|
Long-Distance
Relationships
|
||||
|
By Diane Sussman Once used only on astronauts, pilots, and military personnel, the long-distance form of health care known as telehealth has become a tool for healthcare professionals caring for patients in decidedly more down-to-earth locales. With the aid of specially designed telephones, computers, and miniature television screens, nurses can check up on patients in inner-city apartments, suburban hospices, and rural clinics. The technology lets the nurses monitor blood pressure, adjust pain medication, and supervise wound care, giving them another way to coach their patients into better health. “It’s ‘The Jetsons’ come to life,” said Katie Neal, RN, director of the telehealth program at Memorial Home Health Care in Long Beach, Calif., a pioneer in telehealth home care services. And the convenience for patients can’t be beat. “They can stay in their nice little air-conditioned house and beam me in,” said Joyce Gillette, MS, RN, nursing supervisor at Memorial. Serving ‘frequent fliers’ Memorial most often uses telehealth with pediatric patients, hospice patients, and so-called “frequent fliers,” patients whose difficulty maintaining a treatment regimen repeatedly lands them back in the hospital, Neal said. “These are the [patients with asthma or congestive heart failure whom] you have to call and say, ‘How many pills did you take? OK, now show me the bottle and count the pills,’ ” she said. Part of the reason telehealth technology works is that it lets nurses see their patients well enough to assess them. The resolution on the agency’s equipment is so fine nurses can check for bubbles in a diabetic’s syringe, Neal said. The field has taken off over the past few years. This surge has been driven by the skyrocketing numbers of elderly, the rising number of referrals to home health, the national shortage of nurses, early discharges from the hospital, and the high costs of home care, said Barbara Johnston, MSN, RN, research manager and telehealth consultant at Kaiser Permanente in Sacramento, Calif. And, there seems to be no shortage of ideas for promising applications. “The potential is limitless,” Johnston said. “There’s teleradiology, telepathology, teleschool…” Rural reach In Texas, telehealth began in the prisons, then swiftly found a use in rural clinics in the Big Bend area of West Texas, where one nurse practitioner might be the only healthcare worker for hundreds of miles. “There are frontier counties, where you have 10 people or fewer per square mile,” said Sam Tessen, executive director of the Center for Rural Health Initiatives in Austin. “Telehealth is a vital link for consultations with urban medical centers.” The same is true in Salina, Kan., where nurses at Kansas Care Inc. can spend up to three hours driving to see one patient. Getting nurses off the roads has boosted the clinic’s efficiency substantially. “Our nurses now see more patients than the national average,” said Amy Howard, executive vice president of Kansas Care, which began its program in 1996. After all, she said, “Nurses went to school to be nurses, not drive on the interstate.” Experts say telehealth enables nurses to conduct 10 or more such “visits” a day, compared with five or six by car. A welcome presence Although not all patients want to fuss with the technology, many enjoy the “visits,” treating them as an event that gives some shape to their days. “I have one woman who gets dressed up and puts on lipstick,” Gillette said. Furthermore, the continuous presence of the technology in the home often helps patients do a better job of complying with complicated medical regimens. Researchers have shown that failure to follow medication regimens is a leading cause of hospital admissions. “People need that repeated contact,” Johnston said. “They do better if they know you’re going to call.” The technology can also foster a sense of security in patients, who would otherwise have to call an ambulance in an emergency. “It’s like having access to 911,” Johnston said. “Patients know if they need something, you are there.” Not quite the real thing Still, no one is advocating that virtual visits supplant real visits. “These are visits between my regular visits,” Gillette said, making it clear that touch-tone is not a substitute for touch. “If you have to do hands-on it’s not appropriate. It’s meant to augment or supplement what you are doing, not replace it.” Reimbursement remains one of the stumbling blocks to the growth of telehealth services. We would love to have more for rural Texas,” Tessen said. “But the problem we’re running into is reimbursement and cost of buying the equipment.” Control stations for health care professionals cost around $10,000, while patient units range from $800 for a simple video screen to $5,000 for top-of-the-line equipment with a built-in telephonic stethoscope, blood pressure meter and pulse meter, said Lisa Abrams, associate marketing manager of American Telecare in Eden Prairie, Minn. Federally funded programs have been slow to approve payment for telehealth services, and it was only this January that Medicare agreed to reimburse practitioners in underserved areas such as the Big Bend area in Texas. Eleven state Medicaid programs and a handful of private insurers have also begun to cover the services. Providers might feel different if they looked at the long term, years after buying the equipment. “Most of these systems pay for themselves in a few years,” Johnston said. “And they save money across the continuum. The number I keep hearing is 30 percent.” Paradoxically, the greatest resistance seems to be coming from nurses, Johnston said. “Nurses are advocates and questioners by nature. They want to make sure it’s good for the patient before they accept it.” |
