Technology improves North Carolina rural care

The North Carolina Health and Wellness Trust Commission is funding a $360,000 Roanoke Chowan Community Health Center (RCCHC) three-year program to benefit more than 40,000 residents in four disadvantaged counties to demonstrate how technology centered on WebVMC's (Virtual Medical Care) RemoteNurse can help prevent and treat cardiovascular diseases and diabetes.

Remote Nurse is used for in-home monitoring, in-home vital signs monitoring and telehealth kiosks in senior centers, churches, and schools to fight obesity, diabetes, and cardiovascular disease.

"We are in the business of investing in families, in communities, and in North Carolina," said commission chair Beverly Perdue, the state's lieutenant governor. "As a commission, it is our goal to make North Carolina the healthiest state in America. By funding important initiatives like these, we are moving closer to reaching this goal."

The Patient Provider Community Telehealth Network began in the fall of 2006 with placement of WebVMC RemoteNurse telehealth systems in homes of patients with cardiovascular disease and diabetes. Later, kiosks in senior centers were used to screen people for risk factors and monitor people at risk and those requiring treatment. The program then expanded to a Latino-based church and was to go next to a local middle school. All services are provided at no cost to patients.

Caregivers and patients are able to use RemoteNurse to monitor risk factors on a device said to be as easy to use as a telephone. Monitoring data are reported to the patient's doctor or nurse automatically, enabling health care providers to check on patients' vital medical signs as often as they feel necessary. WebVMC said that with chronic illnesses like cardiovascular diseases and diabetes, ongoing monitoring is essential to help people stay healthy and compliant with their medical regimen.

"Our region is one of the poorest in the state," said RCCHC CEO Kim Schwartz, "with 20% living 100% below the federal poverty level, and our cardiovascular death rate is the highest in the state at 18.5%, and getting worse. With WebVMC's RemoteNurse, we can monitor hundreds or even thousands of people, without requiring them to make the trip to the doctor. By taking this technology to the community—to senior centers, schools, and faith-based organizations—we can track and manage people who receive no or little medical care, and have a positive, immediate, and ongoing impact on their health status."

Interacting as if in person

WebVMC president and chief technology officer Scott Shepherd tells State Health Watch the RemoteNurse interacts with patients the way a live staff person would. The RemoteNurse has an 8-inch color display that allows patients to interact with the system by touching the screen. There also is a built-in speaker for communicating with patients through verbalized assessment questions and instructions for using the measurement devices. Patients can indicate whether they want the unit to communicate in English or Spanish.

The technology, he says, allows for many more patients to be screened and monitored than would be possible through the old manual process.

According to Mr. Shepherd, success of the program has occurred because the medical community has been working together collegially. "Doctors and other medical professionals bought into the community approach up front," he says.

Health care professionals can access individual patients' monitoring data whenever they want by logging onto a secure web site. The system allows caregivers to set thresholds on answers to assessment questions and measurement values that will result in them being notified by e-mail, interactive pager, or cell phone of any answers or measurement values that don't align with their care plan or fall outside of normal parameters.

Caregivers can ask patients unlimited, multiple choice, yes/no, or scale rating assessment questions that can be customized by disease state. The system generates detailed reports, including measurement results, graphs, notes, and threshold violations based on individualized criteria.

The system has been working for a longer period at Atlanta's Piedmont Hospital and at Texas-based Beyond Faith Homecare. An evaluation of WebVMC's Beyond Faith Homecare effort, found that while hospital readmissions have remained at 28% nationally, and Texas has gone from 33% to 34%, the readmission rate among Beyond Faith Homecare patients has gone down from 31% to 25%.

Also, the percentage of patients who get better at taking medications has increased from 26% to 55%, presumably as a result of the program.

In Atlanta, a community telemanagement program was intended to 1) increase geographical reach and service; 2) increase patient volume, and 3) increase intensity of services.

Positive results

Patient volume increased by a little more than 50% when the RemoteNurse program opened, an evaluation report says, and patient volumes far outstripped earlier totals. Intensity of service increased 13 times, and outcomes for geographical reach went from an average of 16.3 miles per patient to 39.84 miles per patient.

The evaluation also found that patient satisfaction numbers are high, with 75% of those surveyed saying their RemoteNurse experience was "excellent," and 25% saying it was "good." All survey respondents said they found the remote nurse technology "easy to use."

Information on WebVMC Remote Nurse installations is on-line at Contact Mr. Shepherd at (866) 4WEBVMC [(866) 493-2862].