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Program Profile:
TeleHealth Monitoring
Passion for a tabletop device that provides better healthcare at lower cost?
New technology, laced with humanity, is what VNSW is about, particularly in the person of Suzanne Brown, RN, who, in March 2009, became the agency’s new TeleHealth Program Manager. TeleHealth is a methodology that allows for remote monitoring of patients in their homes and two-way communication to manage their care and self-care. The TeleHealth device, used like a modem, also has ability to ask questions of the patient and provide immediate feedback in the form of educational coaching.
Suzanne’s diverse history includes work as a cardiac nurse in the Coronary Care Unit at Pennsylvania’s Presbyterian Hospital, a history of over 10 years in the home care and managed care setting, and, most recently, employment at a TeleHealth Company as a Nurse consultant. “Right now,” says Suzanne, “my entire background is coming into play for me here at VNSW!”
TeleHealth at VNSW Today
As regular readers of On The Home Front are aware through ongoing coverage in this space, TeleHealth has been in use at VNSW for awhile now, primarily but not solely for Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD).
“Using TeleHealth, we are able to monitor readings for many different conditions,” Suzanne explained.
We can monitor blood pressure for patients with hypertension, weight for patients with obesity or failure-to-thrive issues, oxygen saturation for patients with respiratory diseases such as asthma, and even anemia.
If we see that the blood pressure is high or low, we can inquire with questions such as, ‘are you short of breath today,’ ‘did you take your medication,’ ‘did you watch your salt intake’ – an entire catalogue of questions that vary slightly every day so that the patient doesn’t get bored with the same questions every day. It is designed to provide basic feedback for the readings on that day, as well as some coaching information.
The TeleHealth nurse monitors the patient’s readings from a computer, either at VNSW headquarters or at home, and calls the patient, welcomes them, gives them information on how to do the readings, helps them overcome anxiety about using the equipment, and offers ‘coaching.’
We’re looking for trends and abnormal findings, and this process uncovers a lot of things. An example would be a patient whose blood pressure is fine during weekdays, but rises every weekend, and determining why. If they’re without symptoms, we ask them to redo the reading, or, if they have symptoms, we may call the nurse, the patient’s doctor or 911, whatever is appropriate. It’s not so much about emergency medicine, and reacting to every fluctuation. Its about trending. We take into account that there are variables, such as a new caregiver unfamiliar with TeleHealth, the patient using the equipment incorrectly, and doing the procedure a bit differently that day (i.e. not placing the blood pressure cuff in the correct position on their arm, leaving shoes on when they weighed themselves, etc. ) We coach them on being consistent: to always test first thing in the AM, after going to bathroom, before they eat, before they take their medications, and before they get dressed.
Bottom line: we don’t get excited about every abnormal reading because of these variables, but we are very concerned about trending and encouraging behavior modification for better health. For example, we saw a patient whose blood sugar was elevated every Monday morning. With further assessment, we learned that his son visited him every Sunday evening, and they regularly shared a beer together. The patient now realizes that this beer is having a negative effect on his health, that maybe he should try having only half a beer, and, if his glucose level remains up, maybe stop having the beer altogether. By looking for such trends, and helping patients become familiar with their behaviors and how these behaviors affect them, TeleHealth has proven to be a behavior modification tool that has been effective.
TeleHealth at VNSW Tomorrow
Beginning this summer, VNSW’s TeleHealth program will expand to monitor patients with diabetes. The results from the patient’s routine glucose monitoring – actual results rather than patient reported – will be transmitted to the TeleHealth nurse. The nurse will be able to monitor results and offer nutritional counseling and other advice to help improve the patient’s health, based on actual data.
Additionally, data derived from VNSW’s TeleHealth program will be used as a research tool to study depression in the elderly. In partnership with Weill Cornell Medical College’s Institute for Geriatric Psychiatry in White Plains, the study will evaluate patients aged 65+ who exhibit symptoms of mild to moderate depression. Patients will be monitored three times a week using the TeleHealth system to answer a few depression related questions.
“Their answers will assist us in monitoring their feelings of depression and also allow us to assess the effectiveness of our interventions,” says Suzanne.
We are indentifying patients over 65 – those experiencing symptoms of depression without currently receiving any therapy or medications – for depression. We believe there are geriatric patients with chronic illnesses that are also suffering from mild/moderate depression and slipping through the cracks. Our goal is to identify this population and treat them accordingly.
Weill Cornell has had a longstanding clinical relationship with VNSW. With TeleHealth being such a good way to obtain meaningful, quality data, this is a natural partnership, using our TeleHealth program to assist with their research.
And what does Suzanne attempt to accomplish in the long-range future?
“I hope to ignite a passion for TeleHealth among my peers, as well as the community at large,” she explains.
I would like to be instrumental in helping people understand the high-quality, cost-effective care that is possible with technology such as TeleHealth. It allows us as healthcare professionals to cover our community in a very cost-effective manner without jeopardizing quality. I’d also like to impress upon the insurance industry an appreciation of the benefits of TeleHealth monitoring and how it relates to hospitalizations and re-hospitalization. True, it does represent an initial cost, but it has a very real potential to save money for them and the community. We currently have a 58% rate of keeping patients out of the hospital.
Back to TeleHealth Monitoring Program Description
E-mail for more info, or call Suzanne Brown (914) 682-1480, ext. 635
