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Telecommunications technologies can improve home health care|
By Celena E. Kusch
In an address on Home Health Care in the 21st Century, Margaret J. Cushman, vice president of the National Association for Home Care, indicated that the future of home care is exceedingly bright and that telecommunications technology is a crucial part of that future.|
She outlined a number of trends that are adding to the opportunities in home health care. Perhaps the most important have been the changes in national demographics and life-expectancy. More people will need help if they are to live independently.
Cushman sees home care as the logical response to these trends. Todays consumers want to be in control of their health care and optimize their health with more preventive medicine, greater convenience, lower costs and increased personal choice. Home health care is integral to meeting these expectations, she said.
Cushman delivered her remarks during the Telecommunications in Home Health Care: Linking Patients to Health Care Providers Through Information Technology Conference held in June at The Penn Stater Conference Center Hotel. The conference drew more than 100 home health care executives, government officials with health policy or rural health policy responsibilities and health care industry administrators interested in exploring technology-based opportunities to improve home health care services.
At the conference, nationally known leaders discussed state-of-the-art technologies and offered firsthand information from nurses and managers who have used telemedicine. Telemedicine refers to a variety of health services conventionally delivered in a doctors office or hospital that are now available through the Internet, telephone, videoconference, satellite, fax or other telecommunications media. From presentations to hands-on exhibits, the conference provided participants with strategic, operational and technical information about telecommunications-based home care programs currently in place, as well as those still in development.
Dr. Barbara Shannon, dean of the College of Health and Human Development and professor of nutrition, explained Penn States role in this field, saying, In the College of Health and Human Development, we believe in providing outreach research and outreach teaching that focuses on the problems facing society today. We are committed to improving the quality of health care across the Commonwealth and nationwide. Today, technology allows us to provide high-quality care in the home at unprecedented levels, enabling us to lower costs to consumers while we maintain the highest standards of care. We know this conference will be an exciting forum for sharing experiences and building the networks we need to realize these goals.
Conference sponsors were Penn States College of Health and Human Development and Continuing Education, the National Telecommunications and Information Administration, the Visiting Nurses Association of Greater Philadelphia, Bell AtlanticPennsylvania and the Pennsylvania Information Highway Consortium. This collaboration between health organizations and technology leaders was crucial to the success of the conference.
Part of our purpose was to present the technology, as well as the specific applications in health care, said Dr. Kathryn H. Dansky, associate professor of health policy and administration, director of Penn States TeleHomecare Project and conference organizer. To do that, we thought it was important to give examples of the technology, as well as actual programs. Stephen Downs, director of the National Telecommunications and Information Administration (NTIA), delivered the keynote presentation. He outlined current and future trends in telecommunications and provided examples of successful technology-enabled projects that received NTIA support.
The NTIA, a federal program of the Department of Commerce, is responsible for the administration of the Telecommunications and Information Infrastructure Assistance Program (TIIAP) whose mission is to promote the availability and use of advanced telecommunications in the public and nonprofit sectors by stimulating innovation through funding competitions. The TIIAP selects projects that can advance the state-of-the-art and serve as models for future development in both public and private enterprises, particularly in rural and underserved communities. Since its inception five years ago, the program has provided 378 grants, awarding more than $17 million in funding this year alone. A number of these grants have gone to innovative programs in home health care, including Penn States TeleHomecare project.
One of TIIAPs goals is to connect Americans to a wide array of services through existing telecommunications infrastructure. The TeleHomecare project works to promote that goal within the health care sector, Dansky said.
According to Dansky, the TeleHomecare Project has four aims: improving the health status of patients, reducing costs, improving patient satisfaction, and exploring different populations who can benefit from new developments in telehealth care. Disseminating information about new opportunities for health professionals who want to use advanced telecommunications to deliver health care is a central part of this last goal.
Throughout both the formal presentations and informal networking opportunities, speakers and participants shared their expectations, experiences and lessons for developing telemedicine services for patients who receive home care. The conference drew together both current and prospective providers of telecommunications-enhanced home care interested in practical models for developing and implementing innovations or improving growing operations.
One of the first companies to develop telemedicine for home health care is American Telecare Inc. (ATI), a Minnesota-based firm. During the conference, Dr. Khalid Mahmud, chairman and chief executive officer of the company and founder of Medisys home care management organization, shared the history and details of this program.
On a trip to Pakistan, Mahmud explained, he was impressed by the general commitment he saw to home-based health care and wanted to adapt that model to the U.S. health system without increasing the amount of time nurses spend on the road when making home visits. Mahmud and his colleagues identified the key equipment and diagnostic needs for their patients and looked for innovative ways to provide those services at a distance for home care patients with conditions including asthma, heart disease, severe anxiety, AIDS, spinal cord injury and diabetes.
The ATI system uses interactive video and medical peripherals that check blood pressure and pulse. While patients and nurses communicate through interactive video, the equipment automates the most common diagnostic tasks and sends that information over the phone lines from the patients home directly to the nurse.
Mahmud was enthusiastic about the uses of this technology, noting that 45 percent of home visits can be performed using telemedicine.
Nurses can make visits over the telephone lines to provide care, education and monitoring, Mahmud said. For our patients, interactive video is paramount. It increases the satisfaction of the patient and also allows better diagnosis of the body cues that instruments cannot measure.
We were very fortunate to have Dr. Mahmud on the program, Dansky said. Dr. Mahmud is one of the leaders in this field. From the beginning, he has been exceptionally forward-thinking in linking the medical community with community health care.
In the panel session Lessons from the Field, administrators of newer programs presented their data about program development and evaluation. Dr. Kathy Bowles, R.N., director of nursing research for the Visiting Nurses Association of Greater Philadelphia and research assistant professor at the University of Pennsylvania, explained her initial concerns in dealing with senior patients and their ability to adapt to the technology.
We were pleasantly surprised, she said, describing patients who would primp for the video visits, getting dressed and doing their hair and make-up in preparation for their appearance on camera. Others became local celebrities, inviting their neighbors over to watch and listen during their video visits. We saw a real change in patient empowerment and their ability to manage their own care.
Other presenters shared the same experience of positive outcomes. Walter Townsend, health systems specialist, is an administrator at the James A. Haley Veterans Hospital in Tampa, Fla., which serves 424,000 veterans in eight counties. According to Townsend, telemedicine has improved access to patients living far away while providing an efficient use of professional time. Before the telehealth care stations were installed, the hospitals nurses made four or five home visits per day and spent four to five hours on the road. With telecommunications technology, the nurses can make as many as 20 visits in a day, improving their productivity and allowing them to notice minor problems before they turn into hospital admissions.
Because of the focus on cost-containment and questions about reimbursement for telemedicine services, there arent many incentives for health care providers to develop telehealth programs, Dansky explained.
Providers have to be courageous and inventive to get into this area. We believe that technology will eventually enable us to provide better care, but we still need to learn how to pay for it. I am convinced that down the road, telehealth will save costs and improve the quality of care.
Dansky is encouraged that this conference will have great outcomes. As a result of the conference, I hope that more providers will try the technology, network, share experiences, and that they will become advocates for telehealth with the policy makers and financing bodies that need to know more about these programs, she said.
An outreach program of the College of Health and Human Development