Telemedicine targets the chronically ill
Service provider markets services to managed care
By reducing hospital admissions and emergency department visits and cutting lengths of stay, telemedicine is proving its worth as a cost-efficient option in the care of chronically ill patients, experts say.
That’s important, considering Americans currently spend about $470 billion annually on the direct costs of medical services related to chronic illness, says James S. Logan, MD, chief medical officer for Strategic Monitored Services, a New York City-based telemedicine company. Strategic contracts with managed care organizations to monitor patients with chronic conditions. Logan adds that, as the American population ages, these costs are likely to increase.
The American Telemedicine Association in Washington, DC, describes telemedicine as the transfer of medical information (graphics, video, voice, etc.) between patients, physicians, and other health care providers who are at distant locations. It includes the use of telecommunications to link the various players in the health care spectrum, including patients, for diagnosis, treatment, consultation, and continuing education.
Telemedicine may even allow ambulatory patients to continue living at home rather than moving into a nursing facility. A telemedicine unit permanently installed in a patient’s home can supplement in-person visits. Hands-on care, while certainly an integral component of home health, is not always essential, such as when the objective is to educate family members about the care of a patient. In emergencies, telemedicine links can provide quick and direct access to health care providers.
Gregory J. Muth, president of Strategic, believes that "medical information and the ability to achieve desired clinical outcomes will dominate the future of disease management." He estimates that Strategic’s operating costs, including a central nurse monitoring station, telecommunications, and other equipment come to about $30 per event. "The average national home health visit costs about $104 per event," Muth says. "That makes telemonitoring of patients very cost-effective."
As part of its disease management focus, Strategic specifically targets big ticket chronic diseases such as congestive heart failure, asthma, chronic obstructive pulmonary disease, AIDS, and diabetes, says Loretta Schlachta, RN, MSHP, CHE, clinical director at Strategic.
"We try to keep chronically ill folks healthier by trying to catch things before they deteriorate," Schlachta says. "That way, providers can take aggressive action and nip problems in the bud before patients get to the point where they have to go to the ER or be admitted to the hospital." If a patient with lung disease, diabetes, and hypertension gets a simple cold, for example, he could wind up in the intensive care unit on a ventilator, notes Schlachta.
"The chronically ill are fragile and labile in terms of their disease process. They live on the edge of disaster all the time," Schlachta says. "With this, you can use frequent but not intensive monitoring to catch subtle signs and symptoms and assess certain key parameters. Then you can identify problems quickly, collaborate with their physician to address the problem, and keep them from deteriorating."
Priority Professional Services, a home health company in Dallas, regularly uses mobile telemedicine to care for patients. "We’re not trying to replace doctors’ visits, but some patients are very debilitated, and it takes an ambulance just to get them in for routine care," says Jamie Mozingo, BSN, RN, MBA, formerly Priority’s chief executive officer. "With the telemedicine system, we don’t have to take these patients in as often, and this makes coordinating care for patients much simpler."
When a Priority nurse or aide sends an image back to a clinical supervisor, the image is added to the patients’ record, which makes it an important quality assurance and outcomes measurement tool, adds Mozingo. Patient confidentiality is protected by covering the patient’s face and using only patient identification numbers when pictures or video images are transmitted. In addition, patients sign a standard release form giving permission for image transmission.
Mozingo also says that minimal time is required to train staffers to use the equipment. Nurses and aides in the office needed only a few weeks to learn how to use the telemedicine system. They then took the system home and practiced sending images from their own homes to the office before taking it into the field.
Other approaches to telemedicine and technologies used for telemedicine include real-time full-motion video transmissions, still images, audio exchange, and, more recently, the use of the Internet. Research in the field is widespread, involving not only private health care but also the military. (See related stories on telemedicine contacts and resources, at left and p. 113.)
Often, still images can be transmitted in quick sequence, creating fragmentary movement. In addition, images can be stored and viewed at a later time or converted to photographs for inclusion in the patient’s record. Some systems can be complemented with equipment that monitors and transmits blood pressure, pulse rate, and heart rhythm. Others can be used for diverse tasks such as looking at the syringe of a diabetic patient to see if it has been filled with the proper amount of insulin.
Kaiser Permanente Health Care based in Oakland, CA, also has experimented with telemedicine for home health visits. A project known as Tele-home Health is one facet of the health care network’s Interactive Technologies Initiative. The program’s goal is to compare the standard of care for home health in-person and telephone home health visits against a telemedicine model. Two hundred patients are participating in the program.
One interesting observation about telemedicine is that even with the constraints of a small video screen and slow transmission time, the patient/nurse relationship "seems to take over," says Jill Deuser, RN, MBA, senior project manager with Kaiser Permanente. "We’re finding that you feel that you’re in the same room with the person," Deuser adds. "Technology doesn’t seem to get in the way."
[For more information about telemedicine, contact:
Gregory J. Muth, president, Strategic Monitoring Services, 1185 Park Ave., Suite 211, New York, NY 101128. Telephone: (212) 996-1613. Fax: (212) 831-1518. E-mail: Strategic_Monitored_Services@ CompuServe. com.
Loretta Schlacta, clinical director, telephone: (212) 996-6113. Fax: (212) 831-1518. E-mail: 110010,[email protected].
James Logan, chief medical officer, telephone: (405) 364-7694. Fax: (405) 321-9703. E-mail: [email protected].]
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