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Test projects will measure effectiveness
Video cameras mounted atop computer monitors have been used by business and recreational computer users alike. Video conferencing allows offices in different cities to talk in real time and even permits grandparents to frequently see grandchildren who live hundreds of miles away.
That same technology also can bridge the distance between hospices and patients who live in distant, rural areas or who are urban shut-ins, experts say. Last year, researchers in Michigan and Kansas began studying the usefulness of telemedicine in the hospice setting.
Critics of telemedicine fear that the technology will lead to less care. Rather than nurses making face-to-face visits, telemedicine visits will replace home visits, they argue.
"I see telemedicine as something that will actually add care," says Stephen Conner, PhD, executive vice president of research and professional development for the National Hospice Association and Palliative Care Organization (NHPCO) in Alexandria, VA. "I believe the number of visits will not change, but the technology will increase access to hospice nurses."
Hospice of Michigan in Southfield and Michigan State University (MSU) in East Lansing are participating in a joint project to study the use of telemedicine for Hospice of Michigan patients.
Researchers have been examining the use of interactive video technology as part of a care program for 40 Hospice of Michigan patients during a two-year period. The goal of the study, which is funded in part by a grant from the National Telecommunication and Information Administration, is to examine the use of technology in eliminating barriers, including geography and cost, to quality end-of-life care.
The Michigan project is part of a two-state study that will examine how the technology can improve hospice care. The University of Kansas is studying the use of telemedicine in Kansas with Hospice Inc. in Wichita, Hays Home Health and Hospice in Hays, and Hospice Services in Phillipsburg.
"We think that telehospice will play a role in enhancing hospice care by increasing the amount of service available to patients and lifting the pressure off hospice providers who are trying to provide greater access to care and relieve some of the costs associated with high-level quality care," said Pamela Whitten, PhD, assistant professor of telecommunications at MSU and lead researcher on the telehospice project in Michigan, when the project began last year.
Since then, Michigan researchers have collected a year's worth of data. Whitten says preliminary figures show:
• Increased access. Patients and caregivers used the system to keep in more constant contact with hospice staff. This was especially evident after hours, when patients and caregivers are often hesitant to call staff out of concern that a nurse will have to make a needless visit.
• System used as triage tool. Staff were able to cut down on unscheduled visits made in response to caregivers concerns. In some cases staff were able to talk the patient or caregiver through the problem, rather than having to send a nurse to the home.
• Patient and caregiver satisfaction. Both patients and caregivers indicated they wanted to use the service more.
For no extra charge (Medicare provides limited reimburses for providers who use telemedicine, and telehospice is not reimbursed by Medicare), patients will have use of a 13-inch television monitor with a camera mounted on the screen. The teams will be able to control the image of the patient using the keypad of the touch-tone phone to enhance the visual interaction. For example, the team nurse will be able to zoom in and take an on-screen snapshot of a medicine bottle held up by a patient or family member.
By today’s technology standards, telehospice is relatively simple. It involves the use of standard telephone lines and interactive video technology, including a speakerphone, a tiny video camera, and television monitors. Hospice patients who are participating in the study will be able to call members of the hospice interdisciplinary team for a video consult. That allows patients and their caregivers 24-hour access to a nurse or physician.
If a caregiver is concerned about the labored breathing of a loved one, for example, he or she can dial into the system and point the small camera at the patient so a nurse or physician can evaluate the patient’s condition. The clinician can then instruct the patient on the next step and evaluate whether a nurse should visit the home.
Telemedicine is nothing new to the health care industry. For example, since 1986, Rochester, MN-based Mayo Clinic has had a satellite-based, full-motion video system to unite its clinics with sites around the world. Since then, more than 300 clinical examinations involving all specialties have taken place by means of this system.
In addition to patient exams, telemedicine is commonly used to interpret electrocardiography, echocardiography, X-rays, and magnetic resonance imaging between remote sites.
Hospices have only recently voyaged into telemedicine. In May 1997, Kendallwood Hospice in Kansas City, MO, embarked on a joint telehospice project with the University of Kansas. This partnership turned out to be the genus of the telehospice project involving Michigan and Kansas.
"We wanted to see if using telemedicine in a hospice setting was feasible," says Whitten, who was a researcher on the University of Kansas-Kendallwood project.
Going on four years now, the experience at Kendallwood has shown that telemedicine not only has applications to hospice, but has promise in improving care and reducing costs.
Original thinking held that telehospice’s greatest potential is in serving patients in remote areas. Routine telehospice consults could be provided in addition to scheduled home visits without having to subject nurses to additional long drives to patients’ homes in rural areas. Urgent calls could be handled in a timelier manner.
When problems or questions arise, the hospice doctor, nurse, or social worker can use the telehospice equipment to see and talk to the patient and family, assess the situation, and respond more quickly than if he or she had to drive to the location.
For Kendallwood, which serves a high number of rural patients, the use of telemedicine made sense. The technology was applied to lessen the need for hospice workers to drive long distances for short visits and give patients immediate access to staff when a crisis arises.
Contrary to rural areas of Kansas, Detroit is predominantly urban and suburban. Yet, Whitten says, access to hospice care is still an issue in these areas. "There are neighborhoods in Detroit, for example, that are too dangerous for nurses to go into after dark," Whitten says. "There are access problems not only in rural areas, but in urban areas, as well."
Among the questions researchers are hoping to answer is how well telehospice will be embraced by patients, their families, and professional staff that provide care. More often than not, patients and their caregivers are elderly, a demographic that has been slow to adapt to rapid changes in technology.
Researchers hope to be able to measure the effect telehospice has on provider-patient interaction. For instance, they will look at what subjects are discussed using telehospice and whether the technology impedes or enhances open discussion with the hospice worker.