Telehealth and Going Forward

By Patricia Stuart

Telehealth and Going Forward

In a few years, the idea of receiving medical treatment exclusively at a doctor’s office or hospital will seem quaint.

~ Harvard Business Review

Although telehealth or virtual visits have been around approximately a decade, it was the COVID-19 waivers that accelerated virtual healths adoption and practice. It has been a learning experience for all.

Telehealth rides on a foundation of technology. Data gathering technology; data analysis technology; and patient - provider engagement technology. There are a lot sources of technology that gather data, analyze data, and support engagement. As telehealth has increased in recent months, it has called attention to technology’s deficits. Where ever we go from this point forward, it is well accepted that the telehealth is here to stay. So what might we see in the future as telehealth?

It has been suggested that persons could be provided “kits” to gather meaningful information for telehealth. A kit may might include some combination of the following:

Weight scales: Patient regular weigh-ins could detect fluid retention; assist with calculating medication dosing; and when combined with height, support weight-loss / gain or malnutrition screening. A scale begs to be stepped on. An unexpected change up or down inevitably become a topic of discussion.

Thermometer: With COVID-19 the temporal thermometer has been introduced as the “no touch” thermometer of choice. Putting a number to the “feeling warm” description will always be preferable to a subjective interpretation.

Blood pressure monitor: While persons with hypertension or hypotension are accustomed to checking blood pressure to access management, knowledge of blood pressure is critical in pregnant women and anyone at risk or diagnosed with cardiovascular disease. Blood pressure monitors with heart rate indicators today are user friendly with self inflation and release, accurate, and available in multiple of price ranges.

Peak flow meter: This is a diagnosis specific item; I have asthma and every now and then I need my peak flow meter. It is a relatively inexpensive, handheld device that is used to measure how well air moves out of your lungs. If you have asthma, measuring your peak flow using a peak flow meter can be important in preventing an asthma attack.

Continuous Glucose Monitor: Another diagnosis specific item is the Continuous Glucose Monitoring (CGM) system. CGM has three parts: (1) a small sensor inserted into the skin, usually on your abdomen or arm; (2) a transmitter that sits on top of the sensor and sends data to the receiver; and (3) the receiver that analyzes data to interpret your glucose levels and glucose trends . . . every few minutes . . . 24-hours a day . . . day after day up to 14 days with some models. Whereas a finger stick is a snapshot of your glucose, a CGM is full color motion of past, present, and potential future.

Miscellaneous: A recent walk through the pharmacy surprised me with other home information gathering items: pulse oximeter (device that snuggly clips onto the end of the finger to measure oxygen concentration in the blood); and an FDA-cleared mobile EKG device. NOTE: you also may have an EKG feature on a cell phone or a fitness tracker.

 

Clearly more meaningful information would be beneficial during patient - provider engagements. Notification of health issues in real time might be better. Imagine hundreds of thousands of patients collecting health data and sharing this data with health care. This is truly where technology could excel by surveilling and analyzing shared data from many contributors for health outcomes or combined data results signifying poor control, or pending health issues. Early risk notification could trigger an intervening phone call, text message, or email. Think how much more effective this would be at addressing patient needs!

Of interest is how the fitness industry gathers and analyzes data and reaches out to participants with words of encouragement. Consumer demand has been pushing for more biometric data with a high level of accuracy. As a result fitness trackers have come a long way from the pedometer that just counted steps. Now trackers count steps, measure vertical elevation (stairs or floors), and sleep patterns. More advanced features continue to be released in fitness trackers like stress indications measured via electrodermal changes, heart rhythm irregularities, skin temperature, and oxygen saturation monitoring. Best of all is these trackers will be available in time for your favorite person’s holiday wish list.

For those most concerned with cardiovascular health, there’s an app for that! Smart phone applications can now monitor multiple biometrics like pulse, entered blood pressure readings and weight; provide alerts when to take medications or get medications refilled; act as a digital food diary with food data bases that will surprise you; and meditation applications to slow down when life gets hectic. Best of all, smart phone applications allow sharing of data.

Smart devices can also work in tandem with each other allowing greater health data possibilities. Smart cell phones can work in tandem with other technology allowing integration with wearable technology and give hour by hour changes, show trends, and send alerts or notifications of undesirable biometrics or to promote healthy choices that actually support good health and disease prevention. While the consumer puts a lot of trust in these products, does the health care provider see value in their data? Would the health care provider use this data for medical decision-making? Additionally, will third party payers accept consumer generated data’s role in the medical visits they reimburse?

As telehealth continues, will it influence a provider’s choice before making a medical device recommendation to a patient? Rather than recommend just any medical device, should the health care provider recommend Brand X because it easily allows real time sharing of results with the medical office?

Lastly, not everyone has internet access or smart phones. If telehealth succeeds on technology, what do those without technology do? In the spirit of the internet cafe, there have always been community fixtures that could act as walk-in internet access portals: libraries, fire stations, pharmacies, schools / colleges, churches, community centers, and local public health departments. In a world where internet access is not always an option or desired, telehealth may need these community access points.

Telehealth is here to stay. Smart devices, fitness trackers, bio-metric data — they’re not just medical devices anymore — they’re telehealth options.

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Orignially published on October 21, 2020, updated on October 21, 2020

Topic: Diabetes Management

About Patricia Stuart