Home telehealth-a means of using telecommunications to deliver more services to persons in outpatient settings-is gaining an increasingly high profile of late. Changes in the financing of U.S. home care has been the wake-up call. These changes require providers to now 'make do' with less monies yet still document maintained or, better yet, improved patient health outcomes as a result of service interventions. Suddenly, after many years of vendors' dogged attempts to spark interest in just trying the new technology, e-health (electronically delivered healthcare information and services, of which telehealth can be one part) is almost at the tips of nearly everyone's tongues and fingertips. Nearly everyone else, it seems, wants to know more about e-applications. Everyone except, perhaps, This Generation of home care patient.
Just as years of keynote addresses about the 'promise of home telehealth' were beginning to lose their momentum, e-health and Next Generation tools have burst on the consumer health market. Articles about new products, such as wearable biochemical sensors for tracking any number of physiologic measurements and transmitting them via discrete wireless mechanisms, are proliferating. And writers have stopped referring to these developments as newfangled sorts of gadgetry but discuss them as wanted and needed consumer health products. Finally, some respect.
But it may be useful to pause and look at today's home care patient market and needs (not the inventors' projected needs for their generation, which is the next one, not this). Doing so may be key to guiding developments that really are needed and wanted-today. What's the value of just plain home telehealth, not 2nd generation or next? There are at least three good opportunities to consider. Through use of the basic common denominator of increased communications, it can:
Delivery and results from just Plain Home Telehealth can be very straightforward. Routine, brief phone contact with a telenurse can remind and extend directives about how patients must eat and exercise properly, and how to be consistent in tracking their physiological measurements (and use the ordinary phone jack to send it). After much of this type of contact, it can seem like an easy step to becoming confident about managing one's wellness needs and self care. That hurdle's been done.
From there, it can then seem like just as easy a step to move toward independently following through with e-health, electronic means which provide thousands of databases and other resources on healthcare and self management. And it probably is posed as just this easy a step on a Powerpoint flowchart at e-health consulting firms. It probably hasn't been seen that way in your grandmother's living room.
The biggest obstacle is generic e-content, and there's a lot of it. For those lower tech individuals among us, such as This Generation of home care patient, this switch to self-managed e-health can seem overwhelming. It's not familiar at all.
The need for enhanced and customized information is essential to enable any generation of people to benefit from learning and using the tools of e-health. There is no question that the communications capabilities are here. Access is easier, and can even be undertaken through the familiar television set if a computer is not on hand. However, we need to look at the successes of fully wired places such as Singapore where e-traffic is almost non-existent. Why? A lack of useable and needed content. Several observers have termed situations like the one in Singapore 'e-ennui'.
There is a need in that case and ours for thoughtful and pointed customization of e-health programs. These developments take work to build and implement. They're not an 'e-health solution,' which often appears to be synonymous with a generic healthcare database, period. Today, it's not that the information isn't there, that there isn't any content, it's just that what's there doesn't matter.
The problem with e-health content development is that it has failed to examine what strides have been made with conventional home care and ordinary home telehealth, and to examine what works. Using the ordinary telephone isn't the highest tech and glitzy approach on the e-highway. But it's a do-able option and effective with this generation of home health patient.
For example, patients with congestive heart failure (CHF) who are participating in a 12-week telehealth program at the University of Illinois at Chicago (UIC) Medical Center are monitored at home using a device consisting of a weight scale and other measuring tools. The system transmits data via an ordinary telephone line to a 24-hour staffed central monitoring station at UIC. An alarm at the monitoring station will signal the need for a nurse to contact the patient directly if the data exceeds or varies from physician prescribed parameters for each patient.
High-tech machinery to identify problems is as glitzy as it gets. Timely interventions via telephone are the only other technological interventions used. These are viewed as "learning or teaching opportunities," according to Mary Bondmass, RN, the telenurse for the program. Take, for instance, a patient with a 2-pound weight gain over a 24-hour period. For CHF patients, Bondmass notes, this occurrence can be highly significant and needs to be addressed immediately, through diuretics or change of diet, to prevent an acute exacerbation. She then telephones the patient and asks: "What did you have for lunch?" Then, "Tell me what you've been eating this week." She might then say, "Sounds like a lot of salt," which would then lead into the 'teaching opportunity' about salt and fluid retention. In a practical way, she might say: "Look at your ankles," which may be swollen with retained fluids, or, if she noted shortness of breath, which can indicate fluid in the lungs, she would point that out. Patients would get an immediate, practical lesson in cause, effect, and correctable actions for fluid retention.
Is this example meant to show that no higher tech interventions are needed or wanted and that the current technologies are adequate for care? No. These interventions by phone should be used as much as is possible, as a starting point to help patients know what to do and how to feel well.
And that's not everything that is possible. Bondmass notes, for instance, that most of her patient population is illiterate and living in very difficult financial circumstances. When they come to the hospital for physician visits, she shows them pictures of new dietary foods with low sodium, low cholestorol, (apples, for instance) or low-fat brand name products. The hurdles to introducing this population to new ways of learning how to eat and take care of menu planning, strictly by pictures, can hardly be guessed at. One option is using e-health to convey more pictorial information that can supplement telehealth and in-person instruction.
Cultural barriers are also a difficulty that Bondmass points to. The typical diets of the Afro-American patients she sees (like that of any cultural group) cannot easily be assessed using conventional measures for serving sizes and exchanges. On-line e-cooking demonstrations, using pictures that show places where typical ingredients fall into conventional food groups and serving sizes, could be useful supplements to the patients' self care routines.
The possibilities are numerous for using new electronic media to extend conventional and more recent telehealth care interventions. This focus is certainly in keeping with a consumer trend of which we can expect to see much more: making the home a one-stop shop for all needed services, health or otherwise. Personalizing healthcare information and sending it into the home more often, as-needed and as-wanted, could very well be a welcomed e-enhancement for any generation of home health patient.
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