Originally Published October 2000

EDITOR'S PAGE

Telemedicine Gets Its Marching Orders

Telemedicine research is getting a shot in the arm from the U.S. Army. According to a recent article released by an on-line wire service, the Army's Medical Research Acquisition Activity has awarded a grant to Mercy Home Health Services to evaluate the feasibility of using telemedicine to monitor the health of patients from their homes. Located in the Philadelphia region, Mercy Home Health Services is using monitoring components developed by Spacelabs Medical Inc. in the study of a group of patients with congestive heart failure (CHF). The healthcare provider and the Army are motivated by a common objective: cost reduction.

As flat-rate payments for patient care become the norm, the healthcare industry is scrambling to find ways to reduce costs while maintaining quality of care. Remote diagnostics may result in fewer patients with CHF being readmitted to the hospital, according to Martha Sheely, clinical research director at Mercy. CHF accounts for a high proportion of healthcare expenditures in the United States. "Patients with CHF are often elderly and, because it may be difficult for them to get to the doctor, they wait a few days after symptoms reappear," says Sheely. "By the time they call 911, their condition has worsened such that they require readmission to the CCU."

For the Army, telemedicine potentially represents a means to maintain adequate medical care in an era of downsizing. It also provides the "tactical requirement to have a smaller medical footprint in the far forward areas," in the words of a grant officer fluent in military-speak. The technological challenges are considerable, but as was pointed out to me recently by William Scanlon, research director at the University of Ulster's Centre for Communications Engineering in Ireland, the human factor should be of equal concern. Scanlon is currently involved in adapting cellular technology to biomedical applications.

Personal telemedicine applications will start to emerge, according to Scanlon, but it will require both patient and clinician acceptance to find its niche in the market. "One of the key issues involves the readiness of the healthcare sector's infrastructure. The biosignal data have to go somewhere and be interpreted," noted Scanlon. I would add that its point of origin should not be neglected, either: operation of the monitoring equipment needs to be understood by a population that may have trouble setting its VCRs.

Patients in the Mercy study will receive an equipment package developed by Spacelabs that is designed to noninvasively assess parameters such as ECG, blood pressure, temperature, and pulse oximetry. The data are then digitally transferred to the central monitoring station at Mercy Home Health via the patient's existing phone line. Communication with the patient is conducted by means of a two-way video hookup.

The patients will receive training, of course, but if home healthcare is indeed the wave of the future, it's clear that device manufacturers will be called upon to do more than produce safe and effective medical devices. A growing number of devices will also have to be designed for use by nonprofessionals. Considering all of the poorly designed low-technology products that surround us, this may be the most daunting challenge of all.
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