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.
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
- 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
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.
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
“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.