How Am I Doing, Nursebot?

Researchers are developing interactive home health stations and robotic assistants to help baby boomers enjoy their retirement years. But with few studies demonstrating cost-effectiveness, the field of "tele-health care" is being slowed by the issue of who'll pay the bills.

Baby boomers have adapted to cell phones and pagers, Internet socializing, and car navigation systems that mean never having to ask for directions. Now that the vanguard of the "me generation" is heading toward retirement, some researchers say the stage is set for the blooming of "tele-health care." Academic and commercial scientists are developing an array of electronic gadgets to give older people more ways to monitor their vitals, keep in touch with physicians, and receive up-to-the-minute medical advice and health care at home, the mall, or the neighborhood pharmacy. The same devices would also benefit health providers and caregivers, allowing them to monitor elders remotely with daily electronic checkups or sensors that track their movements. By allowing people to take charge of routine medical measurements--and providing a means for communicating this information directly to their doctors--the technology aims to prolong independent living for a generation that resists traditional notions of "being old."

The driving force behind the tele-home health movement, says Joseph Coughlin, director of AgeLab at the Massachusetts Institute of Technology in Cambridge, is demographics: The post-World War II baby boom--the 76 million births between 1946 and 1964--will produce a flood of retirees in the coming years. But today's retirees, the boomers included, won't be content to sit in the sun and play shuffleboard. Many will continue to work full- or part-time, start new careers, or just play hard--maintaining the fitness they achieved in their middle years with aerobics and gym workouts. They'll demand an "active aging" lifestyle in which tele-health care could play an important role by delivering health services and information without requiring trips to the doctor.

Although some tele-health care devices have reached the marketplace and many more are in development, it's too early to predict when they'll become widely available and whether insurers will pay for them. Still, home monitoring has already made inroads in some medical applications, and Web sites offering medical advice are gaining in popularity. "The fastest growing segment of the Internet is older women seeking health information," says Coughlin. Health "kiosks" in pharmacies and other stores give customers access to health and prescription information and educational material. Some locations also offer basic screening such as blood pressure measurement or body mass index calculators. Heart patients can have their pacemakers checked over the phone, and thousands of patients with chronic conditions are being monitored by means of interactive "home-to-health care facility" hookups. The tele-health care trend is more advanced in Japan, where large electronics manufacturers such as Matsushita are testing a variety of gadgets, from furry, robotic companions that can interact with their owners and call the doctor in emergencies to nursing home cameras, motion sensors, monitors, and alarms that connect patients with their health care providers.

"Home health stations will become the norm for older adults," says Coughlin, perhaps in as little as 5 years' time. Ultimately, say experts in the field, homes might be linked routinely with health facilities, emergency services, pharmacies, and health education resources. Patients in the future might even be aided by caregiving robots. Researchers at the University of Pittsburgh and Carnegie Mellon University in Pennsylvania have created several generations of Nursebot--a 4-foot-tall (1.2-meter-tall) electronic, voice-activated robot that can follow a person around the house, issuing reminders to take medications, eat meals, or schedule medical appointments.

Before these technologies become commonplace, however, they must surmount many hurdles. "I find there's a lot of rhetoric and hype and talk about the potential of this field, but meanwhile, today, we're stuck with a lot of nitty-gritty problems that interfere with the actual deployment of these devices," says Diane Mahoney, a researcher at the Hebrew Rehabilitation Center for Aged in Boston. Among them: the uneven reliability of wireless signaling and the unknown costs of the seamlessly integrated broadband or wireless systems that researchers say would be necessary to make the technologies work.

Beyond the technical challenges, tele-home health technologies raise social issues including access, affordability, and protection of privacy. Mahoney and her colleagues are field-testing a wireless system that collects information about the movements and activities of an older individual who is at home alone and beams it to the desktop computer of a caregiver, perhaps an adult son or daughter. With adults in nearly half of U.S. families projected to be caring for a parent by 2005, Mahoney foresaw a need for an intervention that would aid "family members who are working and taking care of a frail elder at home." Participants in the study approved the use of motion sensors to track them, she says, but nixed the idea of video cameras in their homes.

What is slowing the tele-home health movement today, however, are not social issues but economics. Private and government insurers are not covering the technology because, they say, few studies validate their worth. In a 2001 report, Telemedicine for the Medicare Population, the Agency for Healthcare Research and Quality wrote that few studies have shown that tele-health care improves outcomes, and almost none indicate that it is cost-effective. Perhaps that's because it's hard to demonstrate that encouraging people to eat properly and take their medications--electronically or otherwise--will translate into huge medical savings. Such studies would require thousands of volunteers and many years to complete. Instead, the technologies might prove most cost-effective for the sickest patients, says Jill Christians of Philips Medical Systems in Andover, Massachusetts. The company uses remote technology to monitor patients with severe congestive heart failure and convey the data to a hub telestation operated by a disease management firm. A European study of the system in 2002 showed that it reduced hospital days by 26% and saved 10% in costs, she says, while improving survival rates by 15% over usual care. For this technology to succeed in the future, she adds, it must be shown to be advantageous in "larger populations and different disease states, such as diabetes, asthma, respiratory, and pulmonary diseases, and at a less acute level, before people develop the chronic disease."

And even if insurers won't foot the bill for Nursebots, says Coughlin, perhaps baby boomers would be willing to bear some of the costs themselves. After all, this generation spends $40 billion out of pocket on alternative health--not to mention faster computers, glitzier cell phones, and home theaters with surround sound.

Richard Saltus is a freelance writer living in Boston. He has yet to connect to the tele-health grid, but he can see the day when a Nursebot might come in very handy.