TELEHEALTH: THE SOLUTION FOR MEDICAL FREQUENT FLIERS

While many people think of telemedicine as a relatively new phenomenon, Sentara Healthcare has been running a TeleHealth program for the past 10 years that has catered to the medical version of “frequent fliers”: patients with multiple serious health problems who often wind up in the hospital.

Based on that track record, which has included a progression of technologies, Sentara is now expanding its program through its North Carolina and Virginia service area.

“We decided we had to get a hold of the problem of how to deal with patients that were very ill,” said Pat Strickland, a registered nurse and clinical manager of Sentara's TeleHealth program. “They were in and out of the hospital a lot and costing the hospital a lot of money. We decided to hone in on our congestive heart failure patients using TeleHealth.”

As a non-profit system, Sentara wanted to determine how it could control costs and still provide good care for these patients, most of whom had what are called “co-morbidities,” other serious ailments such as diabetes or chronic obstructive pulmonary disease, Strickland said.

First using an audio-visual unit from American TeleHealth that worked over a standard POTS line, Sentara connected patients to its call center on a daily basis for standard diagnostics. “The unit was about the size of a bread box with a camera on the top, so I could see them and they could see me,” Strickland said. “We had connectivity as far as a stethoscope, blood pressure, pulse ox[ygen], etc., and I could listen to their lung sounds in the call center here. We continue to use some of those units.”

The technology has evolved. About five years ago, Sentara went to a unit that remotely monitored vital statistics without the audio-visual component, which some patients found intrusive. Within the past year, Sentara has started using the Phillips PTS system with Bluetooth connectivity. This portable solution can travel with the patient, measuring blood pressure, weight and pulse oxygen while recording patient answers to standard questions about swelling, shortness of breath or other symptoms. It still uses a POTS or broadband line to download data to a central location.

Based on parameters set up in advance by Strickland or the patient's doctor, the daily readings are an indication of whether immediate treatment is needed.

“A lot of these patients, because they have so much else going on, can go up and down within a 12-hour or a 24-hour period,” Strickland said. Previously, to stay at home, they would have seen a nurse a few times a week, when they needed to be monitored daily, she said. “A lot of them would wind up in nursing homes,” Strickland said. “The patient wants to stay at home. We start at the very beginning, trying to teach the patient to be aware of what is going on with health status also. If they see the numbers before we see the numbers, they will know that something is going on also. But it's a better quality of life if they are actually in their home environment.”

Sentara has about 160 of the Phillips units in use today and plans to add 120 by year's end. “We could deploy as many as 1000, but it's a cost issue,” said Anne Jones, director of IT for Sentara Home Care Services. The units cost about $2500, and then there is the cost of ongoing IT and medical support.

Sentara does not require patients to pay anything, nor is it getting reimbursement from insurance companies — yet. “This is purely a value-added service that we provide to our patients,” Jones said. “I think Medicaid is looking at reimbursing. The insurance companies are a little slower, but if Medicaid would reimburse for that, they will follow suit.”

An original pilot study showed Sentara saved more than half a million dollars providing this care to a group of 60 patients, but no recent studies have been conducted.

Sentara is also exploring the availability of broadband stimulus money to take this program into underserved areas, Jones said.