I have written a number of articles on the potential positive impact of telehealth, and I still believe in it. It will make a difference, even though it is a slow go, so far. At Support For Home Health Care, we are working with several other agencies and technology companies on projects we think can make a real difference.
There are two points that I would like to make, however. One is that our notion of telehealth, in the past, has been far too narrow. I will expand on that. The second point is that sometimes telehealth means literal eyes and ears in the home providing data, not just a machine talking to another machine.
On the first point, we tend to think of telehealth as (broadly) vital signs-based. Blood pressure, pulse rate, temperature, weight (especially changes), respiration rates, and so forth. These are definitely important, but they do not come anywhere close to covering the full range of information that makes a difference for someone’s health and wellbeing.
Let’s just take one seemingly simple example. A large, excellent home care agency in the Chicago, Illinois area, Wellspring Personal Care, has been working for years on identifying the metrics that are critical to the health and well being of its patients / clients. For one person, her health and attitude was significantly different from day to day. Some days she did extremely well. Other days her ability to function was quite limited.
Wellspring spent a lot of time gathering data – in this case, during and after every shift, answers to a set of questions were faxed by the caregiver back to the agency (Wellspring installed af ax machine in every client’s home). Analysis of the data told Dr. Steven Fox and Sheila McMackin, LCSW, that every time the client was showered at a certain time of day, she did quite well the following day. If the shower was performed too early – or not at all – on day 1, day 2 was not good. This, to me, is a perfect example of the broad view of telehealth which we need to take, if telehealth is truly going to live up to its potential.
The second point is about the eyes and ears – and sometime hands – of the clinicians being those of the caregivers (family and professional) in the home. Because telehealth has to be seen as broader than just vital signs, there is really no substitute for the brain of the home caregiver. What she or he sees, hears and touches is, in the absence of 22nd century wizardry, going to be the basis for a large percentage of medical decisions made by the clinicians. That means training caregivers needs to receive a very high focus from both clinical and non-clinical agencies.
Whether there is a wireless telehealth instrument sending vital signs or a fax – or a bullhorn – the key is communication of a broad set of data, followed by the real strength of technology, which is data mining and analysis, looking for patterns, protocols and actions required.
Your thoughts on telehealth – narrow or broad – are very welcome.
Best wishes. Bert