Telehealth Successes in Patient Health Management

The country’s aging population is living longer with chronic conditions, thus straining a healthcare system facing nurse and physician shortages. Many home care providers and health plans are turning to home electronic monitoring to achieve better patient outcomes.

“Telehealth benefits long-term patients,” said Kathy McCarthy, RN, director of patient services at South Shore Home Health in Oakdale, N.Y. “It’s an excellent teaching tool for making patients more self-aware.”

Patients can see the cause and effect, such as the relationship between salt and different foods and their blood pressure, or for diabetics, how the food they consume affects their blood sugar, she explained.

“It ties into quality care for the patients,” added Kendra Case, RN, MBA, vice president of disease management at home healthcare provider Amedisys of Baton Rouge, La. “It helps them learn to self-manage their condition based on the choices they make.”

Electronic home monitoring equipment, such as those from Viterion TeleHealthcare or Cardiocom, allows nurses to check on their patients’ weight, blood pressure, blood sugar and oxygen saturation without leaving the office. Typically, the biometric information flows from the device over the telephone lines to a Web-based portal that contains the data, although wireless devices are entering the market. The nurse then intervenes appropriately.

The Intel Health Guide, a second-generation unit, feeds the data into a decision-support tool that helps nurses spot trends and offers clinician videoconferencing and multimedia patient-education opportunities. The system is customizable to set risk thresholds. It also provides reminders, such as telling patients when to take their medications.

“It’s interactive and more comprehensive,” said Julie Cherry, RN, MSN, PHN, director of professional services for Intel Digital Health Group in Santa Clara, Calif.

South Shore Home Health Services offers patients two different home monitoring options. It initially began installing Viterion TeleHealthcare units in patients’ homes more than five years ago as part of a York State Department of Health telemedicine grant.

“Patients like it and feel it has made a difference,” McCarthy said.

The agency has since added the Health Anywhere program, in which a home health aide visits patients with a Blackberry smartphone and blue-tooth enabled blood pressure, weight scale and pulse oximetry unit. The device immediately sends the information, transmitting it in real time back to the office.

“Some patients were noncompliant or had difficulty taking their own blood pressure, so the Health Anywhere works better for them, and they like the visit,” McCarthy said.

Across the country, Amedisys has deployed 2,500 Cardiocom devices into the homes of patients at high risk of hospitalization, Case said. The system allows the nurses to ask about how the patients feel in addition to transmitting the biometric data.

“We’re expanding our program this year,” Case said. “We feel it’s been effective.”

A growth industry

An August 2009 report from the consulting firm Frost & Sullivan of San Antonio, Texas, estimated revenues in the remote patient monitoring market at $98.2 million in 2008, with projections it will reach $428.6 million in 2015, as healthcare increasingly focuses on preventive health and self-care.

“I believe it is starting to pick up and get some big names involved, like Intel and IBM,” said Zachary Bujnoch, industry manager for Frost & Sullivan’s Patient Monitoring practice. “It has grown every year since it started, double-digit growth, but not to the billion dollar level people expected by now.”

Telemonitoring equipment companies typically sell their products, such as Honeywell’s HomeMed, to home health agencies to monitor patients after discharge from the hospital, Bujnoch reported.

“The goal is to keep the patient from going back into the hospital,” Bujnoch said. “If your patient doesn’t come back in, you are saving money.”

Evidence supports telehealth

A recent Cochrane review, reviewing 25 studies and five published abstracts, found that structured telephone support and telemonitoring reduced congestive heart-failure-related hospitalizations and decreased the risk of all-cause mortality, with improved patient quality of life and reduced cost.

The Veterans Health Administration reported in the journal Telemedicine and e-Health in 2008, that its Care Coordination/Home Telehealth program resulted in a 20 percent reduction in hospital admissions and a 25 percent decrease in bed days of care. The program cost was $1,600 per patient annually, comparing favorably to $13,121 for home-based primary care services or $77,745 for nursing home care.

Pros and cons

While few can argue with the data showing home telemonitoring leads to better outcomes, cost remains an issue.

“There is a lot of interest, but the big question is how you pay for those things,” Bujnoch said.

Insurers do not reimburse for home telemonitoring, and Bujnoch considers it unlikely direct reimbursement will occur in the near term. However, pay-for-performance models and bundled payments may boost interest in the technology. For instance, incentives to prevent readmissions could spur additional deployment of home monitoring devices.

Amedisys already receives Medicare reimbursement based on readmission rates.

“A telehealth visit by a clinician is still less expensive than a face-to-face home visit,” Case said. “If we can keep in touch with our patients with telehealth, without adding visits, it’s a very cost effective method of keeping an eye on your patients and keeping them satisfied.”

Despite the fact it receives no reimbursement, South Shore Home Health has noted the difference home telemonitoring has made in patients’ lives and has continued offering the service, even after its grant ended. McCarthy said nurses initially expressed concern that the telemedicine systems would eliminate their jobs, but they now understand that the devices enhance rather than take away from patient care.

A remote telemonitoring program implemented by Presbyterian Home Healthcare in Albuquerque, N.M., resulted in greater nurse productivity due to less time spent on the road, and high rates of patient satisfaction, according to a report by the Agency for Healthcare Research and Quality.

Cherry said telehealth is expanding beyond home health to payors and provider groups offering disease management services to their populations.

Wireless networks

Alex Brisbourne, president and chief operating officer for KORE Telematics, an Alpharetta, Ga., firm specializing in machine-to-machine wireless connections, reported that in 2008 healthcare wireless connectivity represented 1 percent of the traffic on its network. One year later, in 2009, that rose to more than 20 percent.

“It’s a segment in growth,” Brisbourne said. “There’s quite a lot of innovation taking place in the market, focusing on the benefits to patients.”

Applications include monitoring blood sugar, tracking medication adherence, diagnosing and managing sleep apnea, and assessing general wellness. The devices continually check the patients’ status and transmit an exception alert over the cellular network to the provider or someone else specified, for instance the health plan’s case manager. Applications are customized to the patient’s needs.

“If you can get critical information from the patient at an early stage, two things happen,” Brisbourne said. “Outcomes improve, but more importantly you get the information passed to the caregiver and the specialized care management organization to intervene rapidly. It’s inexpensive and reliable.”

GE’s QuietCare system monitors patients’ activity 24 hours a day and serves as an early warning system that lets caregivers know if something is wrong in the home. Small, wireless sensors are placed in key areas of the home and send data through a base station to the QuietCare computer, which analyzes changes in behavior from the baseline data collected during the first seven to 10 days of operation.

The call center will alert by email, pager, text or voice the professional caregiver who can check on the person. Jim Pursley, general manager of sales and marketing for the Aging Services Division at GE, said seniors have been receptive to the monitoring, which has no cameras or microphones, preserving their privacy.

“It helps prevent crises and has enhanced the nursing staffs’ response to our residents,” said Zina Quigley, director of marketing at Quaker Gardens Senior Living in Stanton, Calif.

Independent living and assisted-living facilities, typically, install the system to help them detect residents’ emergencies or other situations that with quick intervention could be prevented from becoming an emergency. But Pursley sees the market expanding to home use for elders trying to age in place.

“Only 8 percent to 12 percent of seniors live in senior housing,” Pursley said. “Bringing technology of this type into the home is where we have to go if we are going to positively impact millions of lives around the globe.”

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