Patients with complex comorbidities who receive traditional healthcare services fail to show long-term compliance with prescribed regimens, medications, and dietary restrictions [1
]. It has been shown, however, that strategies that include extrinsic motivators promote long-term compliance and reduce recidivism [2
]. As the population is aging, chronic disease requiring complex treatment and close monitoring is increasing. Moreover, the number of medical personnel is dropping and both homecare nursing and medical staff are expensive. It has therefore become necessary to search for ambitious alternative solutions, which could help the patient to receive adequate treatment and followup from their doctors and to report any emergency, even in the absence of any caregivers and without having to memorize or save emergency numbers, especially when the primary contact is not available. In an ongoing pilot study at our university hospital emergency department, 40% of interviewed patients (>65 years) were not able to recall emergency telephone numbers. Forty-two percent (42%) of them did not own a mobile phone. Thirty-three percent (33%) thought that, in an emergency, more than one hour might pass until somebody noticed. Thirty-seven patients (37%) thought that up to 30 minutes might pass before anyone was notified of their emergency. Almost 40% of the patients communicated their wish to have faster access to medical assistance. Telemedicine and telehealth, especially personalized handheld devices, can offer a new approach to these problems.
Telemedicine (TM) is the use of medical expertise, medical equipment, computer hardware and software, telecommunication infrastructure and the Internet as a healthcare system [3
]. Telehealth (TH) is the delivery of health-related services and information via telecommunication technologies. This is an extension of telemedicine and encompasses preventive, promotional, and curative aspects. TH involves the use of the tools to produce, transmit, manage, and share digitalized information and comprises the use of applications that allow medical activities, including teleconsultation, medical telemonitoring, and medical tele-assistance, as well as remote monitoring and data devices. The latter are known as televigilance or teledata [4
]. The first TH system, operating over standard telephone lines, was used for the remote diagnosis and treatment of patients requiring cardiac resuscitation and was developed and marketed by MedPhone Corporation in 1989 [5
Advances in the area of mobile and wireless communication for healthcare, along with the improvements in information science, have allowed the design and development of new personalized healthcare services, increasing the patient's independence and improving his ability to control and manage his life [6
]. Moreover, many studies have shown that TH can improve the quality of life and clinical outcome and is a cost-effective tool. Noel et al. studied 104 patients with complex heart failure, chronic lung disease, and/or diabetes mellitus who were equipped with a TH device functioning on their home landline. Their twelve-month observational study proved that TH used significantly fewer resources and improved cognitive status, treatment compliance, and the stability of the chronic disease of the homebound elderly with common complex comorbidities [8
]. The UK Department of Health's Whole System Demonstrator (WSD)program was launched in May 2008 and is the largest randomized control trial of TH in the world, involving 6191 patients and 238 general practitioners. Three thousand and thirty people (3030) with one of three conditions (diabetes,chronic heart failure, ordisease) were included in this trial. The trial showed a 45% reduction in mortality rates, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a 14% reduction in days in hospital, and an 8% reduction in tariff costs [9
]. Similarly, in a systematic review evaluating nine randomized clinical trials on heart failure (967 patients), Dang et al. noted that six studies found a 27%–40% reduction in overall admissions; two studies demonstrated a 40%–46% reduction in heart failure-related admissions; three studies found a significant reduction in mortality (30%–67%); three studies showed significant reduction in healthcare utilization costs; two studies also found a 53%–62% reduction in bed days of care; two studies showed a significant reduction in the number of emergency visits; four studies demonstrated significant overall improvement in outcomes with the use of telemonitoring [10
]. TH could also become a very effective tool in providing guidance and support in situations of loss of autonomy, by equipping users with devices that will provide monitoring, continuity of treatment, and reinforcement of social ties. Under no circumstances is TH meant to replace a doctor's presence with a computerized tool but was rather designed to meet the needs and expectations of patients more effectively—people who are vulnerable, dependent, and/or disabled. This paper aim to present (1) an overview of existing technologies, (2) a survey of 100 consecutive ED patients aged >65 years, and (3) the Swiss Limmex emergency wristwatch.