Telerehab Helps Practices Maximize Finite Resources

Telerehabilitation, a method of providing rehabilitation services through the use of technology, such as webcams and teleconferencing, worked just as well as conventional therapy for patients following total knee arthroplasty, according to a new study published in the Journal of Bone and Joint Surgery. "This trial provides evidence for the efficacy of low-bandwidth telerehabilitation in producing clinically relevant physical and functional results six weeks after patients have had a total knee replacement," according to the study’s authors.

Jason Goldberg, Chief Executive of Ideal Life Inc., a Toronto-based health information provider, is not surprised. “We’re really talking about, through the use of technology, extending the reach of traditional methods of care and healthcare delivery,” Goldberg says. “Across the board, in all different segments of healthcare, we’re seeing more scrutiny, more difficulties in utilizing a smaller pool of resources on a wider population. Technology is looked to as the champion of extending the reach to a wider audience of individuals in managing that scarce resource.”

Extending Physicians’ Reach

Goldberg says one of the things that technology, such as a telerehab program, allows physicians to do is access more patients, and open the door to potentially more channels of revenue, with a finite number of resources. In that capacity, physicians can hopefully manage their existing pool of patients, if not more, with the same resources.

“That’s the wonderful part of these types of programs,” Goldberg says. “They fit a wider audience. Based on need, you can stratify the patient demographic.” He believes the pilot programs in healthcare we’re seeing today, such as the medical home and accountable care organizations, are going to require many different types of technologies like telerehab that are built around accountability and results-oriented programs.

The use of such technology allows physicians to stratify their workflows accordingly, even though the implementation of a telerehab program doesn’t require a lot of physician involvement. Physicians can utilize office staff and medical assistants in managing the program quite easily and effectively.

A Teaching MomentGoldberg believes that telerehab is really an extension of remote health monitoring. As such, recent programs developed by Ideal Life focus not just on one way communication of information from the patient to the physician, but affording the physician an opportunity to engage patients during a truly teachable moment. In other words, the telerehab and remote health monitoring devices are viewed as interactive windows of communication.

“We can send down messages to those actual devices themselves,” Goldberg says. “If it’s a blood pressure cuff, the patient has to look at the screen to take his or her reading. Why not take advantage of that opportune moment in time and send down a communication?” In addition to monitoring the patient, the program can send questions concerning side effects and symptoms, but more importantly, it can also send notes of motivation and encouragement, he explains. “It’s all about closing that feedback loop and ensuring that connectivity takes place when individuals leave the clinic,” Goldberg says.

Goldberg believes that feedback loop, from the physician to the patient, is the most important part of a telerehab or any remote health monitoring program. When patients receive some feedback, they see that the system is responding, and they become aware of their condition, more educated. Physicians are then able to guide them more toward self-management.

Short Learning CurveThe key to making telerehab work, says Goldberg, is to take a consumer-centric approach. That means focusing on three main components: Flexibility around communicating the right information in the right manner so that it’s relevant; affordability in set up and use; and ease of use—the latter being the most important piece to the puzzle.

To encourage use, telerehab devices must have the look and feel of products that patients would normally use in their homes. For example, a patient steps up on a scale in the morning and the data is automatically transmitted to the doctor’s office, whether the patient has an Internet connection or not.

“If we expect people to utilize these technologies, and the real goal is for them to utilize them for the long run, they definitely have to fit lifestyle, fit daily routine behavior, and be out of the box easy to use,” Goldberg says. “And the most important part is around connectivity, so it better fit different lifestyles and channels of communication.”