The hospital's reach into the community is getting longer. As healthcare provider organizations get serious about implementing telehealth and telemedicine systems to expand sites of care and improve patient communications, they're stretching the boundaries of conventional brick-and-mortar facilities.
Long considered a pie-in-the-sky concept, telehealth and telemedicine are proving much more significant as the technology advances – namely as a labor-saving and cost-cutting tool that can actually improve patient care. These benefits should help as the ratio of clinicians to patients grows wider, the overhead cost squeeze for hospitals gets tighter and the call for increased patient safety gets louder.
Redmond, Wash.-based Microsoft has been studying how "unified communications" can be applied for healthcare purposes, said Chris Sullivan, Microsoft's national director of U.S. Healthcare Provider Solutions.
"Telemedicine is a good one for us with regard to where the market is going – not just for what we offer in the area of unified communications but also for the overall trend of consumer-based healthcare," he said. "There is more investment toward connecting consumers with healthcare professionals and we are providing the platform. We are focusing on traditional services that fit with telemedicine, such as specialist referrals, patient consultation and remote patient monitoring."
The platform is Microsoft HealthVault, launched last year as a conduit for providers and consumers, supporting personal health records, storing secure patient information and facilitating connection with other third parties such as payers, case managers and even medical device companies for health data exchange. The system, which also serves as a vehicle for correspondence and health education, gives consumers a new dimension for healthcare access, Sullivan said.
"Consumers have come to expect this level of access with other businesses, such as banks," he said. "This represents a cultural shift for healthcare and it will continue to evolve in the future."
TELE-PRACTICE
By deploying interactive video and communication support systems, providers are fostering a more intimate relationship with patients – especially those who are homebound with chronic disorders, said Jan Wuorenma, RN, vice president of partner development for Eden Prairie, Minn.-based American TeleCare, Inc.
The ability to electronically monitor the delicate conditions of patients with congestive heart failure or chronic obstructive pulmonary disease gives providers the ability to perform faster interventions, thus heading off emergencies that may result in costly hospital readmissions. Automated interaction also allows clinicians to have contact with more patients using fewer people, Wuorenma said.
"It lets clinicians do what they would during an office visit," she said. "It is reaching a point where telehealth is becoming its own practice. In fact, there are practices that are now specializing in telehealth."
Involved in the telehealth marketplace since 1993, ATI uses video that runs over the phone line and broadband, and the company plans to add cellphone transmission this year. The system uses "intelligent" monitoring of vital signs and other measurements, such as pain and fatigue levels, medication response and shortness of breath. Patients communicate their conditions through a touch screen display featuring easy-to-read icons.
VIRTUAL HOSPITAL
Presbyterian Healthcare Services, a seven-hospital integrated delivery network based in Albuquerque, N.M., sees telehealth as its virtual "eighth hospital." Launched last October and managed by Presbyterian Home Healthcare Services, the Hospital At Home program is designed to help patients transition from the hospital to home-based care, said executive director Lesley Cryer.
"It's less costly than the 'hotel' accommodations of inpatient care," she said. "The criteria focuses on patients who come into the ED but aren't sick enough to be admitted. Those patients are assessed by the ED physicians and hospitalist and if they qualify for the 'virtual hospital,' they go home with an ATI unit."
Presbyterian currently has three patients in the Hospital At Home program and has a fleet of 100 ATI units. As a network with its own health plan, the services are covered for its members.
"We can't build bricks and mortar fast enough, so we need to use alternatives like this," she said. "Otherwise, healthcare won't be able to keep pace."
PATIENT AS PARTNER
To be sure, telehealth technology has eased the number of unnecessary in-home nurse visits, but in no way can it adequately substitute for personal contact, says Rae Szymanski, executive vice president and chief operating officer for the Visiting Nurse Association of Hudson Valley (N.Y.).
"Technology is a management tool," she said. "It does not replace a nurse visit, it only enhances the services being provided. In some cases, the technology has resulted in more visits."
By becoming more engaged in reporting their vital signs and other information, patients are becoming partners in their own healthcare, Szymanski said.
