Improving Home Healthcare Through Telemedicine

The Centers for Medicare and Medicaid Servicesmuch of the technology for cost and accessibility
reported that in 2009 US healthcare spendingreasons needed the centralized model to be
increased 5.6% to $2.47trillion and representedeffective.
17.3% of the US economy. The increase fromTelemedicine involves the use of
2008 to 2009 is the largest jump in healthcaretelecommunications either through traditional
spending since 1960, and it is remarkable that in aphone networks, cell phone networks or the
year in which the US economy contracted byinternet to diagnose, treat and monitor patients
2.4% healthcare and the federal governmentacross large distances. Early use has focused on
were the only sectors to show an increase. Thistelecardiology and teleradiology where EKG and
growth is also occurring from a high base, startingX-Ray information is transmitted over
at a level 30% to 50% higher than mostcommunication lines and monitored and analyzed
industrialized countries, and is unsustainable.at locations remote from the patient. Recently,
Part of the healthcare cost problem is the waynew procedures now allow surgeons to perform
that most healthcare services are provided.certain procedures remotely and many hospitals
Hospital Care represents 31.1% of all healthcarehave implemented remote nursing stations that
costs and is notoriously expensive. The averagecan monitor patients from many facilities from
cost for 1 day in the hospital in 2002 was $1,290,one centralized location.
nearly double the average cost from 1990 andTelemedicine is also being used in the home
since 2002 hospital costs have increased by morehealthcare setting to provide emergency alerts
than 50%. Professional Services, which in thethrough personal emergency response systems
Center for Disease Control (CDC) data includesand the monitoring of patients vital signs such as
Physician and clinical services, Dental services andheart rate, blood pressure, cholesterol and glucose
other professional services represents anotherlevel. The latest advances in home healthcare
31.3% of total healthcare costs and Nursing hometelemedicine have been in the area of medication
care a further 5.9%. All of these services aremanagement, which given the costs of poor
provided onsite, in facilities and environments thatmedication compliance represents an enormous
are costly to maintain and where costs areopportunity to not only save costs but to also
increasing rapidly and represent more than 68%greatly improve medical outcomes and save lives.
of the total healthcare expenditure in the US inOver 50 million people in the US are on three or
2007.more prescriptions. While many of these
Cost however, is only part of the problem withmedications are critical to improving the health of
this centralized model of healthcare delivery.the patient the average compliance rate with their
Hospitals, clinics, Doctors offices and even nursingmedication regime is only 50%. Poor medication
homes are notorious for spreading disease.adherence according to the Center for Disease
According to a February 2003 article in The NewControl represents a significant healthcare problem
England Journal of Medicine between 5% and 10%resulting in increased costs and poor medical
of all patients admitted to an acute-care hospitaloutcomes. The current poor rate of medication
acquired one or more infections. The CDCadherence results in 10% of all hospital admissions
estimates that there are 1.7million hospital acquired(30% of all hospital admissions for elderly),
infections each year resulting in approximately22-40% of all Skilled Nursing Facility admissions,
99,000 deaths, various sources have estimated125,000 deaths per year and from $150billion to
that these terminal cases alone result in over$300billion in annual cost/waste.
$6billion in healthcare costs each year. TheseAnd this problem will only get worse as longer life
economic costs pale in comparison to the pain,spans and relatively low birth rates increase the
suffering and loss of life resulting from thesenation's average age over the coming years. The
infections.older we get, the more medications we require
The centralized model also provides a setting thatand as the number of prescriptions increases so
is at best impersonal and often dehumanizing. Bytoo does the amount of non-compliance. As a
design the institutional feel of hospitals, clinics,result, the cost to the health care system due to
Doctors' offices and nursing homes can increasepoor adherence is rising significantly.
the physical discomfort of patients through raisedThere are a number of ways to improve
levels of anxiety, disorientation, helplessness andcompliance that have been tested by the medical
even depression. Also the very nature of suchcommunity. Adherence rates can be significantly
institutions entails interruptions at odd hours byimproved through better education, the monitoring
staff and other patients and a constantly changingof patients in the home, and improved medication
cast of care providers that further add to themanagement. Medication management devices
discomfort of the patient.help by organizing dosages, providing reminders to
Treating patients in the home is much less costlytake pills and sending alerts to care givers when
and provides a familiar setting for the patient. It isdosages are not taken. Telemedicine based
also usually an environment that is moremedication management devices significantly
comfortable, lowers the risk of spreading infectionimprove compliance rates by utilizing all three of
and adds to the patient's sense of control overthese strategies.
their treatment. The difficulty is that up until now