Internet medicine offers affordable follow-up rehab
Atlanta rehab facility develops space-age program
Rehab facilities continue to look for ways to treat patients after they’re discharged and after traditional insurance funding runs out. However, home care services are costly; telemedicine has limitations, and, for many rehab patients, frequent returns to outpatient clinics are inconvenient or too difficult.
Internet medicine is one option that holds great promise as some astonishing technology becomes more widely available.
"We’ve explored all the things you can do as far as POT technology, which is plain old telephone,’" says Michael Jones, PhD, director of the Crawford Research Institute, which is part of the Shepherd Center in Atlanta.
"As we move to the next generation of broadband Internet service, instead of having a small 56K-modem hooked up to the computer, you’ll have a very high bandwidth and have continuous service through a cable company or special digital telephone lines," Jones explains.
With broadband Internet service, computer users are able to download material from the World Wide Web from 10 to 100 times faster than the usual service. Video educational material that might take 30 minutes to download on regular Internet lines could be downloaded within seconds, Jones says.
Details sent over computer lines
From a rehab facility’s perspective, that means patients and their families could be sent detailed video and text instructions or information on any kind of treatment and medical service. For instance, suppose a spinal cord injury patient needs intermittent catheterizations. A nurse might not always be available to provide the service, or there may be a change in caregivers so a new family member may need to learn how to do the procedure. The caregiver could access the rehab facility’s Web site, click on instruction materials under "urology management," and download a video that shows how to do a catheterization. There would be no waiting for someone to mail a video or come to the home to demonstrate the procedure. The video could even be downloaded in
different languages, so if the family member only spoke Spanish or Vietnamese, he or she could still understand it.
If the family needed particular help that is not covered on the Web site, it could be connected to the hospital staff through videoconferencing via computer.
The technology is nearly here, at least in large metropolitan areas, Jones says. In rural areas where the broadband technology is not yet available, the rehab facility would have to send patients a CD-ROM to supplement the material they find over the Internet.
The Shepherd Center received $1 million in grant money from the U.S. Department of Commerce and local corporate sponsors to fund an Internet medicine project. One of the corporate sponsors is a company specializing in the development of telemedicine home health devices used to link patients with providers.
For instance, a computer-based system could include a touch-screen computer monitor and customized software with Internet access. The computer is linked to the hospital and a number of medical telemetry functions, so the patient’s caregiver could hook the patient to blood pressure and pulse devices that connect to the computer.
Providers at the hospital, through use of the monitoring devices, could make sure a newly discharged spinal cord injury patient is doing wheelchair push-ups properly to relieve pressure and prevent skin sores.
"The system will monitor whether they do an adequate job of relieving pressure and the frequency they’re doing it," Jones says. "Then over the Internet, the system will send that information back to the hospital."
Shepherd Center has begun testing its pilot Internet medicine program using volunteers among former patients. The patients are given computer units with broadband Internet access. They’ll keep the units for three to six months, and the Internet service will be provided for free during that time.
"Our goal is at the first of the year to roll this out on an ongoing basis to spinal cord injury and traumatic brain injury patients," Jones says.
In addition to the $1 million development funds, the facility received $2.2 million per year for eight years from the Marcus Foundation in Atlanta. The additional funding will enable the rehab facility to make this service available to all patients who need it.
The center is not taking the funding for granted. Rehab administrators also are working on convincing payers that this type of service is necessary to reduce rehospitalizations and post-discharge complications.
"The Marcus money will give us some things we know we won’t get reimbursed for, like giving computers to patients," Jones says. "But we’re going to try to bill for bridge support services, charging for that wherever we can."
So far, workers’ compensation payers have recognized the importance of follow-up rehab care and have been willing to pay for these services, he adds.
Eventually, the goal is to go to provide payers with global pricing options that include inpatient, outpatient, and follow-up rehab care under one price.
"We’ve had some success with that and hope we’ll have more," Jones says. "Rather than negotiating rates for rehab stay, we’d like to move more to where we negotiate that for a lump sum we’ll take responsibility for rehab care and any complications that occur post-injury."
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