Telemedicine brings health care home

Telemedicine brings health care home

by Michael Schroeder

Mornings have gotten busier for Violet Harwick of Little Falls, N.Y., since she was hospitalized for complications associated with congestive heart failure in July.

Before breakfast, the 68-year-old, who also has diabetes, pricks her finger to test her blood sugar, wraps a cuff around her arm to check blood pressure, puts another finger in a device called a pulse oximeter to measure oxygen saturation in her blood, and steps on a scale to check her weight.

The scale, oximeter and blood pressure cuff are attached to a telehealth machine that sends vital information through Harwick's phone line to home health agency At Home Care in Oneonta, N.Y. Called telehomecare or home telehealth, it's the latest offshoot of telemedicine, which has for decades been deployed in rural medical offices to link patients with specialists in distant locations.

Today, remote monitoring and even video consults are happening right at home, and patients everywhere with chronic medical conditions are taking advantage of them.

"If my blood pressure or sugar is up, or my weight is up" - an indicator of fluid buildup associated with congestive heart failure - "[home care nurses] call me right away," Harwick says. The technology allows her to stay safely at home, despite continued health problems, including kidney failure.

A growing need for virtual care

According to the American Telemedicine Association, about 200,000 people nationwide receive treatment in their homes via mobile monitoring units - including telehealth units. Experts say an aging population, increasing prevalence of chronic diseases, the high cost of health care and technological advances are fueling growth.

Harry Wang, a health research analyst with Parks Associates in Dallas, projects the broader home health monitoring market - such as services and equipment to track if an individual has fallen or isn't taking medications - will increase from $770 million in revenue in 2009 to $2.6 billion in 2014.

Telehealth could get a boost from the comprehensive federal health law, which aims to hold hospitals financially accountable for how patients fare after they're discharged.

"I think hospitals will become much more interested in telehealth in an effort to avoid readmissions," says Daniel Gold, managing director of Oceanside, N.Y.-based American Medical Alert Corp., which provides remote patient monitoring equipment and services nationwide.

Some home health agencies provide telehealth as part of Medicare-covered care following a hospitalization and, in some states, it's covered by Medicaid and/or private insurance.

For consumers paying out-of-pocket, the fee for leasing home telehealth equipment and monitoring services is generally around $100 to $300 a month, says Lexi Silver, vice chair of the American Telemedicine Association's home telehealth and remote monitoring special interest group.

That compares with several thousand a month for in-person, in-home care, which can often be scaled back with telehomecare. While home health agencies are most likely to offer home telehealth services, medical providers are often the ones to recommend it.

Telehealth offers big benefits for veterans

Dr. Ileana Piña, a cardiologist with the Cleveland VA Medical Center in Ohio, remotely monitors some of her heart failure patients. She says it can improve care, but emphasizes the patient and caregiver should receive proper instruction on using the technology. "If it's too complicated, they won't do it," Piña adds.

With about 50,000 enrollees nationwide, the Veterans Administration has the largest home telehealth program in the world, permitting research at unprecedented levels.

"We found veterans had fewer hospitalizations, fewer emergency room visits, fewer unscheduled clinic visits when they were enrolled in this program," says Rita Kobb, a geriatric nurse practitioner and education program specialist for the VA's Office of Telehealth Services. Rolled out nationally in 2003, the VA's goal is to reach 100,000 vets cumulatively by the end of 2012.

"A lot of these patients [would otherwise] wait until they're absolutely dying before they will call the doc or come in," says Kobb, who once helped a man who had a stroke during a home telehealth video consult get emergency care.

Technology still has room for improvement

Physicians say remote monitoring of vitals can be critical in determining when they need to intervene to change a medicine or medical therapy, subtle changes that can keep patients out of the hospital and save health care dollars.

"This is a technology that's completely powerful but vastly underutilized," says Dr. Timothy Bailey, an endocrinologist in San Diego who helps patients manage diabetes - in part - using telehealth technology. But, he says, the technology needs to get simpler still, even less intrusive, and more user-friendly to get more patients to buy in.

"Glucose monitoring has revolutionized the care of diabetes," Bailey says, but many dread the finger prick blood-glucose test.

A last chance to stay home

For some, technology is all that stands between a loved one and a nursing home. Jasmine Star of Teton Valley, Idaho, keeps an eye on grandmother Mildred Sloan in Houston, who has dementia, by logging into a secure site that streams live video from two cameras in Sloan's home.

The service - an example of the broader home health monitoring market - is provided by Rest Assured, which has a support center in Lafayette, Ind.

Doorway sensors alert Rest Assured of visitors. If Sloan is outside and out-of-sight for more than 45 minutes, a family member gets a call. "It's enormously reassuring, because if something would happen we would know it," Star says.

If medical concerns arise, the company calls the client's nurse or physician and, if necessary, emergency personnel, says general manager Dustin Wright. Drawing from her late husband's savings, Sloan's family pays Rest Assured $540 a month for the Internet-based monitoring and $5 a day for emergency monitoring.

They pay an additional $4,500 monthly for someone from Rest Assured's parent ResCare - a highly rated Louisville, Ky.-based home health agency - to come out twice daily for four hours at a time. It adds up, but Star says her grandmother is happier and more stable in familiar surroundings.

"It's about her being able to stay home, hopefully forever or at least as long as she can," Star says.

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Jackson L. Gates, MD


I have been practicing general telemedicine for sometime now. It is the best way to practice transparent and accountable medicine while still bringing convenient quality medicine to patients. Visit me at my website, or send me an email.

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