Editor's Corner

Remote monitoring of high-risk and chronically ill patients has come a long way. With recent improvements in mobile technology and wireless connectivity, falling prices on high-end home computing equipment and the wide adoption of consumer broadband, it's getting more feasible by the day. And the clinical benefits of remote monitoring seem to be significant. This approach can help clinicians stay on top of a number of costly and difficult-to manage conditions, including congestive heart failure, diabetes, chronic obstructive pulmonary disease and high-risk pregnancies, and cut down on unneeded hospitalizations substantially.

However, we're still a ways away from dealing with some IT and workflow management issues that stand to scuttle widespread deployment of remote monitoring systems. While the point-of-care technology may work, we're still not up to speed where mobile applications, databases and intelligent enterprise monitoring systems are concerned. More importantly, the industry seemingly hasn't figured out how to make things easy for patients.

One study completed in 2003 gives a hint of what's involved here. A few years ago, Canadian researchers designed and rolled out a PDA-based glucose monitoring tool for Type 1 diabetes patients. The idea was to test whether this tool, in combination with clinical monitoring and support, could help rural families better manage blood sugar levels for children diagnosed with Type 1.

As it turned out, the new management approach didn't work well. Families faced a wide range of technology problems, including PDA problems, glucometer failures, glucometer/PDA synchronization issues and communication failures between the PDA and ISP. Some of the families had trouble even connecting with the ISP, given the spotty connectivity available in their rural location. And if all of that worked, patients and families didn't always have the energy to stick with the program.

Taken together, these problems were enough to doom the project. Particularly given patients' need to test sugars three to four times a day, even small technology issues ballooned into major ones. Researchers concluded that the monitoring process was too taxing for many families to fit into their day-to-day routine.

If you're rolling out remote monitoring to patient homes, you'll want to be fully aware of process obstacles like these. In fact, before launch, you may want to interview a few patients or clinicians who already participate in such programs, and find out what their pet peeves are. The idea is to predict where the implementation might break down, even if the breakdown is human rather than machine-driven. After all, if patients and clinicians aren't on board, even the best technology in the world won't get the job done. - Anne

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