Joseph Ternullo on what's holding back telemedicine

Telemedicine has been a field with a bright future for several decades now. Recently Joseph Ternullo,  Associate Director of the Partners’ Center for Connected Health, shared his thoughts on what factors were at play. Joe was speaking at Monday's meeting of the New England Healthcare Executives Group and pointed out that while analysts have estimated the telemedicine market at$5B to $30B, that pales in comparison to the estimated $1.5 trillion that is spent in the US on healthcare.

Joe named six issues that were at work:

1. Technology
2. Gaps in offerings
3. Usability and Design
4. Behavioral issues
5. Cost
6. Policy

Joe said that technology was only 15% of the problem. We have plenty of things that work today, from videoconferencing to devices that automatically gather vital signs at home. While the technology will continue to improve, the problem today is more a matter of getting products into a form that is easily integrated into the delivery of healthcare. As William Gibson observed, "The future is already here – it's just not evenly distributed."

A more mundane but pressing problem is matching current offerings with the resources and practices of the health care sector. Joe pointed out how doctors, nurses, and patients were ill equipped to deal with the logistics of procuring, installing and maintaining telemedicine equipment. He saw an opportunity for low-cost middlement that could drop-ship a home monitoring system, integrate it into the patient's health record, and retrieve equipment when it was no longer needed or when it needed repair. Another problem is that most products are oriented to the management of one particular disease, while the patient population most in need of this technology are likley to have mutliple co-morbid conditions.

Usability and design have become an issue as technology becomes widely adopted. With users' expectations being set by devices such as the iPhone and iPad, what comes from the IT department looks clunky by comparison. For any new technology to be widely adopted these days it needs to be as easy to pick up and use as the consumer products people use in their daily life.

Influencing behavior was perhaps the most interesting. As Joe put it, “I wish there were a technology that motivated me.” We have plenty of technology that can measure physiological data and even tell us when we are engaging in unhealthy behavior, but the health care world has a lot to learn from the gaming industry how to get people to actually change what they do. In the panel discussion that followed, several people mentioned the work that BJ Fogg was doing at Stanford and the talk he gave at last year's Connected Health Symposium.

Joe said he was thinking of writing a paper on these points. I hope he does so and starts a conversation going.

UPDATE (11 June 2011): Joe says he will be doing more research on this topic over the Summer, gathering data on some controversial issues, such as the extent of co-morbidities and the need of dealing with them in patient monitoring.

 

Comments

[SteveZStein]

Surprised he didn't mention legal issues with tele-diagnosis. I would expect there would be more litigiousness on the part of unsatisfied patients who don't have face-to-face interaction with their doctors. (Note, for instance, the rudeness that occurs on-line which never would happen in person.)

[Christopher Herot]

Actually Joe did mention a number of regulatory and policy issues, including risk management. Hopefully Joe will elaborate in a future article.

[thrill seeker]

I completely agree with this article. More emphasis on number 4: behavioural issues i say.