Researcher seeks more real-world home telemonitoring evidence

There is a lot of research in the area of home telemonitoring for chronic conditions and how it can improve outcomes and reduce healthcare costs. Spyros Kitsiou, assistant professor at the Department of Biomedical and Health Information Sciences at the College of Health Sciences, University of Illinois at Chicago, is one of those researchers and he just published an article about it in the Journal of Medical Internet Research.

Home telemonitoring for chronic conditions has attracted a lot of research, he said in an interview with Clinical Innovation + Technology, including randomized controlled trials, observational studies, and systematic reviews. “We’re starting to see evidence that home telemonitoring with clinical support provided during working hours or 24/7 is effective, especially for patients with heart failure.” These patients, in particular, have experienced both reduced risk of mortality and reduced rates of hospitalization related to heart failure.

There are a variety of technologies used in home telemonitoring from videoconferencing to mobile devices and interactive response systems. “Everybody seems to be very interested in testing or trying to use telemonitoring to reduce hospitalizations. Unfortunately, our field has done a poor job identifying and investigating the differential effectiveness between the technologies.”

Automated device-based and mobile-based telemonitoring techniques are more effective than videoconferencing alone and interactive voice response. “As we move forward in studies and hypotheses, we’re going to see a lot more evidence with respect to what technology we should be using.”

Telemonitoring has not been a part of integrated care models because of reimbursement issues, Kitsiou noted. “With more cost-effectiveness studies, we’ll see a lot more results.”

The integration of home telemonitoring and EHRs will become critical in the next few years, he said, given the increase in the number of patients with chronic conditions and the amount of money spent caring for them. His study looked at all-cause hospitalizations and heart failure-related hospitalizations.

Telemonitoring could be beneficial to hospitals by alleviating penalties for heart failure-related hospitalizations but the evidence for impact on all-cause hospitalizations is inconclusive. Because a lot of chronic condition patients have comorbid conditions, “we may have to monitor more parameters to see some kind of risk reduction for all-cause hospitalizations.”

High-quality evidence is needed to further the use of telemonitoring, he said. The economic evidence is still weak, he said. The lack of more rigorous cost-effectiveness studies is one aspect that prohibits wider scale adoption. “Over the next five years, hopefully we will see more studies and evidence coming from real-world settings to support policy and clinical decision-making.”

Developments in the mobile health arena, such as Apple’s ResearchKit, are driving a shift from collecting data at the hospital level toward collecting data through the EHR as well as collecting data in real-time, 24/7, he said. “Real-time data collection is of vital significance. This is a very important area.”

This field is evolving constantly, Kitsiou noted. “New technologies are coming out at a pace faster than the community can react to them and study their evolution. Every time we talk about the positive effects we have to consider that we still don’t have high-quality evidence. We have made great steps and I think they will play an important role in clinical decision-making.”

 [KS1]The article is available at http://www.jmir.org/2015/3/e63/ if you want to direct the readers to it.