House Calls
Remote monitors can be lifesavers for chronic disease patients
The monitors are hooked up to patients' telephone lines. Using buttons or a touch-screen, the devices engage people in a dialogue about their condition by asking how they feel and if they took their medications. "It will ask a question like 'Are you short of breath?' " says Lisa Canterbury, a nurse and director of a branch of Deaconess Home Care in the small town of Magee, Miss. Her agency uses a four-button device called a Health Buddy. "Then it will follow up with 'Is this unusual shortness of breath?' because a lot of our patients are short of breath anyway."
Better behavior. Some of the monitors also have plug-in gizmos that measure pulse, blood pressure, and weight automatically. The patients' answers and the medical data are zapped to the home care agency, where clinicians can immediately review them. Anything that seems out of whack triggers an alert and a phone call. "It keeps me on my toes," says Charles Thomas, 82, a pulmonary disease patient in Downingtown, Pa. "The other day I missed a question, and my nurse was on the phone, asking why."
The daily back-and-forth helps change patient behavior, and that is crucial. Nothing is as effective as a motivated patient. A nurse or doctor can remind a patient to do something during a weekly or monthly visit, but patients often forget the advice in a few days. "Once you put these units in the home, patients actually start taking better care of themselves," says Chetney. "They get on a scale and see 2 extra pounds and can relate that to yesterday's hot dogs at the Fourth of July picnic and go, 'Whoa!' "
Chetney, whose service uses a touch-screen device called the Vitel Net's Turtle, likes the ability to customize the virtual chat. If she has a question she wants to ask a specific person--say, whether the patient's spouse is around or away--she can easily do that herself.
On the clinical side, telehealth lets agencies spread expertise further than ever before. At Partners, for instance, the agency has several patients with open wounds, from operations or recurring diabetic ulcers. But the agency has only four wound-care nurse specialists. It could take several weeks for the four nurses to visit all the patients, during which time the wound could get infected. Yet a staff nurse can get there in a few days, take photos of the wound with a digital camera, and send them to a wound specialist, who can provide specific instructions on care. "A telehealth visit costs me one third of what it costs to send a nurse out," says Chetney. "When insurance, like Medicare, only gives you a lump sum for home care, you can rip through that really fast with daily visits." Deaconess, in Mississippi, charges patients $9 per day for telehealth monitoring, while a nurse visit costs at least $100 per day.
The VA's Darkins cautions that the technology, though alluring, is not appropriate for every illness. Alzheimer's patients, for instance, may not have the cognitive ability to use the monitors. Yet for people with mild cognitive impairment or stroke, the devices might work quite well, reminding them to take their medications.
Another concern is that the monitors won't be effective without trained nurses and doctors behind them. Agencies can't simply buy the technology and expect miracles, Darkins says. Telehealth works because it provides continuous care, and if the staff doesn't know how to use the machines correctly, there will be gaps in care. But when the monitors are employed with training and commitment, that is exactly what telehealth will prevent: having patients fall through the gaps.
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