By Sandra Ray, Staff Writer
When many rural communities in the 1990s began to look for
options to provide medical care to their area without a
physician in residence, telehealth options surfaced and
flourished. Patients could visit an office once or twice a week,
have a traveling nurse take vitals, and then speak to a
physician through a video relay service. For those areas who
before had no health care, the programs provided much-needed
access to individuals who otherwise may have gone without.
Now telehealth options are expanding into the home and are seen
by some as a way to keep the disabled and elderly at home longer
and out of nursing home care. The costs of long-term care have
increased dramatically in recent years and individuals are no
longer willing to accept that nursing home care is the only way
to age with the basics of medical attention.
The Center for Telehealth and E-Health Law notes, “the use of
home care technology now makes it possible for advanced data
collection systems working in conjunction with remote video and
non-video communication devices to simplify home care practices
for both patients and home care personnel.” In other words,
remote monitoring is now one of the ways that individuals are
choosing to age in place and still keep close tabs with the
doctor’s office and the changing landscape of healthcare today.
Another benefit of remote monitoring is the reduced amount of
hospitalizations or hospital stays that chronically ill patients
endure. An independent study of monitored vs. non-monitored
patients formed by Strategic Healthcare Programs revealed that
patients with chronic obstructive pulmonary disease (COPD)
improved in activities of daily living and were more stable.
Those patients who received home monitoring reported
improvements rates of 80.3 percent vs. 71.8 percent of those who
were not monitored. Another study in the Journal of the American
College of Cardiology demonstrated reduced hospitalization rates
for monitored patients from 3.2 hospitalizations per person to
0.8 hospitalizations per person.
For those who are unfamiliar with telehealth in the home, there
are several basic ways services can be provided that can aid the
patient and the caregiver with everyday medical decisions. Some
physicians may use the term remote monitoring in lieu of
telehealth. Basically, the same services can be provided with
similar results.
No One-Size-Fits-All Systems
There are many different types of systems on the market that
seek to gather data about a person in the home and communicate
that information to a caregiver or physician. These systems
differ from a personal emergency response system (PERS) in that
they allow patients to give a well-rounded view of the
activities in the home environment. From a physician’s
stand-point, having first-hand information of what activities
are going on at home allows them to make better diagnoses than
simply relying on self-report “snap shots” in the office.
Some people feel that the best way to gather information is
through video relay in a person’s home. Cameras can be installed
at various points throughout the home in order to determine
whether or not a patient is able to care for himself, if he is
taking medication correctly, or if he is eating and performing
other activities of daily living. A downside to video monitoring
is that someone has to take time to review the stored video, a
time-consuming effort that may not be practical.
Another “twist” on the video relay method is through remote
link-ups with patients and nurses at regular scheduled
intervals. American TeleCare offers a system like this that
allows scheduled visits, as well as on-demand visits when
patient’s information indicates that a health emergency could
exist. The system does not include installing cameras throughout
the house; rather, it relies on a monitoring station that
patients are taught how to use with little assistance.
Systems like Lifetime Care allow patients to measure weight,
temperature, blood pressure, blood sugar, and other vitals and
enter them into a system on a daily basis. The information is
then transmitted to a central processing center where a nurse
reviews the data and decides if any action is needed. Maybe a
doctor needs to assess the patient for further review; perhaps
no action needs to be taken and the patient is performing as
well as can be expected.
QuietCare offers a monitoring alternative that does not take the
same bits of data, yet it can paint a portrait of activities of
daily living in the home. The QuietCare system places sensors
throughout the home that are triggered by motion. When a person
enters a bathroom, for example, the sensor records the activity.
The system then records how long the person was in the bathroom
by noting the time that the sensor was activated again. Repeat
trips to the bathroom could be a cause for concern at the
doctor’s office that a patient may never mention to their
physician until more extensive follow-up is needed. Other
sensors are placed strategically throughout the home to record
nocturnal wakings, whether or not they took their medicine, and
if a person left the home or if a visitor dropped by for a few
minutes.
Available telehealth systems offer a way for both doctors and
caregivers to access the information (provided proper
confidentiality waivers are in place) in order to determine if
the patient is doing well at home or if they need more
assistance. In addition, since these systems are monitored 24
hours/day, if emergency assistance is needed, alarms can be sent
to whomever the patient designates.
Caregivers may find that these types of systems provide more
than peace of mind. For those patients who are reluctant to
reveal details of their overall health for various reasons, home
monitoring systems can provide the daily outlook of a patient
and notify caregivers and physicians before symptoms become too
serious. By avoiding hospital stays and keeping patients stable
in their homes, patients may be more compliant with physician
orders and stay on track with their health plans.
Who Pays?
Even though the healthcare industry is evolving with technology,
insurers and Medicare are slow to pay for telehealth services.
Those organizations that rely on remote monitoring in the
patient’s home to give a better picture of how a patient may be
recovering or performing on a daily basis are also dependent on
government grants and private pay in order to provide those
services. There is a compelling benefit for insurers and
Medicare to begin providing services through telehealth systems.
A study by the University of Tennessee Graduate School of
Medicine revealed that for patients with congestive heart
failure, medical costs are approximately $8 billion per year. By
using remote monitoring services in the home, those costs are
reduced dramatically to $4.2 billion/year – almost half the cost
of traditional medical services. The cost of remote monitoring
was included in the lower costs, demonstrating that telehealth
is a viable benefit to patients and caregivers in terms of
reduced medical costs.
The American Telemedicine Association supports Medicare reform
to include the costs of remote monitoring in patient care. In
its newly released “Federal Policy Recommendations for Home
Telehealth and Remote Monitoring,” the organization notes that
“home telehealth (including remote monitoring) should be used as
a part of a coordinated, comprehensive care program designed to
reduce health care costs (through decreased hospitalizations and
hospital days of care) and improve clinical outcomes.”
Caregivers can assist patients by helping to research the types
of home monitoring systems that are available and those that are
affordable to the patient. If insurance is reluctant to pay,
there may be more affordable options available. In addition,
organizations that provide services to seniors and the disabled
are now actively seeking grant funding to provide services like
these in the home because they know that healthy individuals are
less of a strain on the social service delivery system in the
community. Since there is no “one size fits all” system
available, individuals need to be aware of what services are
needed and how telehealth companies can meet those needs.
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