Alma’s Technology: Chronic Disease Management

Her physical therapy regimen will have her home soon. Once she’s there … Alma’s doctors will be able to monitor her remotely.

Alma Jones, age 83, has had a stroke that lands her in the hospital. She feels much better by the time she returns home. But she’s not ready to be on her own between doctors’ visits.

Telehealth — the delivery of health-related services and information via telecommunications technology — lets Alma continue working with her doctors on a daily basis from the comfort of her own home. With the help of technology, she’s able to get the help she needs to manage her health and continue her recovery.

Alma, the central character in CAST’s High-Tech Aging video, takes her blood pressure each morning. She uses a special cuff that came with her in-home monitoring device. That device sends Alma’s reading to her home health agency.

Alma’s nurse will receive a special alert if her reading is abnormal. That gives the nurse an opportunity to connect with Alma and to intervene immediately if needed to help Alma avoid health complications or a return to the hospital.

Technologies like telehealth have great potential to improve quality of life among people with chronic conditions while preserving their health and saving health care dollars. I’ll be exploring chronic disease management technologies in this 10th installment of our 12-part series on the technologies that appear in the High-Tech Aging video.

The Challenge of Managing Chronic Conditions

When patients like Alma don’t manage their chronic diseases well, they can develop impairments and functional limitations that lead to disability and require expensive care, according to a recent Report to Congress on aging services technologies written by CAST and NORC at the University of Chicago.

Five conditions top the list of chronic diseases that concern us most:

  • Heart failure (HF): HF is the leading cause of hospitalization among older adults, who make up 80% of the people with this chronic condition. Estimated annual cost of heart disease in the U.S. is $190.3 billion.
  • Diabetes: Half of diagnosed diabetics are over age 60. These older adults frequently have comorbidities and functional impairments that reduce quality of life and complicate care. Annual cost to treat all people with diabetes is estimated to reach $200 billion by 2020.
  • Asthma: Almost 5 million older adults are expected to have asthma by 2030. Annual cost of treating asthma is $20.7 billion.
  • Chronic obstructive pulmonary disease (COPD): Risk of a COPD diagnosis doubles every 10 years after age 40. Annual cost of treating COPD was $49.9 billion in 2010.
  • Hypertension: About 64% to 70% of Americans age 65 to 74 have hypertension. The prevalence reaches 80% among those age 75 and above. Annual cost of treating hypertension was $50.6 billion in 2008. 

Managing chronic disease can be challenging for health care providers and their patients.

For example, health care providers may have trouble accessing high-quality information about patients’ health status between office visits. Without that information, it’s harder for them to make timely treatment decisions, deliver education materials and monitor a patient’s response to interventions.

Better access to health professionals would also benefit patients. Without that access, most patients can’t get timely feedback on their self-management efforts. They probably are not getting the reminders, education and encouragement they need to keep those self-management efforts on track.

Using Telehealth to Manage Chronic Conditions

A wide variety of technologies can help patients and their physicians manage chronic conditions. Telehealth and remote patient monitoring (RPM) are among the most common.

This category of technology gives physicians the opportunity to monitor their patients at home and communicate and coordinate care with other physicians. It also helps patients carry out effective self-care on an ongoing basis.

RPM, a form of telehealth, helps physicians and patients track a variety of health information:

  • RPM devices can collect personal health data, including vital signs readings, through wired or wireless measurement instruments that connect to the RPM device. These peripherals might include blood pressure cuffs, weight scales and pulse oximetry. 
  • Some devices also let patients and health care professionals communicate in real-time through video conferencing or text messaging. 
  • Other systems ask users targeted questions and transmit their answers to a health care professional. 

RPM systems store all of this collected data in electronic records. They also alert clinicians to abnormal readings or responses. Clinicians can use this information to offer educational materials or provide medical interventions, like change of medications or medication titration.

Many RPM features are now available through smart phones and other mobile data devices. These “mHealth” systems use wireless Internet technology and ordinary cellular phone networks to collect and transmit patient data. They also allow physicians to access and evaluate patient data, and consult practice guidelines, through Internet platforms.

Telehealth Selection Resources

CAST has developed 4 resources to help you select your next telehealth solution:

  • Our set of 6 Telehealth and RPM case studies highlight how providers went about implementing these technologies, the impacts they experienced, lessons they learned and pitfalls to avoid. 

If you are in the market for a telehealth system, I urge you to check out all of these resources.