Remotely Monitoring Patients: Pilot Programs Take Off
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| In a pilot project using Philips Telehealth Solution, nursing and long-term care facility Windsor Place in Coffeyville, Kan., clinicians are remotely monitoring patients to reduce preventable hospitalizations. Image source: Philips Healthcare |
At the HIMSS10 trade show last March, Sprint Nextel CEO Dan Hesse envisioned improved patient care via a 4G network that supports high-usage applications, particularly for the home healthcare arena. Hesse predicted the home healthcare market in the U.S. would grow from $304 million in 2009 to $4 billion by 2013.
During his keynote address, Hesse also asked the audience to “imagine the … capability to record a live [video] feed from the EMT on his or her way to the hospital while transferring that data in real time to the physician, so he or she knows the patient’s condition before entering the building.”
Cincinnati Children’s Hospital Medical Center (CCHMC) in Ohio, is well beyond imagining such a scenario. Hamilton Schwartz, MD, director of emergency services at the tertiary care referral center, is piloting a stretcher-mounted telemedicine system that links emergency responders to physicians at the facility to which the patient is being transported.
The GlobalMedia Transport AV system combines a remotely controlled, retractable, HD camera with a 360-degree field of vision that hangs above the patient; a handheld penlight video camera (operated by the transport team); and a digital stethoscope, microphone and headset—all connected via 3G card or standard Wi-Fi from the ambulance to CCHMC.
Transport teams use the examination camera to send real-time live video and freeze-frame images of the patient to the doctors at the hospital.
Descriptions of conditions—the color of a rash, how well a patient is breathing or the amount of pain they’re in—vary from caregiver to caregiver. They’re also difficult to express over a phone and can be enhanced by the visual aid, says Schwartz. “When you first think of how to describe breathing, it sounds simple, but there are subtleties that can make a big difference in what care to enact,” he says. “Seeing a patient makes a difference.”
CCHMC gets referrals from countries as far away as Israel, says Schwartz, and trips to CCHMC, can take hours. The stretcher-mounted HD camera system enables CCHMC to better prepare for that patient while he or she is still in transit, Schwartz says.
Funded by a $75,000 one-time grant, Schwartz and colleagues have been piloting the system sporadically for a year, starting with referred neonatal patients to get used to the equipment and compile data to understand when the system is best used. Schwartz plans to expand the system to the full breadth of patients as part of a research study; he expects that his research team will release their results sometime next summer.
The capabilities of remote patient monitoring via the telemedicine system “will hinge not on the device, but on community and regional network stability,” says Schwartz. “The day there is a cellphone tower on every corner, then this will be standard care.”
Syncing with smartphones
With smartphones, healthcare practitioners are beginning to see a variety of clinical benefits in the palm of their hand. Beau Sorenson, CFO at First Choice Home Care & Hospice, in Orem, Utah, has been piloting Allscripts Mobile HealthCare for three years with 170 clinicians currently using the application. Mobile HealthCare automatically synchronizes EMR data to servers, which route the data to smartphones so users have clinical data at their fingertips in almost real time, Sorenson says.The application shows patient history, including contacts [next of kin], blood pressure, oxygen saturation, weight, and the last seven visits of their history while clinical users visit patients at home.
Currently available only for Windows Phone 7 devices, the application has been a boon for home health and hospice agency First Choice, which serves approximately 450 patients in more than 100 locations across Utah and Salt Lake counties. With a 3,000-square-mile service area, it has been difficult to get information from clinicians in a timely fashion: “People used to drive into the office and submit paperwork, which could take a long time,” says Sorenson. Now, it takes clinicians 24 hours to get visits submitted.
Omitting the filing step has streamlined the billing process by five to six days and mitigated overhead costs by $60,000 to 70,000 annually, reducing two FTEs because paperwork doesn’t need to be filed or keyed in. “The reason the billing time has been so greatly reduced is not just because clinicians are getting information into the office quicker, but also because we’ve experienced a reduction in key errors, meaning fewer audits,” says Sorenson.
Staying home, staying safe
Since 2007, Windsor Place, a 163-bed nursing facility and long-term care organization in Coffeyville, Kan., has been conducting a pilot program to monitor and manage home healthcare patients with chronic disease using the Philips Telehealth Solution. Windsor Place partnered with the Kansas Department of Aging Health, which funded 75 patients for a pilot project to monitor and manage medical and health needs of the elderly through technology.Monitoring tools identify negative trends as they occur, according to Laura Hilderbrand, RN, director of Windsor Place-Kansas Department of Aging Tele-Health pilot project. Depending on the patient’s condition, a scale, blood pressure unit or pulse oxygen unit may be placed in the home to record and wirelessly transmit clinical data to a central remote station.
During the first two years of the program, only 3.4 percent of the home-monitored group went to a nursing facility as a result of deteriorating health, says Monte Coffman, executive director of Windsor Place. Coffman cites a Kansas Department on Aging report that notes that the trend in Kansas is approximately 8 percent of home and community based clients to leave their home every year and be admitted to a nursing home.
Hilderbrand has created questionnaires within the Philips suite for chronic diseases such as diabetes (she’s currently working on developing one for certain cancers). These questionnaires are delivered through the patient’s telemonitor at least once a day, and if a patient enters the wrong answer, he or she is given the correct answer and follow-up questions such as “Have you taken your medication today?” or “Have you eaten today?” will appear.
A patient is taught to respond to the telemonitors and if measures are outside of set parameters, a survey will be triggered to the patient directly via the monitor, reminding him or her to take medication (if applicable) and to repeat measurements after 10 minutes. If measures are still outside parameters after 10 minutes, patients are encouraged to contact their caregivers. The survey and measurements go to Windsor Place and Hilderbrand may contact patients to encourage them to call in their own caregiver, but because patients are encouraged to engage in their own care, Windsor Place does not regularly correspond with clinicians, she says.
Hilderbrand can trend the answers to see whether a patient’s health is improving. Patients using this educational format feel in control of their disease because they understand and retain more information about their condition, says Hilderbrand. “One of the big [benefits] is emotional and mental health status,” she says.
The pilot program covers eastern Kansas; Coffman is seeking to expand the pilot to 500 patient homes across the state. “With the tsunami of baby boomers to enter home healthcare, we have to organize home healthcare differently,” says Coffman. “We know people want to be home. We’re going to help them stay home.”
Technological advancements in everything from devices to internet bandwidth capabilities are poised to assist clinical care even when a doctor can’t be in the same room—or even the same ZIP code—as a patient. As these pilot programs and many others like them proceed, it will be interesting to see where networks and technology stand a year from now. Stay tuned.