As policymakers continue to look for ways to keep patients out of the hospital, there has been a growing interest around the effects of home telemonitoring on patients. Certainly, wearable medical devices posses the potential to create a trove of medical data, and help doctors and other healthcare professionals make real-time decisions on patients’ health even when they're not in the hospital. But as Spyros Kitsiou, Ph.D., Assistant Professor at the Department of Biomedical and Health Information Sciences (BHIS) at the College of Health Sciences, University of Illinois at Chicago, points out, we have only hit the tip of that mobile health (mHealth) iceberg.
As such, Kitsiou and colleagues recently wrote a paper, “Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure,” that was published in the Journal of Medical Internet Research. They wanted to know, what about studies that empirically show the value of telehealth and mHealth? Do they exist? In the paper, the authors aimed to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure to inform policymakers, practitioners, and researchers. A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Kitsiou recently spoke with HCI Senior Editor Rajiv Leventhal about the findings of the study, its implications, and the effectiveness of home telemonitoring as it relates to the future of healthcare and healthcare management.
What was the motivation behind this research?
We wanted to look at the technologies and interventions for patients with chronic conditions, and more specifically, heart failure. Systematic reviews have tried to aggregate multiple studies in order to arrive to the conclusion on if home telemonitoring is effective or not so they can inform practitioners and policymakers. One of the problems we have noticed, and this was part of the motivation for this study, was that several systematic reviews with studies in this area have reached different results with various findings and conclusions. This creates fuzziness and confusion, and makes it difficult for practitioners and policymakers to act, and for researchers to know where gaps exist. Not all reviews have been conducted in the same way. Another thing we wanted to address is that we don’t know which telemonitoring technologies are most effective for which types of patients.
Spyros Kitsiou, Ph.D.
What were your main findings?
The main conclusion from this is that we have evidence that devices that use automated monitoring—meaning they don’t require patients to actually type in results such as values of blood pressure or heart rate—are more effective than other non-sufficient modes of monitoring such as videoconferencing or websites that require patients to insert their vital signs manually. We also saw that mobile devices, despite seeing a limited number of studies (we reviewed about four studies that use devices such as cell phones or personal data assistants) seem to be effective in reducing mortality in heart failure hospitalizations.
So these findings certainly have implications. On one hand we need to start shifting away from randomized controlled trials (RCTs). We need more evaluations of large-scale implementations. Technology as evolved at a very fast pace, so it is difficult for research to keep up with the evolutions. What policymakers need to take into consideration is that our field is different than other clinical domains. These are complex interventions, so traditional RCTs might not be applicable. We need real-time data and evaluation of large-scale projects. These are the studies that will inform practitioners about the effectiveness of these types of interventions.
How is mobile specifically working to reduce mortality?
Mobile-based telemonitoring interventions allow clinicians to gather data from patients remotely, be it at home or elsewhere. We can gather data from them and provide clinical feedback after analyzing it, and then take action. By using the vital signs, we can anticipate exacerbations and react to them. For instance we can invite patients to come to the ED before anything that may jeopardize their lives occurs. In this way, you can avoid mortalities and hospital admissions/readmissions.
More broadly speaking, we are seeing a trend towards mobile apps helping with chronic care management. What effect do you see these apps having?
There are a lot of apps that assist patients with chronic diseases that allow patients to keep track of blood pressure, lifestyle, and nutrition habits. The question is with so much out there, which of these applications are most effective? We don’t have real answers to that right now. These are behavioral change applications that allow management of lifestyles, so it’s hard to say to what extent they help with right now. We think it can provide a starting point for help, but any more than that we don’t know yet.