In my last blog, I illustrated the potential benefits of telehealth in managing chronic diseases in the community. In this blog, however, we will see how telehealth can fail to achieve its intended objectives.
1. Financial benefits?
A home health agency (HHA) expects a steady return on investment (ROI) on the telehealth units in the long term through reduction in nurse utilization costs, but that is often not the case. Many telehealth devices are yet unable to distinguish between genuine vital sign fluctuations and false alarms. Home health nurses have reported increased nurse visits and phone calls owing to the need to check on patients after every alarm triggered by telehealth, especially for patients with complex chronic diseases such as heart failure. Increased nurse workloads without meaningful follow-up interventions can increase nurse frustration with telehealth equipment and, consequently, reduce use of expensive telehealth devices for patients.
Telehealth devices are expensive, averaging around $5,000 per unit. In addition, frequent updates of outdated telehealth devices due to changing telecommunication means used by patients (cell phones or VOIP) further increases the telehealth maintenance expenses for a home health agency (HHA).
Reduction in hospitalization?
Patient co-morbidities such as atrial fibrillation or circulatory issues play a significant role in clouding the accuracy of telehealth measurements. For some patients with complex chronic diseases, there is no prior indication provided by telehealth before hospitalization. For example, weight changes may be too late to signify deterioration in heart failure; more sensitive measures such as cardiac impedance are needed to capture early deterioration.
In addition, unclear communication protocols between health-care providers may result in confusion over ownership of telehealth data and the resultant responsibility towards initiating follow-up interventions. Delayed interventions may increase the odds of patient hospitalizations. The telehealth system is still primitive in its ability to present data in a meaningful manner. Physicians and home health nurses who make decisions on care regimen changes are overwhelmed by the deluge of telehealth data. “Data fatigue” may further reduce the efficiency of telehealth for managing chronic diseases.
2. Sense of security or intrusive?
Some patients perceive the numerous phone calls or visits in response to every telehealth alarm as obtrusive and intrusive to their privacy. Home health patients increasingly use cell phones over landline telephones. To cope with patients’ changing telecommunication means, telehealth devices are placed at locations that are aesthetically unattractive or are dangerous due to increased patient fall risk. Visual perception of fluctuating telehealth vital signs worries patients with anxiety disorders, which may adversely impact their health status or ability to self-care.
3. Promotion of self-care or dependency?
Current home health reimbursement policies require that telehealth devices be removed from patients’ homes at the time of discharge. However, home health patients with complex diseases at times get too dependent on telehealth. They feel vulnerable without the constant assurance of someone checking on their vital signs every day. Patients may stop notifying their physicians of adverse symptoms assuming the telehealth nurses would do so on their behalf. Such patients may need to be weaned off telehealth to foster more independence in their self-monitoring before discharge from HHAs.
These are just some of the issues that expose the need for extensive research on systemic usability and decision support solutions to make telehealth a workable and efficient technology to manage chronic diseases in the community.
—Kavita Radhakrishnan, RN, PhD, MSEE, assistant professor