Home Health Care via Telemedicine

In our last issue (Spring’95, pp. 26-27)) we introduced the concept of telemedicine to the home. What better, more natural place to implement modern telecommunications technology for healthcare? The most pressing need, and the most obvious place to impact healthcare costs, is in providing nursing services to the home. As we noted, there are about 1/2-billion home-health visits by nurses in the U.S. each year. Many, if not most, of these require the cognitive and observational skills of the nurse, but not their actual on-site presence. Several innovative companies are using telemedicine technology to provide home healthcare services, typically at a fraction of the price of an on-site visit.

Tele-home health care in Japan

As in North America, Japan is faced with a rapidly aging society. Currently, about 3 million people need daily personal assistance, and about 15 million have chronic disabilities. Unlike North America, ISDN (switched digital phone lines transmitting at 128 kbps) services are almost ubiquitously available throughout Japan. Because of its ability to carry relatively high volumes of digital information, ISDN offers major advantages for interactive video traffic. This combination of (1) need and (2) telecommunications infrastructure capable of helping supply the need has produced a ripe situation for testing tele-home health care.

Another Kind of Tele-Home Health: Medical Call Centers

Patients today are increasingly proactive about seeking health information and participating in decisions about their medical care. Much of healthcare, perhaps 40%, consists of the simple exchange of information between experts (physicians and nurses) and patients. Until recently, the surest way to assure this exchange was to see a physician in their office. This can be a time consuming, expensive, highly inefficient way to accomplish many of those interactions that don’t require hands-on, face-to-face assessment. This is especially true in the after-hours setting, when what would have been a simple office visit during the day becomes a very expensive emergency room visit at night or on the weekend. There is a simple, inexpensive way for patients to "see" a qualified healthcare worker after hours – for reassurance, for advice, for education, or for triage to a care center as necessary. That is by establishing a "medical call center" staffed by trained nurses.

A POTS-Based Telehospice Project in Missouri

Hospice care refers to specialized, relatively non-interventional care given to terminal patients. Its goals are to relieve suffering and ease the dying process for the patient and family. The concept originated in England and was introduced into the U.S. in the 1970’s, where it is largely used for end-stage comfort care of cancer patients in their homes. Typically, the attending physician continues to manage the patient’s care, as part of an interdisciplinary team that includes nurses, social workers, physical and occupational therapists, chaplains, and volunteers. Payment is through private insurance or the Hospice Medicare Benefit, which provides a fixed per diem reimbursement rate to certified programs. There is concommitant pressure to maximize efficiency in hospice care. A significant portion of the expense of hospice care may be due to on-site visits from members of the multidisciplinary care team. This makes the use of telemedicine technologies especially attractive, since they obviate travel time and cost.

Telehome Health -- Kaiser Report

This is an interim report of a Kaiser Home Health Department study of the use of telemedicine technology in the home care setting. We present our study design and some early findings from the first six months of the project. Preliminary findings indicate the technology is dependable, and that average telehealth video visits are cost-effective and are about 60% shorter (18 minutes vs. 45 minutes) than on-site visits, with no decrease in patient satisfaction. The study will be completed in September of 1997.

20 Minutes with a Tele-home Health Nurse

It's 9:30 AM Monday and Linda McRae is preparing to see her first patient at the Kaiser Permanente home health care center in suburban Sacramento. But Linda's patient is 23 miles away. Rather than drive there, Linda walks into the center's video room, because it's time to become a video nurse.