Another Sobering Result for Home Telehealth—and Where We Might Go Next

Arch Intern Med. Published online April 16, 2012. doi:10.1001/archinternmed.2012.685
Authors: Scott R. Wilson, DO; Peter Cram, MD, MBA
Comment on “A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues to Prevent Hospitalizations and Emergency Department Visits”
“Rapid advances in technology combined with increasing demand for interventions that can “bend the cost curve” have stoked widespread interest in telehealth technologies. … In this issue of the Archives, Takahashi et al2 report on the results of a rigorous randomized controlled trial of telemonitoring in older adults at high risk for hospitalization. They found that in-home monitoring of biometrics (eg, blood pressure and weight) and symptoms failed to reduce hospital readmissions or the need for emergency department (ED) visits compared with usual care. The results of this study are important and sobering and warrant careful consideration. It might be tempting to discount the lack of benefit of the telehealth intervention…”
Find extract here and research article here.

Invitation to Apply for NBN-Enabled Telehealth Programs

Minister for Health Tanya Plibersek and Minister for Broadband, Communications and the Digital Economy, Senator Stephen Conroy, media release 4 April 2012
“Older Australians, people in need of palliative care and cancer patients are among those set to benefit from new telehealth pilot projects designed to be supported by the National Broadband Network (NBN).”
Find release here.

‘Shoo-In’ Strategies Bump Up Against Reality

Health Affairs 31(3): 470
Author: Susan Dentzer
“Our March 2012 variety issue poses a look at two health care improvement strategies: the use of health information technology and public reporting of providers’ performance. As with so much in health care, these strategies have sometimes been sold as shoo-ins for improving health and health care while lowering cost. But reality presents a more nuanced picture.”
Find article here.

A tele future

MJA Insight, online 27 February 2012
Authors: Tim Donovan & Nigel Armfield
“TELEMEDICINE — the use of information and communications technology to provide health care at a distance — has evolved significantly in the past 2 decades.  Now, with the introduction of Medicare Benefit Schedule (MBS) item numbers for video-based GP-to-specialist consultations, the use of telemedicine is spreading from the public hospital setting to the private sector. MBS items provide an incentive for clinicians to make better use of telemedicine services.”
Find article here.

Technology-based patient consultations: Guidelines

Medical Board of Australia, online 16 January 2012
“These guidelines have been developed by the Medical Board of Australia under s. 39 of the Health Practitioner Regulation National Law Act (the National Law) as in force in each state and territory. The guidelines aim to inform registered medical practitioners and the community about the Board’s expectations of medical practitioners who participate in technology-based patient consultations.”
Find guidelines here.

German internet clinic based in London angers German doctors

BMJ 2011; 343 doi: 10.1136/bmj.d7933
Author: Annette Tuffs
“A London based German online medical practice that treats patients by email has been heavily criticised by the German Medical Association. In a press statement on 30 November the association said that the professional code of conduct for German doctors does not allow treatment and medical counselling without any personal contact. “Diagnosis and treatment solely via the internet cannot be in the interest of the patient,” it says.”
Find extract here.

Ethical issues in the development of tele-ICUs

J Med Ethics 2011;37:655-657
Authors: Lior Nesher, Alan Jotkowitz
“The past two decades have seen a dramatic increase in the use of telemedicine while the information technology revolution has contributed significantly to its popularity. In addition, there has been a recent increase in the use of telemedicine in the intensive care unit (ICU), partially driven by a critical shortage of intensivists. However, the ethical questions raised by the implementation of tele-ICUs have not been adequately considered. In this essay, we will discuss the development of tele-ICUs from the perspective of autonomy, beneficence/non-malificence, justice and professionalism.”
Find abstract here.

Treating Posttraumatic Stress Disorder via the Internet: Does Therapeutic Alliance Matter?

JAMA. 2011;306(5):543-544. doi: 10.1001/jama.2011.1097
Author: Shaili Jain
“Mass violence—whether intentional attacks or the result of natural disasters—adversely affects survivors and often causes widespread disruption, displacement, and disability. Epidemiological studies have reported posttraumatic stress disorder (PTSD) or symptoms of PTSD in almost one-third of communities affected by mass violence. 1 Evidence-based psychological therapies used to treat PTSD are available, but obstacles such as a shortage of mental health care professionals and patient stigma toward treatment often limit accessibility to these therapies. … One approach that has been evaluated recently is use of the Internet to deliver therapist-assisted treatment to trauma survivors.”
Find extract here.

Regulators to rein in medical apps

Australian Doctor– 22 July, 2011

Author: David Brill

“The days of listening to your heartbeat on your phone could soon be over, with regulators moving to rein in the explosion of medical mobile apps. In a long-awaited step, US authorities last week proposed the first regulation for medical mobile phone applications, amid a booming number of new programs and platforms.”

Read article here.