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Can Telemedicine Actually Make Outcomes Worse?

Posted by Lawrence Kerr on Thu, Nov 21, 2013 @ 08:03 AM

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A recent article about poor (or at least mediocre) outcomes at Northside Medical Center's eICU program in Ohio saddened but didn't surprise us. Although not statistically significant because of the small sample size, the hospital reported:

  • Year-over-year mortality rate rose from 78 to 90
  • Mean length of stay increased from 3 to 3.2 days
  • Rate of falls went from 0 to 0.81
  • Code blues rose from 39 to 54.

We are advocates for telemedicine that doesn't demand expensive hardware or synchronous monitoring (like this project did). That said, we think that the "told you so" tone in some of the coverage about Northside Medical's brave experiment is useless. In a brave new world of medicine and technology, there are bound to be experiments, success, and failures. Northside's boldness, honest appraisal, and reporting helps all of us.

Plus, this telemedicine outcome is a bit of an outlier. As Chris Wasden, global health innovation leader for the consultancy PwC said, "Telehealth reduces mortality, hospitalizations, duration of stay and improves drug adherence. If you had any drug that had the outcome measures demonstrated by telehealth, you would have a blockbuster." While on a small scale, a recent study of Nantucket Hospital's telemedicine program showed exactly those blockbuster results, including:

  • Tele-dermatology saving nearly $29,000 a year
  • A telestroke program that is quickly evaluating patients and saving lives.
  • Waiting lists cut by hundreds.

With any telemedicine program, the goal is to decrease things like readmissions and length of stay (not to mention mortality) while increasing profitability, patient satisfaction, and provider satisfaction. Anecdotally and statistically, it seems that this Nantucket Hospital outcome is far more common than the eICU failure. So what makes the difference between a program like the eICU program above and the program at Nantucket Hospital?

What makes the difference between a telemedicine success and a telemedicine failure?

  1. Keep hardware investment to a minimum. We've seen over and over again that telemedicine projects thrive when they invest in people, systems, and software -- not in hardware systems that break and go obsolete. ClickCare, for instance, works on the smartphone in your pocket -- so your investment dollars can be spent elsewhere.
  2. Be realistic about people. We've always believed that synchronous communications (like teleconferencing) are inherently harder to coordinate and less sustainable than systems like hybrd store-and-forward that don't need everyone available at the same time. Overall, we think it's crucial to understand the people who will be using the system and to work with their limitations and needs, rather than against them. 

So, continue to experiment boldly! And continue to use other people's experiments as information on what to do -- and what not to do.


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