0 The 3 Legged Stool of Telemonitoring The Device A Non Physician Professional and the Patient

Just when the Disease Management Care Blog has barely learned to control itself when its in the company of clueless electronic health record (EHR) techno-weenies, enter the equally intolerable "telemonitoring" enthusiasts. Their jargon-laced claims of pan-medical and cost efficacy is enough to give the DMCB a migraine.

Their bombast is easy to spot.  According to this new class of leprechauns, small wearable telemonitoring devices for blood pressure, temperature, breathing, heart rate, weight, calories, blood sugar, cholesterol, brain waves, nail length, eye-blinks and minutes spent in the bathroom upload the data to the doctor who, thusly armed with critical insights of well-being, can do more of their... doctor stuff like... give out some prevention and stomp out disease.

For the best example of how that is simply not true, the DMCB is reminded of this negative December 2010 heart failure symptom telemonitoring study that alerted the patients physicians about "variances."  The DMCB readership already knows that physicians are already busy and just dont have the time to fit one more task into their busy days.  Thats doubly true if the data is unfiltered and without any context.

Yet, while the DMCB is unwilling to hop aboard the telemonitoring train, that doesnt mean that this has nothing to offer.  In the DMCBs estimation, itll increase quality and probably lower costs if it is combined with two other key ingredients:

1) a non-physician professional being in the loop, who can a) monitor the information and b) contact the patient with significant variances and c) use a combination of clinical judgement and standing orders/protocols to guide a patient response (which, by the way, doesnt have to include seeing the physician).  An example is here.  Theyre usually nurses and they can be part of the Patient Centered Medical Home or as part of a population health management program (or both).

2) an empowered, engaged, enabled and educated patient who understands the "output" of the device and can respond autonomously, confidently and collaboratively.  While some readers may pooh-pooh the DMCBs unrealistic idealism, the DMCB has found that most patients are smarter than they are given credit for.  As far as the DMCB is concerned, if a patient can manage a telemonitoring device, they can usually deal with the non-physician professional and also have some insight about what the device is "saying."
   
The DMCB thinks of it as a three legged stool.  Having telemonitoring patients be 1) passive and 2) unsupported bystanders while their data uploads scramble their overburdened physicians workflows isnt health reform, it isnt cost saving and it isnt quality. 

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