journal—equivalent to the New England Journal of Medicine, but for home health care—“would obviously be productive.”

Committee member Christopher Gibbons said that reimagining the delivery of health care requires asking what recipients want and need, not just doing what others think they want or need. Crawford agreed, saying “there is certainly a lot of interesting feedback out there that is not obvious.” Taking such steps requires a sound infrastructure for regulation, technology development, and reimbursement, said committee member Laura Gitlin. “It’s not developing the same infrastructure we have for [institutional] settings but what a new infrastructure is going to look like.”

In response to a question about incompatibilities caused by technology upgrades, Crawford said that Intel has emphasized backward compatibility, so that capabilities are not lost when a system is upgraded. The issue also arose of incorrect data entry into home health care technologies by users, whether a care recipient or a formal or informal provider. The possibility of erroneous data entry requires both user testing and safeguards built into technologies that could cross-check entries. But full capabilities in this area will require that systems be integrated across different devices and technologies, which will require even greater attention to human factors issues.

Committee member Judith Matthews raised the issue of trust. “Does the system do what it’s intended to do?” Airplanes rely on redundant systems, which increase the level of trust among fliers. “It’s not just a matter of the information being put in or the output at the other end to the recipient of that information. It’s also knowing that the system is working, that it’s calibrated, that it’s good to go.”

Carolyn Humphrey observed that a large number of formal caregivers have had extensive experience with home health care devices and technologies. These individuals could inform discussions about user needs and trust. She also mentioned that current reimbursement structures do not necessarily lend themselves to the widespread adoption of particular medical devices, including telehealth applications. “If we do get telehealth for a patient while they are on formal home care, we most of the time don’t have a way to get it continued after their discharge from home care.” And the removal of equipment can be traumatic for people who have learned to trust it. “We had people crying, literally, when their systems were leaving,” said Crawford.

Several physician participants at the workshop questioned the value of at least some of the data generated by new technologies. Much of this information is simply discarded by physicians too busy to consult or use it. The data need to be filtered and analyzed. Gibbons said, “This is why health care has to change. There are some things we do now that we shouldn’t do, that we don’t need to do. But there are some things that we are not doing that we should do.”



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