Tech View: The Role of Telehealth Remote Monitoring in Healthcare Reform

by: Robert Miller, Thu Feb 12 10:07:00 EST 2009

There is a gathering realization that healthcare in the United States and elsewhere in the world is approaching a crisis: Medicine is improving, and people are living longer. However, costs are also rising, and with a population bump from the aging of the “baby boomers” adding chronic disease treatment to the bill, there are concerns that maintaining a high quality of life for the whole population may stress the healthcare system and payers beyond sustainability. According to recently released figures by the U.S. Centers for Medicare and Medicaid Services of the Health and Human Services administration, the U.S. healthcare spend in 2007 was about $2.2T annually, with more than half of the expenditure to treat chronic diseases. That was about 16.2% of the Gross Domestic Product, and expenditures are projected to almost double by 2017 if action isn’t taken.

The healthcare industry has already been moving to streamline operations, improve efficiency, and shorten hospital stays to cope with the trend. An important part of the rework has been e-enablement: the conversion of medical records and management systems to electronic form, displacing paper records and filing facilities while allowing medical staff to do what they do best---heal people---rather than have them act as scribes. Aside from more efficient use of critical human resources, reduction of errors and e-prescription support, electronic medical record-keeping allows a group of specialists to collaborate to treat patients more holistically and better track medical outcomes to ensure that the best and most cost effective treatments are the ones that patients receive. Today there is virtually no systematic mechanism in medical care for tracking outcomes – based on either treatment or health care provider records.

But now a new e-enablement technology tool is emerging to further improve treatment and lower costs: Telehealth Remote Monitoring.

The essence of telehealth is to enable assessment of an individual’s medical status in real time regardless of his or her location, and to allow a doctor to view the information anywhere to aid diagnosis, observe how a treatment is working, or determine if a condition has become acute. Such a capability can combine more accurate, more up-to-date data gathering with better trend analysis, while allowing the individual to remain in comfortable surroundings. By eliminating many trips to a physician’s office or care facility, cost is significantly reduced and convenience and care quality is improved. Moreover, if the monitored individual approves, concerned family members or caregivers can also become part of the shared medical information environment, providing an enlarged personal care “safety net”. With an aging population intent upon remaining active and independent, such telehealth solutions can provide a coping mechanism for chronic or acute medical conditions without invading lifestyle choices.

Telehealth is not a new idea, but it is an idea that has finally come of age powered by a constellation of advances in electronic technology: broadband connectivity, multimedia information protocols, secure databases and VPNs, advanced sensors and new wireless solutions that now make it practical, cost effective, and convenient. For example, modern Micro Electro-Mechanical System (MEMS) sensors are as accurate as hospital-grade equipment of just a decade ago, at a fraction of the cost. Likewise, powered by the same “chip radio” technology that led to Wi-Fi’s pervasiveness, the data from these new sensors can connect into the network reliably over the air for months on a small battery using new wireless standards such as ZigBee. Moreover, our growing comfort with the electronic devices that help us with our everyday lives makes personal health devices a natural extension of our increasingly “always on” environment.

This is not to say there aren’t hurdles: privacy and how personal data will be used is on everyone’s mind today. However, leveraging HIPAA regulations and other safeguards such as virtual private networks and advanced encryption systems, the way for the initial introduction of remote monitoring capability as a supplement to overall e-records enablement seems within reach. But clearly in order to do this, an “ecosystem” of device makers, service providers, network operators, and medical professionals has to be created.

AT&T Labs Research is addressing this challenge by partnering with standards bodies, industry groups, and device makers to collaboratively craft an architecture and supporting elements capable of providing a seamless, transparent remote monitoring, networking, and data storage/access solution that allows healthcare professionals and care recipients to extract benefit without having to understand the details of the technology---something that AT&T has repeatedly done for more than 100 years.

The AT&T Remote Monitoring architecture was created to complement an AT&T service which has recently entered the marketplace: AT&T Healthcare Community Online. HCO, as it is called, allows hospitals, doctors, and healthcare payers to exchange e-records anywhere using the AT&T network and a secure “dashboard” accessible over the Web. The HCO portal can interwork easily with various existing hospital databases using “edge intelligence” that acts as a translator. Using this architecture, the dashboard can provide medical professionals with a human interface they can customize themselves for optimized information access and readability, rather than the characteristics of a specific hospital database system. Using the dashboard, physicians can access an entire practice, a particular patient, or particular areas of treatment.

The new remote monitoring feature appears as an additional web “page” that enables a physician to view patient measurements both in real-time as well as historical context to better determine a course of treatment. The “Personal Health Devices”, or PHDs, a patient uses would typically be prescribed by the doctor as appropriate for the particular condition being treated. Currently available devices can measure, for example, temperature, weight, pulse rate, blood oxygen level, blood-pressure, and blood glucose. A wider variety of instruments are now approaching certification for use. However, these established measurements may be joined soon by more specialized PHDs, for example: fall detection.

Falls are a particular enemy of older people as coordination, muscle strength, and balance tend to deteriorate with age and advance of chronic diseases such as Parkinson’s. In managed care as well as home settings injuries resulting from falls may render individuals incapable of calling for help and/or require emergency treatment. Resulting bone fractures can require lengthy and costly treatment, severely impact quality of life, and can trigger a cascade of other factors that lead to rapid decline.

To attack this problem, AT&T Labs has been working with industry, hospital, and university partners to research methods of using wireless monitoring technology to detect---and perhaps predict---falls. To accomplish this, research is continuing to understand how position, acceleration, and pressure measurements on areas of the foot could be used with signal processing to identify “signatures” representing either a fall or unsteadiness that could lead to one. Such unsteadiness might be caused, for example, by disease progression, medication, or disorientation (e.g. a bathroom trip in the middle of the night while not yet fully awake). In any case, knowledge of either condition could trigger an alert for help or an intervention to improve gait stability (e.g. by medication adjustment). Several prototype devices are being studied, including a novel “smart” insole with self-contained sensors, radio and long-life battery that can be inserted into footwear. A geriatric trial is currently in the planning phase to utilize these research-prototypes for fall-detection in conjunction with currently-available blood pressure, glucose, and blood-oxygen PHDs for fall causation determination. The goal of the study is to document the value of telehealth remote monitoring to reduce the time it takes for caregivers to react to falls, and If possible, to avert them before they happen.

Author's Biography

Photo of Bob MillerBob Miller currently heads the Communications Technology Research Department at AT&T Labs Research in Florham Park, N.J. His department develops new concepts and technologies for next-generation AT&T wired and wireless broadband packet access systems and services.

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  • HIPAA - Health Insurance Portability and Accountability Act, a government regulation that (among other things) protects the privacy of individual health records without the approval of the individual.


  • Micro Electro-Mechanical System (MEMS) sensors - a technique which uses the same manufacturing techniques (masking, etching, metallic deposition, etc.) used to make electronic integrated circuits to make tiny machines with movable (even rotating) parts. MEMS devices can include accelerometers, microphones, stress sensors, gyroscopes, etc.


  • Personal Health Devices (PHDs) - derivatives of devices originally standardized under IEEE P11073, which was originally created to allow hospital-grade devices to exchange information. A few years ago, the standard was expanded to PHDs targeted for remote monitoring in homes and managed-care facilities. These devices are characterized as much less expensive than hospital equipment, and designed for regular people to use effectively as health maintenance and athletic training tools. PHD "profiles" (what a device is, what it measures, how the measurement is formatted, and how it is communicated) are being coordinated by the Continua Health Alliance. The Continua Health Alliance is an industry body which formulates PHD device profiles, approves communications interfaces, tests for P11073 adherence, and ensures interoperability of devices.


  • ZigBee - the IEEE 802.15.4 wireless standard, a framework of radio and protocol that allows powerful networking for low throughput sensor and control applications using very little battery power. The industry body affiliated with 802.15.4 is the ZigBee Alliance (operating similarly to the Wi-Fi Alliance's relationship to 802.11, the wireless LAN standard).