Boston hospitals have taken the lead in telemedicine, the practice of diagnosing and treating patients from a distance by using computers and high-speed telecommunications. But that's hardly new. In fact, says Dr. Richard Bakalar, past president of the American Telemedicine Association, telemedicine was invented here in the 1960s, when, in order to avoid tunnel traffic, an audio/video link was created between Logan Airport and Massachusetts General Hospital (MGH). Physicians at MGH provided medical care to patients at the airport 24 hours a day.
Today, advances in telemedicine continue to improve medical care and cut treatment costs, as Boston-launched initiatives-from home-based vital sign monitoring to "smart pill bottles" that remind patients to take their medicine-bring health care closer to patients. This "connected health" is the future of health care, applying the internet, cell phones, digital cameras, and sensors to connect medical specialists with patients, says Dr. Joseph C. Kvedar of Partners Healthcare, director of the Telemedicine Division, now called the Center for Connected Health. Instead of expensive, specialized medical equipment, Kvedar says that "plug and play" consumer electronics can deliver quality care, without requiring a visit to the hospital or doctor's office.
Although telehealth is just beginning to move from theory to practice, patients like Judy Calder of Saugus, a 67-year-old grandmother who suffers from heart failure, is one of the hundreds who was enrolled in a telemonitoring program that was rolled out across Partners Healthcare after a successful pilot at MGH. Every day, Calder transmitted her blood pressure, weight, and other vital signs through a device located in her home, which was connected to a homecare nurse. "I knew what was going on with my blood pressure, if it was going up or down," says Calder, who is no longer enrolled in the program. "Hearing from the nurse each week gave me a sense of comfort and kept me on track."
Can a blinking orb, strategically placed in the kitchen or bathroom, be a reminder to take medicine? Getting chronically ill patients, those with diabetes, high blood pressure, and obesity, to take their pills is a well-documented problem. But in a Connected Health medical adherence trial, a stoplight-type signal shows whether a pill bottle has been opened or not on a given day. A shining red glow indicates medication is overdue; the light turns green when the pill bottle is opened and the medication has been taken. "We're trying to make health care convenient for patients, improve workflow efficiency, and ensure cost-effective preventive care," says Kvedar.
But Kvedar and other telemedicine advocates admit that there are still plenty of tweaks to be made. The "off-the-shelf" technology used for home monitoring still isn't as intuitive or user-friendly as Kvedar would like. "We spend a lot of time training patients how to use equipment. That's an added cost we'd like not to have," he says. And although new e-visit experimentation allows patients to visit physicians online and even upload images of their symptoms, Kvedar admits that there are limitations to internet-based communication. "We want to make patients feel cared for, and not just monitored. We want to push the communication side of the technology to be more lively." And, of course, he says, "It's one thing if my teenager is text-messaging and it doesn't get through, but if it's my blood sugar and it needs to get to my provider, it's a whole other matter."
In the meantime, Boston innovators continue to push the boundaries of technology, even on a personal level. Dr. John Halamka, CIO of CareGroup Healthcare, is implementing electronic transactions system-wide through the CareGroup hospitals and is developing "next generation tools." Halamaka himself is a walking telemedicine test case. He has a chip implanted in his right bicep; it contains his medical information, which can be read by a scanner.
He's not sure what will come of it, but as a practicing emergency room physician, he knows there are applications, and that's what counts. "Such implanted health care identifiers might prove useful to identify confused or incapacitated patients," says Halamka. "It's a test worth trying."
