"With the new technologies in healthcare, the question isnít whether these technologies will work, but how are we going make them work best, how creative can we be in using this technology to help patients at home become independent in their healthcare," said Margaret DiLascio, RN, BSN, the telehealth nurse at VNA of Hudson Valley in Tarrytown, N.Y., adding that real-time telemonitoring enhances field nursesí case management of the patient.
"The patients served through not only the home care nurse visit, but also through a telehealth visit, are likely to experience a higher level of care than someone at home without the equipment," she said.
DiLascio considers the equipment cost effective. Although there is no Medicare reimbursement, telemonitoring allows for faster interventions, such as a change in medication or dose.
"The purpose is to catch negative trends," said Laurie Chichester, vice president of home care at MJHS in New York City, who called it a good investment. "It also helps with continuity of care."
MJHS sends the physician a trend report biweekly, so he or she can see biometric patterns. The nurses also benefit from the additional information, and it allows the agency to better use its nursesí services, Chichester said.
Richard Brennan, vice president of technology policy in the government affairs department of the National Association for Home Care & Hospice in Washington, D.C., and executive director of its affiliated Home Care Technology Association of America, added as an example that nurses can spend more time interacting with patients, albeit remotely, and reduce driving time.
Steven Boym, RN, BSN, MHA, a staff nurse at MJHS, called telehealth beneficial for patients because it can eliminate the cost of an ED visit and admission and prevent crises from occurring.
"It stabilizes patients," Boym said. "This is very good for the patient who goes back and forth to the emergency room. Itís good for the patient who is not very compliant. Itís also good for the people who are depressed due to [congestive heart failure] or diabetes."
Boym said patients donít feel as alone with the equipment. Family may become more involved, and patients may take more control of their care, all contributing to better outcomes.
With penalties now associated with some readmissions within 30 days of hospital discharge, preventing returns through better home health management is paramount. In addition, payment for care is shifting from fee-for-service to more bundled and coordinated care, such as accountable care organizations.
"Accountable care organizations are focused on controlling cost," Brennan said. "They will have to bring innovation into that. Ö They will need to do it at home and use technology when the provider is not in the home."
Telehealth offers an opportunity to improve patient outcomes.
"Telehealth is making healthcare more efficient and allows patients and professionals to do things impossible before," DiLascio said. "It will bring home healthcare and physiciansí offices closer in providing care to their patients."
VNA uses AmericanTeleCareís LifeView patient monitoring system, which includes a stethoscope, scale, blood pressure meter, glucose meter, pulse oximeter, thermometer and protime/INR meter. The stethoscope lets DiLascio assess lung sounds when the patient or caregiver applies it to the chest or back, matching placement as outlined on a chart left in the home. The device also asks patients questions.
"This equipment is fast to use [with] easy access to higher-quality healthcare," DiLascio said. She also reported high consumer acceptance. The LifeView patient station includes a camera and screen to allow video encounters, essentially virtual nursing visits. DiLascio can see patients, and they can see her. She can assess a wound, watch and coach a diabetic patient drawing up and administering his or her own insulin or visualize how well the patient is listening and understanding her teaching.
"Thereís probably no limit to it," DiLascio said. "Of course, I cannot reach through the camera and touch them. But weíve walked patients through so many scenarios."
MJHS uses Cardiocom equipment to monitor blood pressure, heart rate, blood sugar and weight. The device asks patients about their status, with questions tailored to their condition, and triages based on the responses.
Both systems can send information via telephone lines or an aircard. The bandwidth allows for transmission of large amounts of data.
"We are now [seeing] innovations started in other industries floating to the healthcare space," Brennan said.
He offered as examples tablet computers and mobile apps that seamlessly capture clinical data with wireless sensors, all part of the mobile-health, also known as mhealth, movement. He said more than 6,000 consumer health apps exist. Home healthcare nurses are using those apps.
"The technology is a matter of taking what we normally do with education and behavior change methodologies we provide in home care and reinforcing that with feedback loops from the technology," Brennan said. "Itís a matter of time before the industry is able to react to the ability to connect further with consumers."
DiLascio expects telehealth equipment to decrease in size and transmit information via smartphones.
"It will be more sophisticated, more accepted and the norm," DiLascio said. "There is no limit. Internet-based care delivery is the future."
Debra Anscombe Wood, RN, is a freelance writer.
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