Can Telehealth contribute to successful longevity?

Picture of Sputnik

When the Soviet Union launched the Sputnik satellite on October 4, 1957, it did more than trigger the Space Race — it also laid the foundation for today’s telehealth, the remote provision of health care and education via communications technology.

As the Space Race rushed forward, from simple radio communications to putting animals and then humans in orbit, scientists and engineers in the USSR and in America wrestled with the need to monitor vital signs of the cosmonauts and astronauts. They took advantage of cutting-edge electronics to transmit heart rates, blood pressure measurements and other data from spacecraft to Earth. This same concept — aided by many evolutions in technology — is at work today as telehealth communications.

Here on the ground, telehealth services were later rolled out (on dog sleds) to people living in Alaska in the last century as a way to provide health care outside the main cities. Originally remote monitoring drew on television technology and bulky camera systems to beam images of patients and their health conditions (including data from devices such as electronic stethoscopes) from remote clinics to physicians who could diagnose and treat the problem.

Today telehealth involves much more compact devices, including smartphones, but still the most popular format is videoconferencing between a patient and a health care provider. Services that required a visit to a clinic or an office (or a hospital) can be delivered to the home (or a remote clinic), enabling health care professionals to “see” patients more efficiently and hopefully, more cost effectively.

The verdict on cost effectiveness is still open, particularly after a very large clinical trial in the United Kingdom (the Whole Systems Demonstrator project) failed to find cost effectiveness compared to usual care, though it was “usual care” pitted against usual care plus telehealth.

Given important advances in communication bandwidth, imaging, and even telerobotics, remote provision of care can now include remote operations where a surgeon at one location guides equipment at a different one. (Hopefully the telecommunications link is sound and doesn’t fail at a critical junction.) It can also involve having a rehabilitation specialist looking in on a client to be sure that exercises are being performed the right way. Many forms of telehealth can reduce the costs of interacting, particularly travel costs for patients and provide health care resources in a timely way.

So what has telehealth to do with successful longevity?

People around the world are living longer than ever before, though there are some worrying indicators that progress may be stalling or even reversing for some groups here in the United States. Nonetheless, increased age is still strongly associated with costly to treat chronic conditions such as heart disease, cancer, respiratory disorders, diabetes, and dementia. Some estimates suggest that nearly 90% of health care expenditures in the United States are on behalf of those with chronic conditions. Thus, managing chronic conditions cost effectively is a major challenge. Management involves monitoring, detecting negative trends, and intervening before someone reaches a crisis requiring costly emergency care.

The monitoring part is ideally suited to telehealth technology. Rapidly improving sensor technology can be packaged in wristwatch like devices. It can be coupled with intelligent software that can detect negative changes and send alerts via text messages and email to health-care providers. So, it is increasingly feasible to offload monitoring usually done via regular visits to overburdened physicians to telehealth systems.

There are still plenty of issues to resolve before intelligent agents (think Siri) replace or even just supplement usual care practices. As one example, how reliable are such systems? Here in Florida, we have regular power interruptions during summer thunderstorm season, not to mention, occasionally experiencing more severe weather events such as hurricanes. One hundred percent reliable electrical transmission systems are not likely to be in place. A recent study my colleagues and I conducted showed that our telehealth system was pretty reliable, with up time for the network around 93%. Strikingly, the human components of the system were less reliable, with patients completing around 80% of measurements that we asked them to take daily (such as weight, blood pressure, filling out survey items). Finding ways to minimize (fallible) human effort by substituting more reliable machine components is going to be a challenge for the field, though monitoring is always going to be a collaborative enterprise between the human and the monitoring system.

Another potential barrier to adoption is knowledge about and attitudes toward telehealth. Several large surveys (mainly in Europe and Canada) have shown that only about 10% of people know what telehealth is, though most saw potential value once it was defined. That finding extends even to clinicians in some countries.

Attitudes may be a much tougher nut to crack for aging adults as many seniors are reluctant to embrace new technologies given the greater cost to them of learning new things compared to younger adults. Perceived usefulness and perceived ease of use dominate as predictors of technology adoption and use, as my colleague Wally Boot and I showed in a recent review chapter. The cost of new learning contributes negatively to perceived ease of use. Even health-care professionals such as nurses have shown some concerns about adopting telehealth in their practices, as a study we conducted jointly with colleagues in the Netherlands discovered.

Nonetheless, assuming other important hurdles such as licensure for practitioners (to practice across geographic regions rather than solely in the state in which they are licensed), and payment for telehealth services can be surmounted, it seems inevitable that health-care delivery will migrate from hospitals and clinics to the home. That process will require better design of telehealth systems and better training for users, both professionals and the people they treat, mainly the growing numbers of seniors with costly to manage chronic conditions. Telehealth will increasingly be in the spotlight in our quest to reduce health care costs and enhance the prospects for successful longevity.

Neil Charness, Ph.D., is the William G. Chase Professor of Psychology at Florida State University and director of the Institute for Successful Longevity.