Home Telehealth: Does Its Higher than Conventional Healthcare Technology Work in Today’s Ordinary Home?

Home Telehealth: Does Its Higher than Conventional Healthcare Technology Work in Today’s Ordinary Home?

We’ve all seen the latest gadgetry of telehealth devices described in articles’ authors’ altogether astonished detail in the popular press.3 Radiofrequency identification devices (RFIDs) or other devices embedded in your sneakers can even read the bar code on your milk container. Devices will tell you to buy new supplies, or become otherwise a very timely, all-around personal assistant. Unfortunately, for better or worse, much of this “tele-ready” equipment, including its inventors, are still in the lab, not the average home where some, particularly elderly people, need regular health services and personal health monitoring.

There’s good news about how these needs are being addressed, if slowly, though. In the last 10 years telecare-ready devices have become better designed to meet today’s health needs and have become extremely affordable—enabling their use by ordinary people/patients who need health services at home. Telecommunications-ready blood pressure cuffs, glucose meters, and other peripherals average only several hundred dollars or less. Similarly, the full-scale telehealth workstation, which can accommodate most needed monitoring devices in healthcare (pulse oxymeter, weight scale, glucose meters, and so on) are available for as little as several thousand dollars (compared to more than $20,000 per station less than 20 years ago).

Thankfully, increased simplification of home telehealth products and systems have also become the hallmark of good design. Typically, today’s full-scale workstation and peripherals will have only one operating button, such as an on/off switch. Color-coded buttons and easy-to-follow verbal or printed directions for helping patients to obtain and transmit information are commonplace. For example, for congestive heart failure (CHF) patients, who are among the largest and costliest group in home care today, a significant part of their daily “televisit” simply involves stepping on an automated weight scale that is connected to the household telephone line and transmits the number directly and accurately to the patients’ nurse at the home care agency. Telenurses at the home health agency wear an alerting device and receive indications of the name and phone number of home care patients who have gained one-to-two pounds within a 24-hour period (a significant number for a CHF patient), and ought to be contacted immediately by phone.

How does this automated transmission translate into more effective telehealthcare? According to Mary Bondmass, Ph.D., RN, a nurse who worked for years with a CHF home telehealth program in Chicago, every one of these telephone contacts with patients is a “learning or teaching opportunity.” 4 Nurses get the chance to reiterate or re-phrase information that they have provided to patients in person, or to offer new information. And, the telenurse’s interactions can be entirely informal, as indicated in this example:

Bond mass asks patients who show a weight increase a series of questions:

She might ask, “What did you have for dinner last night?" (Patient response) "Hmm, Chinese take-out, again?"

Then she might respond with, “Tell me what you’ve been eating this week.”

She might then say, “Sounds like a lot of salt,” which would then lead into the “teaching opportunity” about salt and fluid retention that the patients would have heard at least once before.

She might say: “Look at your ankles,”

which may be swollen with retained fluids; or, if she noted a shortness of breath, which can indicate fluid in the lungs, she would point that out. Patients would then get an immediate, practical lesson in cause, effect, and correctable actions for managing and preventing fluid retention.

No, the nurse did not have to calibrate or program the scale to do telehealth. She did have the opportunity to get information that the scale automatically transferred to her pager and computer and to use the telephone to reinforce details for her CHF patients about their newly learned daily routines. She also could order a diuretic for the patient in a more timely fashion than might be the case with less frequent patient-nurse contact.

When viewed this way, telehealthcare practice and its provision for augmenting and extending usual in-person services may seem much more attractive than its reputation for “automating” (rather than providing in-person “caring”) services bears out.

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