoring’s use within a highly complex, multivariable condition. Additionally, there are potentially significant differences in telemonitoring technology, not to mention the hybrid use of various approaches. “At this time, standardized definitions of telemonitoring systems and approaches are not universally accepted, so these differences should be considered when combining data in meta-analysis,” said Cummings.

Research into heart failure telemonitoring will continue, with an expected focus on cost-effectiveness, data security and further clarification of selection criteria among patients and parameters. As the current evidence has shown, there is significant growth within telemedicine in general, and heart failure telemonitoring, more specifically. Its use is producing increased rates of patient satisfaction and improved clinical outcomes in select patients.

Interested in learning more? Contact Joe Cummings

Published: March 13, 2018