Telemedicine helps bridge gap between patients, care

Given the choice, most people probably would prefer to receive medical care in their homes rather than in a hospital.

Luckily for them, an expanding group of technologies used by some midstate home health care agencies is making that easier.

Telemedicine centers on technology that enables medical professionals to track patients’ health remotely via equipment like telephone lines and video-conferencing screens.

Proponents say it lowers health care costs, reduces hospital admissions and allows home health care agencies to provide more efficient, targeted care.

Telemedicine was being used by about 20.7 percent of home heath care agencies nationwide, according to a 2007 survey commissioned by health care technology-maker Philips in partnership with consulting firm Fazzi Associates Inc. and the National Association for Home Care & Hospice.

That number probably has grown since then, because the survey estimated that the use of telemedicine systems would double over the two following years.

Telemedicine also is attracting the attention of major companies. This month, Intel and General Electric formed a partnership to develop a home health care monitoring system.

Upon first glance, a telemedicine system doesn’t look like much. But the small, white box placed in about 100 patients’ homes lets staff members of Visiting Nurse Association Community Care Services (VNA) keep a virtual eye on the patients – monitoring weight, heart rate, oxygen levels and even difficulty breathing each day from miles away.

VNA is owned by Lancaster General Hospital.

The monitor comes with devices like blood-pressure cuffs and a scale so patients can take readings on a daily schedule. It verbally prompts patients through the steps of taking readings, and then asks preprogrammed yes-or-no questions, such as, “Are you able to lie flat?”

The monitor transmits results to the VNA, where a staff member combs through them for major shifts that could signal trouble, such as rapid weight gain or shortness of breath. The monitor also lets the VNA know if a patient has skipped a reading.

Those situations could trigger a visit from a nurse or physician, or modifications in the patients’ medication.

Physicians recommend which patients, upon being discharged from the hospital, should have monitors, said Bill Dunstan, the  VNA’s vice president of homecare services.

The VNA usually gives monitors to patients with cardiovascular and/or pulmonary conditions, or in cases where post-childbirth complications might occur, such as pre-eclampsia.

A similar mix of cardiovascular and pulmonary patients each have one of 144 telemedicine monitors owned by PinnacleHealth System’s  Home Health Care segment, with maternal health soon to follow, said Laurene Stepp, a registered nurse and cardiac team leader for the Harrisburg-based group.

The devices don’t replace home visits from a nurse — which occur two or three times a week — but instead allow home health care agencies to provide services more efficiently and thoroughly, Dunstan said.

Use of the systems also helps the VNA catch potential health issues earlier, which saves money and might prevent a return to the hospital, Dunstan said.

A study by the U.S. Veterans Administration released this past winter found veterans who used the technology saw a 25 percent reduction in the average number of days hospitalized and a 19 percent reduction in hospitalizations.

Roughly 35,000 veterans receive care through the VA’s telehealth initiative, which makes it the largest program of its kind in the world, according to the VA’s Web site.

The VNA has used telemedicine equipment since the early 2000s, and has steadily increased the number of monitors it owns. At Pinnacle, the monitors also have been in use for about 10 years, Stepp said.

The VNA is planning, in the next few months, to begin using wireless broadband video monitors to replace some of the older systems, Dunstan said.  VNA staff members then will be able to see patients during readings, as well as send them video tutorials about how to better care for themselves.

The new systems, of which the VNA has about 10, include wireless devices that measure vital signs such as weight and blood pressure, Dunstan said.

Stepp said she sees further growth of telehealth at Pinnacle and nationwide as well.

“I think overall, this is the way health care is going, in the sense of trying to reduce hospitalizations and keep track of these patients to prevent re-hospitalization,” she said.

President Barack Obama has proposed tying some federal reimbursement for hospitals to their readmission rates for certain conditions.

Telemedicine monitors of any type also might become a common sight in the homes of people managing chronic conditions, such as diabetes or pulmonary disease, said Richard Brennan.

Brennan is deputy director of government affairs for the National Association for Home Care & Hospice and director of the Home Care Technology Association of America, both based in Washington, D.C.
The monitors would help patients stay healthy by leading patients through wellness regimes, as well as catching signs of trouble earlier, he said.  

“Waiting until people are sick, it’s almost too late,” Brennan said. “We’re trying to keep them out of hospitals.”

Telemedicine also will ease the crunch of caring for the millions of aging baby boomers, Brennan said, and will help patients in rural areas, who might have poor access to medical care.