Sunday, August 8, 2004

Video device alters home nursing

System lets caretakers conduct checkups from remote sites

By Tim Bonfield
Enquirer staff writer

While sitting in the comfort of her living room, Mason resident Effie Saunders can get a checkup on her heart condition just by pushing a green button.

The button activates a videophone connection with a nurse 20 miles away. Beyond talking face to face, the nurse can take Saunders' blood pressure remotely, listen to her heart and lungs via an electronic stethoscope and collect a variety of other vital signs.

Effie Saunders uses a telehealth device to check her blood pressure, blood oxygen, and lung condition from her Mason, Ohio home.
(Enquirer photo/GARY LANDERS)
And with the data, the nurse can decide if Saunders is doing fine, needs to talk with her doctor about a medication adjustment or is suffering a problem that requires hospital care. All without setting foot in Saunders' condo.

Welcome to the latest innovation in home nursing, and one of the few local applications of the growing field of telemedicine.

"The whole thing reminds me of Dick Tracy and his two-way radio," says Effie's husband, Russell Saunders.

Effie Saunders participates in a pilot program for patients with congestive heart failure run by the Visiting Nurse Association, one of the area's largest home nursing agencies. The program seeks to augment live home visits with remote checkups using the videophone system.

Using the equipment allows the agency to change its traditional way of scheduling nurse visits. Instead of sending a nurse to a home three times a week for nine straight weeks, the nurse gradually reduces personal visits from three a week to once a week.

During the entire time, the nurse makes at least three "telehealth" visits per week. So instead of getting 27 live visits, the patient gets 15 live visits plus 27 telehealth visits.

"With telehealth, we can increase visits to almost daily when needed, and make live visits when they need to be done," said Angi Johnson, executive vice president of clinical services.

Patients say they like the new arrangement because they can get a professional checkup at any time of day. Home nursing agencies, constantly wrestling with rising demand for care and a limited supply of nursing staff, say the devices allow them to use nurses more efficiently, which saves money while stretching services to more people.

By eliminating travel time, one nurse at the office-based telehealth console can make 12 to 15 visits a day compared with about six visits a day for a field nurse, Johnson said.

"When they told me about it, I had never heard of such a thing. We were lucky to have a radio when I was a baby," Effie Saunders said. "But I was glad to do it. It makes you feel good knowing you can run right there and push that button and they come right on."

The information available from the telehealth system also helps avoid hospital trips, mostly by catching changing symptoms before they become more serious problems.

Since launching the program just three months ago, and serving just 18 patients, the Visiting Nurse Association already has documented five avoided hospital admissions, Johnson said. Combined, those hospital stays would have cost $40,000 to $100,000, she estimates.

The program has been successful enough that the agency plans to expand the service during the next two years to patients with diabetes, respiratory problems and those who need wound care, said Warren Falberg, president and chief executive.

An expanding field

The telehealth equipment is made by Minneapolis-based American TeleCare, which has sold systems to more than 400 health organizations in the United States, Canada and Mexico.

The Visiting Nurse Association is the first Cincinnati agency to use the system. The system also is being used by CareView Home Health in Middletown, said Kathy Schmitz, vice president of customer services for American TeleCare.

Nationally, some of the biggest successes have been reported by the Veterans Health Administration, Schmitz said.

The VA launched a telehealth system in 2000 to serve veterans living in rural parts of Florida and Georgia. During the program's first two years, hospital admissions for heart failure complications dropped 76 percent to 37 admissions, compared with 155 during the two years before launching the program.

Most state Medicaid programs and most private insurance programs do not pay directly for telemedicine services, so it has not been easy for health organizations to absorb the costs. The central part of the system costs more than $20,000, while the home units cost about $8,000 each, Schmitz said.

But the way Medicare pays for home nursing visits does provide an incentive. Rather than a fee-per-visit, Medicare pays home nursing agencies a flat rate based on a person's condition.

That means whatever cost savings are achieved through telehealth technology can help a home nursing agency increase profits. But reducing live nurse visits makes money only if patients fare well in the process. Agencies lose money under the Medicare system if complications develop that require extra nursing visits, Johnson said.

Whether the concept spreads or not, the Saunderses say they are impressed by the telehealth service. They've also been surprised at how well the system's baseball-sized video camera can see all the way across a room.

"If they call you, you better make sure you have your clothes on," Russell Saunders said.

About the system

• Interactive telehealth system made by Minneapolis-based American TeleCare.

• Includes a videophone that allows patients to speak face to face with a nurse. Attached video camera can be moved to allow nurses to view body areas or to read medication labels. Can be connected to an electronic stethoscope, a blood pressure cuff and other devices to measure blood oxygen levels, glucose levels, blood thickness and weight.

• Used by more than 400 medical organizations nationwide including Cincinnati's Visiting Nurse Association.

• The system costs about $20,000 for the central unit and about $8,000 per home unit.



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