I am a big fan of massaging the scenario that says that eventually the hospital will be a highly diminutive version of what we know today. The connected health initiative focuses mostly on the medical management of chronic illness and how to better care for these patients in a non-hospital environment. We should also be following innovations in surgery that will allow the movement of that discipline out of the hospital. We see that in some sense already with the movement toward minimally invasive surgical procedures of all types. All that is needed is the next innovation in anesthesia to allow more effectivce conscious sedation and the free standing surgical suite will rapidly become a reality.

I believe that the scenario you suggest will render the hospital "emergency room" to be used only for "emergencies" like car accidents - incidents that cannot be anticipated.

With basic RPM there is already a 63% decrease in emergency hospitalizations. Just stepping on a weight scale every day that transmits one data point, allows a remote algorithm to see a sudden jump in weight, alert a nurse to put a patient on a diuretic days before heart failure. This will continue until there are only a minor fraction of chronic conditions that ever get to an actute stage as they will be spotted days, weeks, even years in advance and corrected before the patient needs to be hospitalized.

This will free up resources at hospitals to do preventative work, therapeutic work and "maintain health" not just "fix you when you are broken".

Andrew, What is "basic RPM?"

I found it...Remote Patient Monitoring. Here in Honolulu, we have been some experience with "technology enabled chronic care mangement" using a team of docs, nurses, home care givers and RPM plus video house calls to manage very ill patients in home quite successfully...chronic vents, ALS, CHF, severe Parkinson's, severe hyponatremia, dementia, behavioral disorders, wounds, etc. Hospital days are a small fraction of what was expected.

One of my concerns is that proper use of RPM, video house calls, and related telecare technologies require very astute clinicians. The problem solving is different than in the usual medical center setting...more probabalistic...more benefit/cost assessment. I am not sure that current clinical training is preparing new clinicians to best use these tools. Any thoughts on how the clinical decision and management processes are different in the telecare setting than in conventional in-office encounters?

Daniel, "Very astute clinicians" In my experience of providing behavioral mental health care both conventionally (face to face) and remotely (telemental health), I find that telemental health assessment forces me to be more attuned to what the patient is saying and my assessment skills need to be clearer and more direct. I do think it requires someone who has excellent assessment skills. As we move into this area of providing medical and mental health care remotely it is imparative that our educational systems or added training provide these tools for the next generation to come.

As a Home Care provider the idea of "connected health" gives me hope that we can all treat the patient in concert, rather than as isolated entities based on where we meet the patient in their health/illness continuum. A connected health approach involving RPM will allow each clinician access to the patient's medical history and current medical information enabling us to intervene "in time" to prevent unnecessary hospitalizations and ED visits. Using the skills that we as home care nurses have developed in assessment, teaching, and appropriate early intervention we have embraced telemedicine as part of our toolkit, helping us meet the needs of our patients while dealing with the capacity issues that the current nursing shortage has created. I believe that we will always need hospitals to treat the acutely ill, or those patients with chronic illnesses who have acute exacerbations, but will no longer require hospitals to treat chronic medical conditions. A team approach which includes physicians, nurses, and therapists, all using the appropriate technology, will allow us to care for the patient in the location which is best suited for the patient.