What is Home Telehealthcare and Why Is It Needed?
Typical Day in the Life of a Home Telehealth Patient
(A compound Case Drawn from Many Examples)
63-year-old Mary Allen of Gatesville, Kansas has lived with diabetes for 15 years and has had many complications during that time. Travel to hospitals and specialists has been difficult and the visits expensive. On her last discharge from hospital to home, her doctor approved home telehealth service and monitoring.
It’s 6:30 AM in Mary's rural farmhouse, a house where she lived most of her life. Mary is awakened by her alarm going off reminding her to measure her blood glucose and blood pressure and to send those readings through her telephone to her telenurse, Susan Brown, who works 200 miles away in Wichita. Susan will receive the information and contact Mary if there is a change of health status or if help appears to be needed.
Mary sends her first report at 8:00 AM but she doesn't do it with a regular phone call. She does it by using two telemonitoring devices—a blood pressure cuff with a telecommunications plug-in and a similar device to monitor blood glucose—that are attached to a telehealth, computer workstation. The telehealth work station is connected to Mary's phone line and is linked through the line to Susan's computer in Wichita. After Mary's computer sends its data, Susan receives the information on her own computer and can instantly interpret the state of Mary's health. In addition, an inexpensive camera perched on top of Mary’s telemonitor can take snapshots of Mary as she measures her insulin, inserts her syringe, and rotates injection sites, and will send the pictures along to her nurse so that Susan can actually see Mary and how she is doing. If she needs to, the nurse can give her patient a phone call and coach her along. Using her telemonitoring machine and a telephone, Mary can be connected with a nurse, ask a question, or be reminded of a routine on a 24/7/365 basis.
Mary, who lives alone, also suffers from hypertension and has had some bouts of depression related to living with multiple chronic diseases. Until now, her children had felt that sending her to live in a nursing home was a good choice, but, with telehealth, Mary can monitor herself regularly and learn lifelong self management routines. Currently, nursing home placement is not necessary; she can get the assistance she needs at home. And the challenge of monitoring and managing her own health on a daily basis has given Mary focus and helped her with her depression. In addition, with the regular counseling she receives from her nurse and careful management of exercise routines, she has already reduced her number of medications and has not made any emergency room visits in a long while.
Mary also notes: “I’m able to stay at home with my books, my music, and my birds.”
Cost savings typically realized by the use of home telehealth, as in this case, are seen in the short term (in reductions of on-site personnel) and in the long term (as a result of reduced numbers of costly hospitalizations and visits to emergency rooms).
After more than a decade, throughout the 1990s, some acceptance has taken hold of the idea of home telehealthcare service use. Home telehealthcare is health and education services delivered to patients in their homes in part by telecommunication devices like the telephone and telecommunication-ready healthcare monitors like a blood pressure cuff. More remote (rather than in-person) contact with patients is possible using telehealthcare as an adjunct to conventional care. With telehealth and the increased opportunities for communications that it affords, health professionals can assess patients’ status and change and reiterate parts of their care plan routines, as frequently as is needed.
This increased contact is much needed today apart from the comfort value that it provides. Now, at the beginning of the 21st century, changes in the financing of conventional home care have significantly affected doing home care “business as usual.” A greater thrust toward demonstrating improved patient health outcomes and accountability of monies spent has become the order of the day as a result of home care’s chief payer--the Center for Medicare and Medicaid Services (CMS)--instituting the Prospective Payment System (PPS) for Home Care, in October 2000.1 The impending nursing shortage nationwide will affect the delivery of usual home care services as well. Add to the mix an increasing number of patients discharged earlier to home care (owing to hospital-based PPS and its bent toward reduced lengths of stay, LOSs) and telehealth contact that is used as a supplement to the conventional two-to-three-times-per week in-person home nursing visit is becoming very much welcomed indeed.
But using telehealth is not a last resort option by any means. Challenged by fewer (affordable) visits, fewer nursing staff, and increasing and often costly legions of elderly home care patients, nurses and patients alike can benefit from focused and frequent telehealth contact. According to Gary L. Glissman, BS, RN, CCM, who is a long-time nurse and home care agency manager, the opportunities for providing home telehealth solutions are virtually unlimited. He tells us:
"What we know from experience and hard data is that we can achieve better patient outcomes (whether they are cost-related, clinically-related or subjective patient improvement) by improving our diagnostic skills, providing better treatment intervention and educating patients for long-term self-management. Appropriate and timely telehealth services can dramatically improve the quantity and quality of our patient contacts without always adding significant costs. It can help us deliver patient-specific support for maximum effectiveness. It can help stimulate important behavior changes in patients that have resisted change. It can help us do more with less." 2
Is there value in telehealth? Yes, and it’s two-fold at least. Among these:
1. Nurses can be more alert to patients’ current needs and address these needs in a more timely manner than ever before;
2. Patients who receive telehealth interventions can receive more comprehensive management, leading to more rapid stabilization and, ideally, learn how to become more competent in self management skills (learning self management being the most cost effective home health service interaction of all).
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