Fragmented Thinking Hobbles Health Care Technology Enablement

Neither government nor industry is doing enough

Devices, devices, everywhere. I guess I just don't get telehealth-related technology “progress”—it seems like two steps forward in one area and a few backward somewhere else. On the one hand, there will be 15 million mobile and wireless telehealth devices by 2012, says an ABI July 22 research report, devices that will be jabbering away with information about our chronic disease measurement readings. Kind of exciting, especially for those who may be home-bound or live a long (or traffic-jammed) distance from the doctor's office. But who's going to monitor their readings? Oh yeah, the current health providers (i.e., today's doctors and nurses in hospitals and standard practice settings).

Yay! States recognize “tele” in health care—one state at a time. In other telehealth news, New Hampshire and Wyoming passed legislation this spring that ended the requirement that health insurers only reimburse for face-to-face visits. That's good. Meanwhile, in January, a medical malpractice insurance company issued guidelines for doctors when using the telephone and email (“check your spelling and grammar and never use all caps”). Okay, these are signs of progress. But you gotta pause and sigh. Let's imagine the progress of one state at a time deciding that it has a shortage of doctors and an overabundance of driving distances (”windshield time”). Now let's imagine that wording in each state (as in New Hampshire) requires that tele-anything fit into “current scope of practice,” avoiding anything so-called experimental. Fifty states may take a few years. And a doctor responding to a call in New Hampshire better not try to diagnose a patient in Wyoming with different state licensing requirements.

Consumer moves forward, despite the industry. Meanwhile, back at the alternative medicine ranch, US consumers are now spending $34 billion per year on homeopathic remedies, acupuncture, and practitioner visits not covered by health insurance (CDC and NIH survey). And a telephone/email doctor consulting service like TelaDoc has grown from 300,000 to 1 million subscribers within 18 months. But of course, we all believe the commonly accepted theory that consumers won't pay for health care delivery outside of the insurance reimbursement system. And so, one insurance reimbursement scenario at a time will be assessed.

What care will we expect as we age? Meanwhile aging-in-place baby boomer and senior consumers will exercise their power to stay out of the car when possible, even in short-haul traffic zones, and especially for the 72% of today's nonemergency care visits to the doctor and ER (per the AMA). They will seek and switch to a telephone-prescribing, email-responding (spelling and grammar checked!), online-chatting, remote-monitoring, video-conferencing, alternative-medicine-aware set of providers.

Who will provide it? These will include nurses, EMT-trained response services, walk-in clinics, and consultative pharmacists to help them deal with their diabetes, renew a prescription, respond to changes in their blood pressure. As we get smarter about what exists to help us, we will understand that solving multiple physical ailment issues is not going to be left up to risk-averse insurance companies, states, federal programs, and yes, to doctors. Yeah, sounds crazy, I know.

But who knows, maybe all of the above, plus a way to lower the cost of malpractice insurance and improve prescription coverage nationwide, will be in the latest health care bill before Congress.

By Laurie Orlov
Aging in Place Technology Watch Blog

[Originally posted August 5, 2009, at Laurie's Aging in Place Technology Watch Web site.]