Telemedicine: The latest tool for the chronically ill

New technology for pharmacist-run programs

Although no formal telepharmacy programs have been designed to reach into patients’ homes, it’s a safe bet that’s where the technology is headed. Managed care companies already are experimenting extensively with telemedicine in home health care, where it is reducing hospital admissions and emergency department visits and proving its worth as a cost-efficient option in the care of chronically ill patients.

That’s important, considering Americans spend about $470 billion annually on medical services related to chronic illness, says James S. Logan, MD, chief medical officer for Strategic Monitored Services, a telemedicine company in New York City. As the American population ages, those costs are likely to increase.

The American Telemedicine Association in Washington, DC, describes telemedicine as the transfer of medical information (by graphics, video, or audio) among patients, physicians, pharmacists, and other health care providers who are at distant locations. Telecommunications link the players in the health care spectrum, including patients, for diagnosis, treatment, consultation, and continuing education.

Telemedicine may even allow ambulatory patients to continue living at home rather than moving into a nursing facility. A telemedicine unit permanently installed in a patient’s home can supplement in-person visits. Hands-on care, while certainly an integral component of home health, isn’t always essential; sometimes, for instance, the objective is simply to educate family members about patient care. In emergencies, telemedicine links can provide quick and direct access to health care providers.

Gregory J. Muth, president of Strategic, estimates that his company’s costs, including a central nurse monitoring station, telecommunications, and other equipment, come to about $30 per event. "The average national home health visit costs about $104 per event," Muth says. "That makes telemonitoring of patients very cost-effective."

As part of its disease management focus, Strategic targets big-ticket chronic diseases such as congestive heart failure, asthma, chronic obstructive pulmonary disease, AIDS, and diabetes, says Loretta Schlachta, RN, MSHP, CHE, the company’s clinical director.

"We try to keep chronically ill folks healthier by trying to catch things before they deteriorate," she says. "That way, providers can take aggressive action and nip problems in the bud before patients get to the point where they have to go to the ER or be admitted to the hospital." If a patient with lung disease, diabetes, and hypertension gets a simple cold, for example, he could wind up in the intensive care unit on a ventilator, she says.

Reach out and touch

Priority Professional Services, a home health company in Dallas, regularly uses mobile telemedicine to care for patients. "We’re not trying to replace doctors’ visits, but some patients are very debilitated, and it takes an ambulance just to get them in for routine care," says Jamie Mozingo, BSN, RN, MBA, formerly Priority’s chief executive officer. "With the telemedicine system, we don’t have to take these patients in as often, and this makes coordinating care for patients much simpler."

Other approaches to telemedicine include real-time, full-motion video transmissions; still images; and audio exchange, such as the University of Utah in Salt Lake City uses in its telepharmacy program. (See cover story, "Interactive telepharmacy could solve staffing problems.") Research in the field is widespread, involving not only private health care but also the military. (See box at right.)

Almost like being there

Still images often can be transmitted in quick sequence, creating fragmentary movement. In addition, images can be stored and viewed at a later time or converted to photographs for inclusion in the patient’s record. Some systems can be complemented with equipment that monitors and transmits blood pressure, pulse rate, and heart rhythm. Pharmacists could use such systems to see if a diabetic is administering the correct dosage of insulin, for instance.

Kaiser Permanente Health Care in Oakland, CA, also has experimented with telemedicine for home health visits. A project known as Tele-home Health is one facet of the health care network’s Interactive Technologies Initiative. The program’s goal is to compare the standard of care for home health in-person and telephone home health visits with a telemedicine model.

[Editor’s note: For more information, contact: Gregory J. Muth, President, Strategic Monitoring Services, 1185 Park Ave., Suite 211, New York, NY 101128. Telephone: (212) 996-1613. Fax: (212) 831-1518. E-mail: Strategic_Monitored_Services@ CompuServe. com. Loretta Schlachta, Clinical Director. Telephone: (212) 996-6113. Fax: (212) 831-1518. E-mail: 110010, James Logan, Chief Medical Officer. Telephone: (405) 364-7694. Fax: (405)321-9703. E-mail: TelemedJL@ CompuServe. com.]