Mobile Technology Expands Vista for Telehealth, and Complications
SILICON VALLEY -- Privacy problems are among the most stubborn of a cluster of obstacles to a shift to mobile and Internet technologies that healthcare needs for financial and service reasons, executives said. Telehealth requires a high “level of invasiveness” in patients’ homes, “in their personal lives,” said Dr. Michael Blum, chief medical information officer of the University of California-San Francisco’s Medical Center. It calls for monitoring of patients’ weight and activities including eating and movement, he said late Wednesday at the Institute for Health Technology Transformation’s Health IT Summit, and only “a small group accepts that.” Dr. Yan Chow, Kaiser Permanente’s director of advanced technology, said there are techniques for placing devices for digital monitoring and communication so they are unobtrusive.
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The flip side is the security problem for healthcare providers in giving patients access to data about them, for the benefit or their care and their information autonomy, said Vice President Paula Skokowski of Accellion, which sells mobile file-sharing technologies. Mobile access aggravates the issue, she said. “A small minority of privacy defenders” blocked adoption of a national health ID in the U.S., complicating data-sharing greatly, Blum said. Allowing patients to see and correct their information would be “incredibly helpful,” he said, but would open up new problems: People would demand not to be labeled obese, for example, and would contest drug abuse that’s documented.
On the receiving end, healthcare professionals resist having to use secure devices provided by their employers when they're already carrying their own unsecured smartphones, Chow said. He said telehealth goes hand in hand with medical automation. Kaiser gets “10 times the data” from patients using mobile technologies than those interacting online through computers, Chow said. And “as everyone knows, the healthcare system we have is not scalable, is not sustainable,” he said. Making mobile access equally easy requires file-sharing that can pass muster under the federal Health Insurance Portability and Accountability Act, Skokowski said.
"It looks like we're going to be paid less and less,” Chow said of the outlook for providers in relation to efforts to control medical costs. “The incentives will be to design new kinds of relationships with patients,” such as through efforts to prevent health problems. Mobile devices are well-suited to the new world of care and marketing because they're considered highly personal and they're good at allowing a provider to know “what your patients are doing,” he said.
But acceptance of telehealth has been poor outside remote places, Chow acknowledged. How much and how fast that will change “is still an open question,” he said. “But it’s very exciting.” Adoption varies widely among patients, notably by age, UCSF’s Blum said. “It’s pretty dangerous folly” to extrapolate to those with chronic diseases the enthusiasm of tech-savvy younger people for health applications, he said. All kinds of people love using iPads, but “it’s still a big leap” to be “present enough in a person’s life … to be able to change the course of a chronic disease over a lifetime,” Blum said. The key is getting across the right motivation for getting with telehealth, Chow said: “You don’t have to go to a nursing home."
Distance care requires patients to be willing and able to provide information consistently and accurately, and many are bad at it, speakers said. “All the obstacles have to do with people and cultures and business models,” Chow said, adding, “It’s not a technology question.” The ideal enabled by mobile technology is a new, collaborative “self and provider directed care,” but that requires working out liabilities, since institutions can’t allow themselves to be held responsible for what they don’t control, he said.