No you hang up first … No you do … Love at first Telemedicine

I was recently appropriately corrected when I blended the definitions of telemonitoring and telemedicine. It seems that I am just as guilty of mixing up these concepts as many others. It is very important to distinguish these two, most notably because there is already significant research about each. Not that long ago, a paper was published that questioned the benefit of telemonitoring. This news was unsettling because it seemed to challenge a fundamental new type of technology that many assumed would quickly prove its own value.

Telemonitoring refers to the remote monitoring or measurement of a patient’s status. It could be something as simple as remotely checking for a pulse. It could be far more involved by including a whole series of devices intended to measure a person’s weight, pulse, blood pressure, heart rhythm, temperature, and in the near future, a great deal more. As point of care units become capable of doing elaborate blood testing, the power of telemonitoring will increase exponentially.

I should take a moment and also clarify the term “point of care [POC]”. Point of care means exactly what it says – the location at which the healthcare is being provided. Usually, especially when talking about advanced laboratory exams, the equipment necessary takes up a huge amount of space and requires very specialized technicians to make use of it. POC devices are intended to be far cheaper, far smaller and far easier to use. Lately, there are multiple companies offering POC devices that are the size of a desktop computer’s box, that can do a whole range of blood tests on a drop of blood with very minimal training.

If POC devices are so effective and so much cheaper, why do they not replace entire hospital-based labs? The answer is that at some point in the next 1 to 2 decades, they will. Many point of care devices still lack certain features that are readily available with professional laboratory systems. So it will take some time until an entire hospital’s laboratory can be replaced with a desktop device.

Therefore, telemonitoring, using more and more advanced POC devices, will make it possible to monitor the status of patients at home and in remote clinics, all around the world. In time, telemonitoring devices will make remote monitoring so inexpensive, that telemonitoring devices will become de facto items in almost everybody’s home around the world.

Telemedicine is actually a very general term which effectively refers to any type of healthcare service that is delivered at a distance. Telemedicine can definitely include telemonitoring, and there are many telemedicine companies that use telemonitoring to provide a far better service. A recent report from the Healthcare Performance Management Institute [2013] noted that 70% of physician visits and 40% of hospital ER visits could be handled by just a phone call, i.e. without any additional technology. This data is actually old. So if it were to be updated and if one was to add even just Internet-based web conferencing, I suspect that these numbers would be much higher.

Another recent survey found that only 6% of interviewees [who had used telemedicine] did not feel that telemedicine had any benefit over an in person visit. For the other 94% who did see value in telemedicine, some of the benefits cited were quality of care, availability at any location and comfort of home, quick access to care  and altogether cost-effectiveness.

You might ask how watch based sensors, that feed a person’s pulse and activity, to their mobile phone, are different than other telemonitoring devices. The simple answer is, they are not. In a somewhat backwards way, the people who tend to be using these telemonitoring devices, are healthier, more physically active and less in need of a physician’s intervention. This is simply because the whole field of on–person monitoring stemmed out of the fitness world. But there is absolutely no reason why the exact same sensors could not be used to track the status of an older patient who has gone for a walk.

This begs the question: how could research find no benefit to telemonitoring?

When research provides us with  conclusions that go contrary to our present impressions, there are generally two possibilities: either some of the research was incorrect (for any number of reasons) or we got an answer to a question different from the one we asked. And yes, this happens.

One of the most critical principles in research is to formulate a very specific question and then to design a research study that generates data specifically intended to answer that specific question. The problem is that humans are imperfect and any part of the research process can be faulty. Another very important possibility, when doing research, is that the conclusions of a study are not generalizable. So it could be, in this case, that the failure to see a benefit to telemonitoring was because it was being tested on a specific set of conditions. So, for those conditions, it did not work. But it still could work in many other situations. Such is research.

Even with such research on the books, I feel very comfortable making the following statement. Any type of communication with a healthcare service is usually better than no communication at all. A parent who reads the insert on a bottle of antibiotics is in a better position to properly utilize those antibiotics than someone who does not. I am talking about simple paper inserts. And yes, I would consider this a form of communication with the healthcare service.

Now let’s say, that the mother does not understand something on the insert. If that mother has the option of calling up a healthcare service and asking a specific question, that is definitely better than not having such access. And one can go on. If the concerned mother has access to a web conferencing tool, along with a whole suite of telemonitoring devices, a remote physician could be able to assess the sick child, in many cases, as well as the physician could assess the same child in an office visit.

I think the key to all of this is never to think of this entire topic as all or nothing. If a person has ready access to a physician at no additional cost to the patient, then this is definitely a worthwhile option. If a person has a very complicated healthcare situation, beyond the ability of present-day telemonitoring to fully assess, the patient will likely need to travel across town, in any case, to be fully evaluated. The range of options today are good and that range is increasing all the time.

In time, telemonitoring [supported by POC devices and sensors everywhere] and it’s integration into telemedicine systems that also have the support of artificially intelligent medical computers, will make a huge difference that is felt by everyone around the world. When you add to this the growing ability to cure a whole variety of illnesses with advanced technology, the world will really be a very different place within the next 20 years.

Thanks for listening

My website is at

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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