Medicare spending for a patient’s last year of life accounts for a staggering one-quarter of the national Medicare annual budget (abstract cited) http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2010.01082.x/abstract. An article in the most recent issue of the Journal of the American Medical Association, ‘Regional Variation in the Association Between Advance Directives and End-of-Life Medicare Expenditures’ http://jama.ama-assn.org/content/306/13/1447.short describes the economic value of advanced\ directives. The conclusion was that directives had a higher impact of reducing spending in geographical areas of higher end-of-life Medicare expenditures. These areas also showed a lower in-hospital death rate and higher utilization of hospice.
Wireless heath technology may, in the future, find a place in end-of-life care. The transmission of many wireless physiologic messages from the patient’s bed in a critically ill patient may algorithmically trigger a physician to consider the futility of continued intensive (or aggressive) treatment. This may be transmitted to the physician via a cell phone, for example. A text message may be sent automatically to a family member or caregiver that the patient has taken a turn for the worse, to consider coming to the hospital if not already there. A message prompt to the physician requesting consideration for hospice care may also be sent, along with the contact information of a family member (all HIPAA compliant).
Wireless health can also play a role in hospice care itself. Remote home monitoring of vital signs, medication status, and basic observations by the caregiver may be transmitted to the physician or nurse. Family members may take advantage of wireless health communications tools to seamlessly contact the hospice or primary care physician, clergy, pharmacy, medical equipment company or funeral home.
Education of family members can take place via mobile apps regarding specific diseases if the patient suffered from a hereditary condition, medication side effects/toxicities, or perhaps the patient’s plan of care (via the patient portal to the EHR).
Family Medical Leave forms could be part of a hospice app that can be easily accessed and electronically sent via a cell phone. A patient’s pacemaker or implantable defibrillator may one day be able to be remotely programmed (remote programming is not possible at the present time) at the end-of-life to appropriate settings.
All these wireless platforms and apps may be programmable before the patient leaves the hospital with one or two clicks of the patient’s EHR, into designated mobile devices, doing away with paperwork, extensive case manager and hospice interviews, thereby decreasing the patient’s family’s stress.
Identifying patients for hospice at the earliest appropriate time will itself lead to decreased end-of-life spending in areas of high and medium expenditures (but not in low spending regions), as the above article states. I submit that beyond that, the use of wireless technology may decrease end-of-life spending even further as proposed. The possibilities are endless. I write this as a former cardiologist who referred many patients to hospice for end-stage congestive heart failure, which has a worse prognosis than cancer. I saw the workflow process which is laudable but prolonged. Anything that may expedite it, cause less family stress, and save healthcare dollars sounds like a win-win proposition to me.
