‘Passive monitoring’ used to mean exclusively sensor-based activity monitoring–telecare–in studies from the mid-00s with perhaps some telehealth thrown in. Now telehealth is being conceived of as passive and part of a new area called ‘home health IT’. Dr. Robin Felder’s presentation at HIMSS11 explores this notion with new terms such as ‘medical cloud’. If 95% of blood pressure monitors are stashed in drawers (unless the patient is under some kind of medical supervision), monitors in clothing–or embedded in bathroom or home fixtures–are vastly preferable. The analysis level can get a bit creepily deep (the toilet), but it still begs the FBQs (four big questions): who’s looking at the data on those web ‘dashboards’, who’s actioning it, who’s paying for it and how much? (And what about the wellness coaching/support?) To make this happen: the technology is not quite there, then the long-term, large N studies are needed along with policy and reimbursement changes, but a lot of the infrastructure around this is already being used (AMC Health [TA 14 Aug], VRI [TA 7 Dec] and Cardiocom [TA 14 Jan] in reporting and models integrating with case management). Dr. Felder also ‘walks the walk’ in several ventures, including being on the board of WellAWARE Systems which is studying passive sleep monitoring at an assisted living facility. Neil Versel in Mobihealthnews, Is passivity the future for home health monitoring?
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The real problem with achieving passivity in health monitoring is what are we truly looking to achieve?
If we just want to gather health data for clinicians to review at regular clinic appointments then yes passivity may be the way forward; but that will not make a dent in the costs of running our health services.
Or are we looking to a future where people are better informed in the choices they make; where citizens take appropriate responsibility for self-management of health and social care needs or actively contribute to management of those needs when an Authority has a duty of care to step in. In this scenario passivity will only work once the people have bought into the concept and so initially they need to make active and conscious decisions in their health monitoring. In this case passivity constitutes a risk!
[i]For example – my Mother has diabetes which is totally food controlled – she needs to know the outcome of her monitoring for that to work.[/i]
Either way please don’t offer me a toilet that assesses my health … I can just hear the condescending voice now “… Cathy please come and take a seat, you haven’t passed urine for a few hours and your health check is overdue …”
Given my low tolerance for an Allied Health Professional counselling me that I should lose weight by eating lots of carrots; based on her having zero knowledge about my diet which includes more portions of fresh fruit and veg than an average zoo monkey … I don’t think the toilet telling me how to be healthier is going to work?