Devices & Technology

Telehealth and the Home Care Nurse

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By Suzi Birz, principal, HiQ Analytics

Telemedicine and telehealth continue to expand their presence in hospitals across the country. In December 2001, Kathy Thompson, RN, home care and hospice manager at New Ulm Medical Center, in New Ulm, Minnesota, implemented an innovative telehealth program for congestive heart failure (CHF) patients. Using a variety of technologies from American TeleCare, Thompson and a team of home care nurses began video-conference patient visits.

The Technology

American TeleCare, a leading telehealth company based in Eden Prairie, Minnesota, offers a variety of products and services for use in home telehealth clinical settings. According to the company’s Web site, “A clinician at the provider station can conduct an interactive video and audio visit with a patient with any of the video patient stations at home or alternative sites outside the hospital. The attached communications module contains video hardware for the two-way video interaction between the health care provider and the patient at the patient station. The moveable camera allows the clinician to provide the patient with additional images, demonstrations or information needed for further care and treatment.”

There are several peripherals available depending on what monitoring is required for the state of the patient’s disease, including:

  • American TeleCare CareTone® Telephonic Stethoscope
  • Blood Pressure and Pulse Meter
  • Glucose Meter
  • Pulse Oximeter
  • Digital Scale
  • PT/INR
  • Digital Thermometer

In addition to CHF, there are numerous conditions that can be monitored through American Telecare’s home telehealth programs, including asthma, diabetes, end-state renal disease, severe anxiety, cancer, spinal cord injury, AIDS, high-risk pregnancy, pregnancy-induced hypertension, hospice, post stroke, wound management, medication compliance and post-operative conditions.

The Implementation at New Ulm Medical Center

Since December 2001, New Ulm Medical Center has installed patient stations in nine CHF patients’ homes. The hospital took into consideration the equipment’s ease of use; it uses standard telephone lines and electrical outlets.

New Ulm’s home care nurses installed the equipment and instructed the patients how to use it. Once the equipment was installed and the patients trained, the home care nurses determined which home visits to replace with a video visit containing all the elements of a home visit. The video visit, however, uses two-way video/audio and the peripherals that send the data to computers at the hospital. The nurse speaks with the patient; gets vital signs, pulse-ox levels and weight; and listens to heart, lungs and bowel signs. The nurse and the patient have each other in view for the entire visit.

According to Thompson, the patient base involved in the telehealth program is an older demographic that was initially skeptical of the new technology. After getting started, however, each has had a positive reaction. After being seen in a telehealth visit, the patients reported that they did not feel denied access to nurses.

Nurses have had a similar reaction. Thompson said that home care nurses place high importance seeing and touching the patient—an ability that would be lost through a telehealth visit. However, Thompson stated that because of the eye contact created with two-way cameras, the nurses still feel that they have this connection.

Thompson explained that while home care nurses love to go to patients’ homes, they have noticed that during a telehealth visit, they still have the complete attention of the patient. There is a certain ease of making a visit, noted Thompson, thanks to the reduction of interruptions and the patient’s focus, which both result in a quicker, yet complete, visit.

New Ulm Medical Center is considering expanding the program to other patients requiring palliative care. The available cardiac technology lends itself to other cardiac diseases as well, such as chronic obstructive pulmonary disease (COPD). Hospice care presents another opportunity, especially for patients at the onset of hospice care or where distance is a consideration.

Clinical Studies

When possible, American TeleCare interviews their customers for result information, from which the company writes clinical summaries. Typically, the customer installation is characterized with a program overview and site challenges. Results measured by the customer often include admissions, re-hospitalizations, emergency room visits and a series of financial outcomes.

The company’s client studies indicate that customers commonly experience a reduction in hospital admissions and readmissions. This reduction translates into a reduction in hospital days and hospital costs. The technology is providing better patient outcomes while also improving financial outcomes.

New Ulm Medical Center describes similar results. Thompson stated that the hospital studied the readmission rates for these nine patients over 18 months. The study criteria included patients who had readmissions within a few months for CHF. Thompson reported that once they started the use of telehealth, they were not readmitted for CHF during the study and beyond.

Take Away Message

Thompson is enthusiastic about the telehealth program. She encourages nurses to accept that technology is the way of the world and embrace it.

“We all need to think outside the box in an effort to keep costs down,” Thompson said. “There are endless possibilities for home care and other palliative care situations.”

For more information visit the American TeleCare Web site

© 2005. AMN Healthcare, Inc. All Rights Reserved.

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