Think bigger when measuring remote monitoring effects
The highly publicized and disappointing results of two recent controlled trials on the effectiveness of mobile health and telemonitoring have shaken the digital health movement.
Study #1: This study, released in PeerJ in January 2016, focused on patients with chronic diseases including hypertension, diabetes, and cardiac arrhythmias. The intervention combined consumer-grade biomedical sensor devices that measured physiologic metrics such as blood pressure, electrocardiographs, weight, and blood glucose with a smartphone to display information to the patient and transmit data back to case managers. This study failed to show any reduction in costs or use of healthcare resources over a period of six months.
Study #2: This study, released in JAMA Internal Medicine in March 2016, focused on older adults discharged after hospitalization for heart failure. The intervention combined health coaching phone calls and telemonitoring of patients’ blood pressure, heart rate, symptoms, and weight on a daily basis. This study failed to show a reduction in readmissions within 180 days of discharge.
So what's going on here? Have the digital health hypemeisters sold us a bill of goods?
Each study sought to find out if the addition of remote monitoring technology reduced costs or improved outcomes beyond the baseline program. That should be the focal purpose of any intervention, including telemonitoring, right?
Wrong, and here’s why.
We know that the experiences, exposures, habits, and social forces of life are critical determinants of health and recovery, and in many cases are more powerful than what happens inside the patient and care facilities. But the outside-the-facility outreach programs that work best for managing patients with chronic disease today (such as telemonitoring programs like those studied above) are costly and labor intense because they require nurse case managers and interdisciplinary care teams—which explains why the cost-benefits of chronic disease management programs have, so far, been elusive.