“Just what do you think you're doing, Dave?”

For those of you not quite old enough to remember it (or who aren’t movie buffs), that was a quote from HAL the robot in 2001 Space Odyssey. HAL is a robotic/computer system that communicates with the crew, expressing emotions both positive and negative.

In a story that ran July 20, 2010 in the Wall Street Journal, I learned that Hong Kong-based Intuitive Automata has developed a robot designed to help individuals combat obesity by actively communicating with them. The product is a cute little robot that looks the spawn of a talking ET and the iPad. HAL is back, but hopefully this time he is on a mission for good.

Known as Autom, the little dude (or should I say dudette…they say it’s a girl) is meant to sit on the kitchen counter and track your eating and exercise behavior, but also give you tips on how to improve compliance with diet and exercise plans. It communicates with the user literally by talking. According to the article, these conversations are formulated after users input information about their diet and exercise regimen that result in prompts from Autom to make good choices. I’m guessing she doesn’t say “hey, what do you think you’re eating Dave?” or “have you seen yourself from behind lately?” but she might think that really loudly.

The WSJ reports that Autom also “uses social cues to seem more lifelike, a big psychological difference from working with a static computer screen. She blinks her eyes, turns to look at who she’s talking to (in the future she will apparently have facial recognition capabilities), and ends conversations by saying, ‘I hope we can talk again about your progress,’ in a female voice.” I am guessing that they have to use someone that sounds more like Angelina Jolie than Fran Drescher to get you to actually listen (it isn’t going to get your attention if it sounds like your mom, right?), but you have to love the concept. It’s basically a techno-conscience with big puppy dog eyes. I can think of a number of product extensions that could really expand their market opportunity….I’ll be the first in line to buy the one that tells my teenager to set the table, do her homework and feed the dog, all in Zac Efron’s voice. But back to the subject at hand.

According to Intuitive Automata research, users adhere to their diets longer when using Autom. This is not really surprising to me, as there have been many demonstrations of the power of daily remote monitoring for the effective management of chronic diseases, obesity, and even certain mental health conditions. My firm, Psilos Group, was the lead investor in a company called Health Hero Network, now a division of Bosch, which sells a remote monitoring product called the Health Buddy. While it doesn’t have cute little eyes or a voice like Christina Aguilera, the Health Buddy is used for remote monitoring in the home for patients with chronic diseases.

Health Hero has shown time and again that when you regularly and frequently (daily) engage on a personalized basis with a patient, you can make a major material difference in health outcome and health cost. For instance, the US Department of Veterans Affairs recently published four years of data showing a reduction of 19 percent in hospitalizations and 25 percent in bed days of care among a population of 17,025 veterans enrolled in the VA’s Care Coordination and Home Telehealth (CCHT) Program, where the Health Buddy is a central feature. In January of last year CMS extended an existing 3-year pilot of the Health Buddy as a result of similar outcomes.

If it’s so great then, why isn’t tele-monitoring used everywhere throughout our healthcare system? Shouldn’t everyone over 65 have a Health Buddy or Autom in their home? The biggest challenge in getting adoption of these programs has been a fundamental lack of reimbursement by insurance carriers, both public and private. It has been a serious challenge to get carriers to pay the cost of the devices, even though the return on investment has been demonstrated many times over.

A second and related challenge is ensuring that the patient’s primary care physician is fully engaged in looking at the data that comes out of these systems. While the patient’s engagement with the system is, of course, essential, the positive effect of remote monitoring is significantly compounded when the patient’s physician is part of the team and actively reviewing the data to ensure that appropriate interventions occur before the patient enters a high-risk state. By and large, the physician won’t practically engage in the process unless they are reimbursed for the time they spend on data review and patient outreach, but when they are motivated to participate with the patient in the tele-monitoring process, it can be a powerful partnership. Patient+physician+robot: not exactly a Norman Rockwell painting, but it seems to work.

It appears that, after a solid 12-15 years of trying, the opportunity to foster a true market for remote monitoring may slowly be arriving. The recently passed Accountable Care Act calls out remote monitoring as a core methodology to improve Medicare performance and is starting path down a road of more consistent reimbursement for this valuable approach to patient care. As there is greater discourse about Accountable Care Organizations and a move to adopt global payment structures that bundle payments around chronic conditions, the return-on-investment for remote monitoring becomes crystal clear. As always, it is “follow the money.” But that’s human nature and that’s business and in the end, the opportunity to meaningfully engage the consumer through the application of this proven technological approach will play a part of the salvation of our ailing healthcare system. No doubt when that happens, remote monitoring devices everywhere will look up at us with their big blue eyes and say, “what took you so long?!”