Technology study shows growing use, increased satisfaction with telehealth

Benefits: Better outcomes, fewer hospitalizations, compliant patients

More than 88% of home care telehealth providers report that the service has produced an increase in quality outcomes for their agencies by reducing hospitalizations and emergency department visits. These home health providers shared their feedback in a national study that looked at the use of technology in home health.

"This is an important statistic as home health agencies look at reimbursement under a pay-for-performance system," says Jill Christians, senior marketing services manager for Philips Home Healthcare Solutions in Bothell, WA. Philips underwrote the Philips National Study on the Future of Technology and Telehealth in Home Care, which was conducted by Fazzi and Associates, a Northampton, MA-based research and consulting firm that specializes in home health, and co-sponsored by the National Association for Home Care and Hospice. "Almost 1,000 home health agencies responded to the survey that asked about use of four different technologies," she explains. Billing systems, point-of-care technology, electronic health records, and telehealth were addressed in the survey.

Over 17% of respondents report using some type of telehealth system, but among larger agencies the percentage is higher, with 32% of large agencies reporting the use of telehealth, says Christians. "We also found that hospital-based or hospital-owned agencies offer telehealth less often than nonhospital agencies," she says. The survey did not identify reasons for this difference, but being part of a larger system, having to coordinate systems and budgets with other hospital departments, and different geographic locations might be reasons for not adopting telehealth, she says.

"We installed our telehealth system 14 months ago," says Krista Kelly, RN, BSN, assistant executive director of home health for Integrity Home-care in Springfield, MO. Her agency has seen a 3% decrease in rehospitalizations, a 1% decrease in ED visits, and a 2% drop in urgent care visits, since the start of the telehealth program. "We've also been able to reduce our visits by about one visit per episode," she adds.

Although the decrease in nursing visits is a benefit to the agency, it should not be the primary reason for adding a telehealth service, points out Kelly. "Telehealth is just one more tool in our toolbelt to give us more information to enable us to better care for our patients," she says. Forty-one percent of respondents to the study identified improvement of overall quality as the primary goal of telehealth, and 33% of respondents cited reduction of unplanned hospitalizations and ED visits as their primary goal. Only 9.6% of respondents said that reduction of nursing visits was a primary goal.

Although slightly more than 61% of respondents say that their telehealth service is a part of a disease management program, Kelly's agency takes a different approach. "We assume that all patients are candidates for telehealth until the nurse excludes them," she says. Nurses may not recommend patients for telehealth if they have no landline phone service in their house, if the home is infested with bugs that can interfere with equipment, if the patient is unable to use the equipment and has no steady caregiver in the home to manage the equipment, and if there are mental conditions that will be aggravated by the equipment. "We do have some psychiatric patients that might view the telehealth system as 'big brother' watching them, and the system would exacerbate their paranoia," she explains. Other patients might refuse the equipment because of their discomfort with the technology, she adds.

At this time, 50 patients are on the telehealth system, which represents 10% of the agency's caseload, says Kelly. Telehealth patients monitor their blood pressure, weight, oxygen level, and heart rate every day and transmit it to the agency, she says. "Some of our cardiac patients also have the electrocardiogram (ECG) feature on their systems," she adds.

Success increases staff acceptance

The ECG feature and the ability to identify a problem for a patient that warranted medication changes actually helped Kelly garner more support for telehealth throughout the nursing staff. "One patient told our telehealth coordinator that he felt funny, so she suggested that he use the ECG feature," she says. The ECG strip did show palpitations, so the telehealth coordinator sent the information to the patient's physician who then changed the patient's medications. This patient's nurse was a member of staff who was skeptical about the value of telehealth, but after this incident she became a proponent of the technology, she adds.

An important component of implementing any telehealth system is to have staff members and patients buy into the value of the service, says Kelly. In addition to staff educational sessions prior to implementation, telehealth is kept top of mind in all case conferences in which every new patient's case is reviewed and the question "Why was telehealth not recommended?" is asked, she points out.

One tip that Kelly offers other home health managers is to include therapists in the telehealth training. "I did not include therapists in the initial training, and that is one thing about our implementation that I would change," she says. "There are telehealth patients who receive therapy, and the therapist needs to be familiar with the equipment in order to use it, or to answer questions," she explains.

Patients realize the value as they use the equipment, says Kelly. A patient who did not take her diuretic regularly because she didn't think she needed it could easily see herself gain weight from fluid retention as she weighed herself every day, she explains. Because the patient knew the nurse was expecting her to monitor herself each day, she would take her blood pressure and weigh herself, she says. "The everyday weight gave the patient the opportunity to see exactly what happened when she didn't take her medication, and she better understood the relationship between the medication, her diet, and her fluid retention," she explains. Because the patient saw the proof that the medication helped, she became more compliant with her medication schedule, she adds.

Patient satisfaction improves with the use of telehealth according to over 71% of study respondents, and over 79% report that patients and family members are reluctant to disconnect the telehealth equipment. "Patients become more involved in monitoring their symptoms and self-management," says Kelly. This may be due to more consistent education as the nurse reinforces education and refers to telehealth reports and trends, and it may be due to the patient feeling that he or she has some control over their medical condition, she adds.

The telehealth experience at Integrity Home Care has been positive, and Kelly recommends that every home health agency evaluate the possibility of adding the service. "Telehealth can be as simple as telephone calls to patients who have a blood pressure cuff, a scale, and a glucometer in their home," she points out. The patient can just report the findings to the nurse who tracks it on a chart, she explains. "Whichever system you choose, telehealth is a good tool to help prepare for pay for performance."

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For more information about telehealth and the telehealth study, contact:

  • Jill Christians, Senior Marketing Services Manager, Philips Home Healthcare Solutions, 22100 Bothell Everett Highway, P.O. Box 3003, Bothell, WA 98041-3003. E-mail: jill.Christians@philips.com.
  • Krista Kelly, RN, BSN, Assistant Executive Director Home Health, Integrity Homecare, 4247 South Glenstone Avenue, Springfield, MO 65804. Telephone: (417) 889-9773 ext. 704.. E-mail: kkelly@integrityhc.com.

To receive a free copy of the Philips National Study on the Future of Technology and Telehealth in Home Care, go to www.philips.com/HomeCareStudy. Complete the online form, and the study along with a slide presentation will be sent to you.