Matching patients’ needs with the right technology
Clinical requirements must first be identified
When Strategic Monitored Services is hired by a managed care plan or other payer to deliver telemedicine services to a specific patient population, the New York City-based company doesn’t rely on just one telemedicine system.
"We work with all the vendors of telemedicine equipment and are fluent in all the systems that exist, explains Loretta Schlachta, RN, MS, clinical director. The key task in setting up the service is to match the clinical needs of the patient with the appropriate telemedicine system. "Based on the particular application and the need of the physician group or the medical care group, we identify what the clinical requirement [of the patient population] is," explains Schlachta.
For example, a managed care plan may request that a patient or group of patients with congestive heart failure be kept healthier and out of the hospital. Strategic would choose a telemedicine system for these patients that has a stethoscope and an oxygen saturation monitoring device, she notes. "Depending on what the payer wants to accomplish and what the needs of the patient are, we will go to the system that has the capabilities to monitor those things," Schlachta adds.
Using disease management protocols
Telemedicine systems range from cumbersome systems requiring high-speed phone lines to portable systems using regular telephone lines. "We have the full gamut of telemedicine systems from the Volkswagen to the Cadillac at our disposal, depending on the application requested," says Schlachta.
Another important step in setting up the telemedicine service is to take preexisting disease management protocols and tailor them to patients’ needs. [For more information on Strategic’s disease management focus, see story, p. 118.]
"We use protocols that are approved and modified by physicians to serve the needs of each patient," she says. "For example, if a patient only weighs 100 pounds, we would adjust the protocols for the pain medication based on weight and the physician’s orders."
Strategic gives managed care plans the option of using their own staff or clinicians and support staff provided by Strategic. Once staff have been selected, nurses travel to patients’ homes to install the telemedicine systems and prepare the patients for the telemonitoring. A nurse, for example, might explain to a patient preparing for surgery what to expect before, during, and after the procedure, says Schlachta. Afterward, the nurse would install the telemedicine system, explain how it works, and make a test run to ensure the patient is comfortable with the system.
A way to interact with patients
Information from the home is transmitted to a central monitoring station and computer system, one of several staffed by nurses trained in remote monitoring. All the patient protocols, visit information, and data are stored in a data-base in the central monitoring station. The stations are networked to allow the accumulation of outcomes data.
The telemedicine service acts as a physician extender and allows providers to have a "virtual presence" in their patients’ homes, Schlachta says. If problems occur during electronic home visits, the nurse contacts the physician and transmits the data to the physician. The nurse and physician then discuss the situation, and the physician calls the patient directly, if the need arises.
The telemedicine system also allows the transmission of teaching information to the patient. "We can provide patients with information about their medications and how to care for their wounds," she says. "There’s a lot of demonstration that can occur back and forth. It’s not one-sided or cut-and-dried."
And this interaction can occur whether the patient is in the same town as the provider or across the country. "Geographically, it doesn’t matter that you’re in rural Florida and your physician is in Miami," Schlachta says. "You and your provider can be any-where, and this type of interaction and services can still occur and you can still get the care you need."
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