Are you using Teladoc, MDLive, or Project ECHO? Have you downloaded monitoring health apps on your smartphone? Telemedicine, the remote delivery of healthcare and clinical diagnostics via internet, satellite, wireless, or telephone technology, is rapidly expanding in the U.S. and is central to Federal plans for managing aging America's care. If you haven't encountered it will. "Over the last 5 or 10 years what we've seen is an explosion of the management of chronic disease, in the management of mental health...we're seeing telehealth being used to provide daily ongoing care for patients...." states Ashish Jha, the Director of Harvard's Global Health Institute, in the video below. While insurers, practitioners, healthcare services, and government planners are well informed on the capabilities and goals of telemedicine the average elder needs to build awareness. Will I still see my doctor? Do I need special equipment? Why is healthcare changing? How will telemedicine change the way I plan for late life care?


Will I still see my doctor? Yes and No. One way to think about telemedicine is that it's personalized care with wider access to care providers and information. It's customizable. Through sensors, home monitors, and remote access to medical consultation patients receive care and continuous monitoring. Access to your primary doctor is available anytime an in-person evaluation or procedure is needed but there's no longer a need to find transportation or summon energy to get to a doctor when you're sick or frail because telehealthcare brings the doctor (though perhaps not your doctor) to you or helps you or your caregiver to self evaluate via a digital device. Telemedicine collapses distance. First class services reach patients everywhere, including many rural areas, providing important access to specialists where distance may once have been a patient's barrier. Telehealthcare collapses time. Most people wait to investigate a medical concern until their doctor can see them or they can reach the doctor's nurse which often delays important treatment. Telemedicine tears down the barrier of office hours, empowers the patient with medical information and maximizes the availability of good care with 24/7 service or health monitoring feedback.

Why is healthcare changing? As Dr. Daniel Kraft explains to Paul Tarini at the Robert Wood Johnson Foundation, "Traditional medicine has been siloed inside hospital or clinic and after there's been a presentation of disease or symptom. What I think that technology trends are enabling now is sort of the democratization and ubiquitous low cost access to data where vital signs can now be measured on low cost devices that we wear or something that can be attached to our watches something  embedded in our mattresses. It's the ability now to get clinically useful data at home sometimes on a continual basis that will hopefully enable us to pick up things far earlier than when they present at stage three, stage four with a heart attack or stroke or large tumor." In addition technology presents us with "wearables, externals, and insidables" as Kraft tells a TEDX audience with exciting examples in the video below. "Think about all the technologies that are merging and moving very very is shifting from one that's been episodic and reactive to an era that's more continuous and proactive." 

Do I need special equipment? Yes and No. Some telehealth monitoring relies on specialized or proprietary equipment or devices. Most, such as video conferencing with a medical professional, requires available technology: a computer, tablet or smartphone with video and audio capability and a broadband connection. Some, such as mobile pacemaker monitors, transmit on a basic telephone landline. Since most rely on fast internet connections planners urge an expansion of broadband access to all elders. In addition, PCAST (The Presidents Council of Advisors on Science and Technology) advocates a wide range of programs on computer/telehealthcare literacy and computer ownership as a strategy to meet the goals for elder care. In the March 2016 Report to the President on Independence, Technology, and Connection in Older Age (PCAST) authors state, "Internet access at home should not be a luxury for those who can afford it; it has become like the telephone--a utility necessary to function in the modern world...and underlies many of the technologies in this report." However, at this point in time: laws, insurance compensations/incentives, provider coordination, and privacy all need to be worked out to expand the telehealthcare system. What can you do while we wait for these changes to occur at the federal and state level? Put time and resources into becoming internet ready. Consider writing elected officials and urging movement on PCAST recommendations. Stay in touch with telehealthcare developments.

How will telehealthcare change the way I plan for late life care?  Remote healthcare access and home monitoring makes aging in place easier and more realistic. Already a large inventory of adaptive and assistive home modification products and many CAPs (Certified Aging in Place Specialist) advisors are available to help homeowners accommodate a wide range of medical conditions. In addition, Virtual Villages, organized networks of caring neighbors willing to help, are spreading throughout the United States. Together those systems, emerging smart home advances, and telehealthcare create a bright future for the movement to age in place. Don't own a house? Doesn't matter to telehealthcare. Enjoy greater access to healthcare from almost anywhere you can be monitored or receive digital information. Don't have retirement or long term care coverage? Telemedicine may mitigate that risk because early data suggests that it's helping to curb hospital admissions and re-admissions and reducing nursing home admissions. Telehealthcare removes many barriers to care and enables more fluid monitoring of health conditions. We can only imagine how it might alter and improve the later years of our lives.

What should you know about telemedicine? It's coming. Whether you live in a house, apartment, or your car telehealthcare will reach you soon with improved healthcare access and 24/7 response. Via audio and visual ready computers and smartphones our healthcare will largely transform from a service we travel to receive into a service that meets us where we're at. As Mercy Virtual president, Randall Moore summed up, in the opening video, telehealthcare requires a paradigm shift. We need to "understand that we're not just talking about technology we're talking about whole new solutions..."