An Ulster County-based company called LifeLink Monitoring is one of the leaders in the field of telemonitoring, a fancy name for gathering patient data remotely and reporting it to a central office. The firm, currently operating in Bearsville, is expanding into one of the old Edgewater IBM buildings in Lake Katrine.

LifeLink Monitoring provides a turnkey telemonitoring service that is being adopted by major healthcare and disease management companies across the nation. The company provides equipment as well as monitoring and data management services.

Telemonitoring is by no means a new concept. Telephone devices that converted an EKG signal to an audio signal sent over standard telephone lines have been around since the late 1970s. Telemonitoring is a concept that has been waiting for an economic model that could support it. Today's efficiency-driven medicine is not just supporting it but pushing its development.

From the patient's point of view, telemonitoring involves a device that measures weight, blood pressure, heart rate, blood sugar or some other easily measured parameter. Automatic blood pressure cuffs have been available in drug stores for years, and you don't need broadband telecommunications for this device to work like a charm. What is measured, however, can be delivered over a standard telephone line to a monitoring center. The monitoring center is where all the high technology comes into play, a technology that has gradually become cost-effective in the past several years.

If you or someone close to you is one of the millions of Americans that suffers from a chronic disease such as diabetes, hypertension, or heart disease, you are familiar with the routine testing required for management and therapy. Most diabetics need to be under "tight" control if their condition is going to be effectively treated. The same is true for a variety of other diseases. Routine testing and monitoring of the results is required in order to observe a patient's condition, the changes over time, and the response to therapy. Drug dosages and even entire treatment regimens can be tailored to meet specific symptoms and treatment goals.
LifeLink Monitoring was started in 1996 by local area resident John Holland and his partner, Roger Greene. The current president and CEO, Art Avedisian, joined the company from Welch Allyn in 1998.

Far more than just a database for vital signs, LifeLink Monitoring provides telemonitoring services to disease management companies, home health agencies, and managed care organizations for a variety of chronic diseases. Data maintained by proprietary software at LifeLink Monitoring's facilities is made available to clinicians according to protocols set up by the physician. The software can alert a physician or nurse about a patient's results in real time, and the data can be archived for tracking, comparison and historical reporting.

The service also polls patients with voice prompts for routine subjective symptoms. This information can be corroborated with the objective data being measured. In keeping with LifeLink Monitoring's service-oriented approach, patients have access to their results through an interactive voice response system.

The hardware is designed to be extremely simple to use (one push of a button is the goal). The services are designed to provide the patient with a simple, routine experience while giving case managers and clinicians valuable patient data. The balance between a simple experience for the patient and a sophisticated disease management tool for the clinician is where you find the elegance of LifeLink Monitoring's work. This is one of the reasons the firm seems to be gaining traction in the global marketplace.

Telemonitoring services from LifeLink Monitoring are easy for clinicians to order and quick to set up. LifeLink Monitoring sends out the equipment, and within a couple of days the patient is in the system. The kit received by the patient includes the monitoring device or devices - with all the cords already plugged into their proper places - and a very simple one-page instruction sheet. All the patient has to do is plug a phone line into a small box and press a button. Avedisian says that the goal is for patients to be able to get up and running quickly and easily - "even if their VCR is still blinking 12:00."

Several academic studies have validated LifeLink Monitoring's clinical value and business model. Telemonitoring does more than lower medical care costs. It increases the quality of patient care and decreases morbidity.

One example that Avedisian points out is the so-called "white-coat syndrome." "White coat" is medical jargon for doctor. A patient said to have white-coat syndrome displays symptoms or has signs in the presence of a doctor that are absent under normal circumstances. The syndrome most often refers to a patient who has false positive high blood pressure. In the office, the blood pressure is high. At home, the blood pressure is normal.

Primarily a result of patient anxiety, this problem is quite real. Studies indicate that about a quarter of patients who have high blood pressure on an initial examination are in fact "white coats." Such patients are frequently prescribed expensive blood-pressure medications that are not needed.

Avedisian's solution is to put the patient on telemonitoring for a short period before writing the script: "You'll know very quickly whether the patient is truly hypertensive or not, and you'll avoid the possibility of unnecessary medication." Patients avoid unnecessary medications and health insurers avoid wasted drug expenditures.

On the other side of the hypertension issue, patients taking blood pressure medication can be more tightly controlled and achieve their clinical goals more quickly and efficiently if drug dosages are correlated to blood pressure measurements on a frequent basis. Telemonitoring provides a valuable tool for excluding white-coat syndrome, preventing unnecessary prescriptions, and maximizing the effectiveness of medication in those patients who truly have high blood pressure.

Far too often in our technological age, the patient is merely the specimen, the vessel for the disease or the cost center. Avedisian believes that the human side of medicine is what's missing from most patients' experiences. His company is working hard to deploy highly technical products that don't lose the human touch.

LifeLink Monitoring maintains an interactive voice response system for routine assistance. It also provides a customer service center with real live human beings to help patients with problems. The customer service center makes initial calls to set new patients up and to make sure everything is working. For a business that relies on devices and that's run by someone who is from the device side of the industry (Welch Allyn is the premier American manufacturer of medical diagnostic equipment), this focus on service and the human touch is not just refreshing. Avedisian says "It's one of the things that sets our company apart from the rest."

While competing telemonitoring firms require up front investments of expensive patient monitors, central office equipment and software or frequently employ what amounts to gold-plated monitoring devices, LifeLink Monitoring has focused on services that are inexpensive to deploy and easy to use. Telemonitoring services from LifeLink are able to provide clinicians with valuable medical data inexpensively (average service costs range between $60 and $100 per patient per month).

Telemonitoring is just starting to play a significant role in managing chronic disease. New telemonitoring technologies for asthma and pulmonary diseases as well as monitoring the effects of anti-coagulation drugs are currently being evaluated, and more tools are on the way. Wireless technologies will almost certainly have a big impact on telemonitoring. As we continue to advance our understanding of disease and diagnostic techniques, and as our technology for miniaturizing complicated devices progresses, Avedisian sees telemonitoring as becoming a more routine and more utilized tool, and perhaps even the standard of care.

LifeLink Monitoring is one of a handful of privately held companies that are funded through Fidelity's Small-cap Growth Fund. This in itself is an interesting fact - and one that tells volumes about Avedisian's business model and the prospects for growth. LifeLink Monitoring is expanding on all fronts. Currently employing 17 people at facilities in Bearsville and Lake Katrine, Avedisian expects to hire 10 more people over the next 6 months and a total of about 110 by the end of next year. With major contracts with companies in California, New Jersey, Illinois, Maryland, Virginia, Pennsylvania, Delaware, Washington DC, Mississippi and Texas, LifeLink Monitoring is poised to take advantage of this new market.

SIDEBAR: The disease management industry
Talking about chronic medical care (chronic meaning "long term") means dealing with a relatively new type of medicine called disease management - a more preventative approach to health care. The doctor and patient already know the disease is there and now they are working together to treat and manage it: testing, monitoring and perhaps altering treatment as necessary on a pro-active basis rather than reacting once the patient ends up in the hospital.

By and large, this type of testing and monitoring does not require a great deal of direct physician time or even special hospital or office visits. It can be performed by trained staff in the patient's home and is sometimes performed by patients themselves. The key is that someone has to make sure that the testing is done and the results are being tracked. We now have an entire category of firms devoted to this type of care: the disease management industry.

Working alongside insurance companies and managed care companies and interacting with large pharmacy benefit management companies, hospitals and physician groups, disease management companies work on the margin by hedging risk. They decrease the costs of medical care through ensuring that proper routine care is performed. Their mission is to reduce more expensive interventions by decreasing their necessity.

How? They tightly control treatment and therapy by monitoring and helping manage the disease. In the long run, it's a lot less expensive to make sure that Mr. Smith's blood pressure is well controlled than it is to treat him for the stroke that might occur if his blood pressure remains out of control. It's also a lot better for Mr. Smith. With the need for acute care decreased, the patient's quality of life and length of life can be increased.
So now, rather than having your blood pressure measured at your doctor's appointment once or twice a year, your vital signs can be measured daily or weekly and your treatment modified accordingly. While it's fairly easy to teach patients how to take vitals signs like blood pressure and do finger sticks for measuring blood sugar, relying on patients to objectively report their own data has been shown time and again to be unreliable. People don't want to admit that their blood pressure is high, that they ate an entire quart of Ben and Jerry's, or that their definition of quitting smoking is really just not buying or being seen with a cigarette.

Sending a nurse into a patient's home to do five minutes of routine vital sign testing is not cost- effective - home nursing visits range from $50 to $100 a visit, depending on the geographic region. Some disease management companies have built huge telephone centers with hundreds of nurses working the phones like telemarketers: call the patient, ask if they took their blood pressure, if not, coach them to do it, record the results, ask them if everything else is okay, and make the next call. This approach limits each nurse to handling a case load of about 150 patients at a time.

Problems of cost, accuracy and limited patient coverage are the major drawbacks to this approach. Replacing an automobile with a telephone certainly can increase the number of patients that a nurse can survey. But nurses are still expensive (the average overall cost of a nurse to a disease management company is about $100,000 a year). Add to that the missed calls, annoyed patients and the other problems of telephone solicitation, and you have a mediocre solution at best.

The goal is to get accurate information from patients. The automation of testing and reporting seems to be the best solution. This is exactly what is happening with telemonitoring.