JENNIFER BOULDEN

Susan Carr of Little Rock used a telehealth monitor regularly while receiving home care this year from the Visiting Nurse Association and physician Joe Hargrove.

Mom always seemed to have eyes in the back of her head, and now, so do many Arkansas home health agencies.

All over the state, home health professionals are using telemedicine systems to track their patients’ daily health even when patients go days at a time between nurse or doctor visits.

St. Vincent Infirmary’s Visiting Nurse Association (VNA) in Little Rock, which purchased an initial 10 telehealth monitors in 2005, recently invested in another 13 and expects rapid expansion of its telehealth program, said Sheila Davis, director of clinical services. The devices include a monitor about the size of a clock radio, a scale, a blood pressure cuff and a pulse oximeter. Some of the units have thermometer probes, and other peripherals such as a connection to a glucometer or EKG are available.

A nurse visits an eligible telehealth patient — usually a patient with a chronic condition such as diabetes or congestive heart failure — to connect the HomMed monitor to the home phone line and enter the patient’s settings into the device. Like an alarm each morning, the monitor comes on at a pre-set time and speaks to the patient. “Good morning,” it will say. “It’s time to check your weight.

Please step on the scale.”

The monitor continues to prompt the patient through the simple process: step on the scale, have a seat, put on the blood pressure cuff, etc. The patient pushes green and red “Yes” or “No” buttons in response to questions about how they are feeling, such as if they have swelling or are in pain, and similar questions a nurse would ask. When the process is complete, the monitor wishes them a good day and reminds them to take their medicine.

Back at the agency, a nurse reviews the data from a central monitor. If there are any questionable data or causes for concern, the nurse will call the patient for more information, and possibly contact the physician or schedule a home health visit that day to assess the patient in person.

In Harrison, Northwest Arkansas Regional Medical Center’s (NARMC) home health agency has been using the same brand of telehealth monitors as VNA for four and a half years. They have 25 monitors in almost constant use and usually have a waiting list. Program Director Lori Youngblood said while they’ve been enormously happy with the system, the agency is looking to upgrade to smaller, newer monitors in mid-2008 when its contract with the current supplier expires. She said the greatest barrier to more widespread adoption of telehealth is not learning to use the technology, but rather, affording it.

“No matter what brand you use, they’re enormously expensive, around $6,000 to $9,000 per monitor,” Youngblood said. “Our hospital picked up the tab. We were fortunate that they understand that these are life-saving devices that add significant value to our quality of care and in the long run will save money by decreasing rehospitalizations.”

Telehealth has enormous benefits for patients, especially in avoiding return visits to the hospital. Davis said that out of VNA’s 64 congestive heart failure patients using telehealth during the course of a year, only 13 percent had to be rehospitalized, compared to national average for CHF rehospitalizations at 39 percent.

A 2006 Canadian study published in the journal Telemedicine and e-Health listed several less concrete benefits of telehealth monitoring, including patients’ improved sense of security associated with nursing oversight, improved understanding of their own health status and improved self-monitoring of their own condition.

Additionally, the study showed that the increased amount of timely data and communication about patients’ health helped foster closer trust relationships among all parties, from patients to nurses to physicians to hospitals, and promoted new forms of collaboration.

This rings true for most patients, concurred Youngblood and Davis. “They are few and far between, but some telehealth patients are just non-compliant because they don’t want us watching every detail,” Youngblood said. “But overall, we have noticed a big difference in our patients because knowing that they’re going to be checked every day makes them more compliant. They like the idea that someone is checking on them between visits, and they also like the idea that the doctor will be able to see these reports when they go to a visit. They trust us more because they know we’re paying attention.”

She said the telehealth data is also important because it records patients’ vital signs under normal conditions, without the stresses and higher blood pressure levels associated with visits to the doctor.

Telehealth takes many forms, according to agencies’ needs and resources, but the benefits seem to be a commonality of many programs. Crittenden Regional Hospital’s Home Health program serves 13 counties in northeast Arkansas. The agency’s current telehealth system involves a technology much less sophisticated than VNA’s or NARMC’s but similarly useful for keeping up with patients’ conditions: a telephone.

Director of Homecare Services Cindy Parker explained that the agency was still exploring the many telehealth systems available and wasn’t prepared to purchase the equipment, but that it wanted to employ some measure of telehealth services. The agency decided to dedicate a registered nurse to calling patients daily between nursing visits to check on their condition. “We thought at the time that it would be better than nothing, but it’s really become invaluable,” Parker said. “They appreciate the phone calls so much; I expect we may have difficulty switching over to monitoring devices.”

She said much of the program’s success is attributable to the skills and personality of the RN assigned to make the calls, Betty Allen, more commonly known as “Tele-Betty.”

“She lets them talk and doesn’t cut them off,” Parker said. “When you’re old, without many visitors, you really appreciate that. Now, instead of calling 911, they call Tele-Betty. They really trust her, and some of them may never meet her, but she’s their lifeline.”

Crittenden’s director of Homecare Quality Management, Cheryl Beene, said that one of the biggest challenges they face is that so many of their patients in the depressed Delta region don’t have phones. Their telehealth solution won’t work for those patients, but neither will more expensive monitoring devices, which also require a phone line. “When we’ve got to reach patients who are home from the hospital by themselves with no caregiver and no phone, telehealth isn’t any use,” she said. “Skilled nursing visits are the only way to reach them.”

All the agencies agree that telehealth helps extend and enhance skilled nursing services, particularly in light of the nursing shortage and the increasing number of homecare patients (due to shorter hospital stays and an aging population). Youngblood said the benefits to patients, physicians and nurses are undeniable, and she predicted that telehealth will soon break out everywhere.
“Telehealth is here. It’s going to remain here, and it’s going to grow bigger and bigger. Sooner or later, it will be a standard service because it is going to keep saving us all money while giving us daily trending information about our patients,” she said. “If you care about your patients, you need to be signing them up for telehealth. Help them out.”



November 2007