Telehealth & wearable health-monitoring technologies

Discussion board post for NURS609 Trends and Issues, posted on February 23 2023. Post is in response to thread about wearable health-monitoring technologies as a social trend impacting healthcare.

I agree with the assertion that telehealth is the way of the future, but I am not sure that future is near. There are two factors of telehealth that have not yet been optimized for effective and quality care delivery: the human factor of its users, and the technical factor of its data.

The human factor is still not fully solved for telehealth. A telehealth CEO, and a Harvard editor, both agree that there are several challenges or barriers to the implementation of telehealth related to the user experience (Maheshwari, 2022; Watson, 2020). One of these barriers is the fact that telehealth is not comprehensive care and cannot fully meet patient needs. For instance, diagnostic testing, lab work, and even thorough systems assessments cannot be completed virtually and require in-person interaction. The telehealth CEO reported in Forbes that, according to their evaluative data for their software, over 50% of doctors admit that care delivered through telehealth is subpar in quality to care they would deliver in-person, and that the care delivered does not actually meet patient expectations (Maheshwari, 2022). He also reported that virtual care delivery did not even improve burnout among doctors; they did not feel any improvement in their job satisfaction, despite being able to reach more patients through a less physically intensive means (Maheshwari, 2022).

The technical factor of data automation and processing is discussed in detail in King's article (2017). While it is true that wearable technology can gather rich data, and solve ongoing monitoring and symptom detection issues, it is not entirely accurate when used in real-world situations (King et al., 2017). The issue with data processing is that its automation is calculated and built in a laboratory setting, which has been "shown to fail and lead to unacceptably high rates of false alarms" (King et al., 2017). In order to develop the data models, such as detecting that an individual is experience an abnormal gait and alarm them, the data needs to be built based on a lab-derived model of a normal gait; however, "people rarely perform activities and ambulation in the same way as they would naturally [in real life,] when being cued to do it, or carrying out a script [in a lab]" (King et al., 2017). The technology available is not quite ready to replace human/in-person medical assessment because automation does not allow for natural variation.

This links to our other trend topic in this unit: overdiagnosis. With more of this inaccurate technology at our fingertips, tracking our every move and alerting us to every variation from normal even though it may be a harmless variation for our particular body, we will inevitably develop a cultural hyperfocus and anxiety toward health. This anxiety is heightened by the distanced element of virtual care, which lacks the interpersonal engagement and therapeutic touch that in-person visits can provide.

References

King, R. C., Villeneuve, E., White, R. J., Sherratt, R. S., Holderbaum, W., & Harwin, W. S. (2017). Application of data fusion techniques and technologies for wearable health monitoring. Medical Engineering and Physics, 421-12. doi:10.1016/j.medengphy.2016.12.011

Maheshwari, P. (2022, February 14). Telehealth: The good, the bad and the could be better. Forbes. https://www.forbes.com/sites/forbestechcouncil/2022/02/14/telehealth-the-good-the-bad-and-the-could-be-better/?sh=4ec00f997bb9

Watson, S. (2020, October 12). Telehealth: The advantages and disadvantages. Harvard Health Publishing. https://www.health.harvard.edu/staying-healthy/telehealth-the-advantages-and-disadvantages