Home TeleHealth Excerpt: Introduction

Dramatic increases in the numbers of chronically ill patients in the face of shrinking provider numbers and significant cost pressures mean that a fundamental change is required in the process of care. Several imperatives are born of this impending crisis. One is the need to provide patients with feedback systems that will allow them to self-manage more effectively. A second is to create models in which population-based care is practiced and rewarded financially. The one-to-one model of care, especially the transaction-based care model currently employed in the US, is outmoded. A third imperative is to move care out of institution-owned physical spaces. Today’s healthcare leaders are gravely concerned that they will not be able to continue to service demand by constructing more buildings.

All the above factors combine to create a serious situation for healthcare planners around the world. They also, however, create the opportunity for innovation in the process of care.

Why a book on home telehealth?

Home telehealth depends on technology, although it is very important to recognize that the technology is only one component of a successful home telehealth programme. This book therefore mentions the technology but does not dwell on it. As in much other telemedicine work, the human and organizational factors ultimately will determine success or failure. The experience reported in this book shows clearly that the success of home telehealth rests as much on the behavior of the providers and patients as it does on the underlying technology. The American Telemedicine Association has drawn up guidelines for home telehealth (Box 1.1), and, properly, the criteria that relate to technology are but one aspect of the whole.

The history of telemedicine has been bedeviled by loose terminology that, some observers feel, has not helped its cause. What began originally as ‘telemedicine’ successively has become ‘telehealth’, ‘online health’, ‘e-health’ and so on. In this book, different contributors use slightly different terms to describe their home telehealth experience, depending on their local environment. Although the editors have tried to reduce the number of terms used, we deliberately have not enforced a uniform terminology throughout, in recognition of these local differences.

It is the editors’ intention that this book should serve two purposes. It is a state-of-the-art review of home telehealth in the early twenty-first century. It also should provide a reference and a high level operations manual. Readers should feel more comfortable about implementation of home telehealth applications after reviewing chapters of specific interest to them.

The first two sections of the book describe the nuts and bolts of successful planning for the implementation of telehealth – business models, evaluation strategies and an up-to-date literature review all are included here. In addition, a wide variety of home telehealth techniques are described, including wound management, smart homes and the role of telehealth in quarantine. The third section is application oriented. This section uses a disease-state-oriented approach to illustrate the application of home telehealth technologies in practice. The book concludes with a glimpse of what the future may hold.

We hope you enjoy reading the work reported in this book and benefiting from the experience of others.

Richard Wootton, Susan Dimmick and Joseph C. Kvedar