The explosion in technological know-how has created a new wave of efforts to keep patients “connected” from their homes to their doctors. In particular, the “aging in place” movement has put a lot of stock in the concept of harnessing technology, in order to keep physically or cognitively frail people in their homes longer. Now machines exist that can transmit all kinds of information, from blood pressure and heart rate to blood sugar, weight, compliance with pill dosages, even how often the refrigerator is opened.
The possibilities seem endless, given the evolution of computer capabilities. On this blog, I’ve expressed some concerns about over-medicalizing people’s lives (turning one’s abode into a “mini-ICU” could actually convert the home into a rigid institution!), and issues of privacy. But a bigger question surfaces: does knowing all this data create healthier patients? The latest issue of the New England Journal of Medicine raises serious concerns about this.
A Yale study of 1653 patients recently hospitalized for congestive heart failure was split into a daily telemonitoring group (reporting weight and symptoms of heart failure) and a “usual care” group. The results after 6 months?
- Hospital readmission rate: no difference (49.3% vs. 47.4% usual care)
- Death rate: no difference (11.1% vs. 11.4%)
- Heart failure readmission rate, number of hospitalizations, and overall length of time in the hospital: all no difference
This is not to say that telemonitoring is a totally wrong-headed idea; it will certainly serve an important function in the future of medical practice. The point is that just because a technology is available, we still have to prove that knowing the information will actually lead to a better outcome. Otherwise it’s just another intrusion on a life worth living.