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Technology for Independence

December 1, 2003
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Why telemedicine is the key to full-service long-term care BY SALLY HUSTON
Technology for Independence
This multilevel seniors community has found telemedicine useful for home care, assisted living, and nursing home care

BY SALLY HUSTON As a multisite provider of CCRCs, Ohio Presbyterian Retirement Services (OPRS) has seen how the continuum has changed over the past 10 years. In the past, our residents have moved through our system, entering first through our independent housing apartments or villas. As their health failed, they might have moved to assisted living, then eventually to the skilled healthcare center. Residents were required to move to a site of care that provided the type of service they needed and, most often, the changes in site of care were permanent, with little movement back and forth. The situation has changed drastically. At OPRS, we talk every day about how the type of service does not equate to the site of care. Services are now portable-patients can get an IV or other therapy in their homes, in assisted living, or in the nursing facility. We are limited only by the qualifications of our staff, regulations, and available beds. Moreover, residents now have a voice in the choice of service location.

As an organization, we always have been interested in moving forward. We seek out what is new and what might help us improve quality of care and the quality of life for our clients/residents. So when Senior Independence, the home- and community-based services division of OPRS, decided in 2002 to start a telehealth program, we wanted to be sure this service would also be "portable" and be available to people regardless of where they live. We began by implementing telehealth with our home healthcare clients, but we now see many opportunities to transfer this technology to assisted living and the nursing home.

Telehealth: How It Works
In getting started, we found many telehealth vendors offering different types of equipment, the main difference in equipment being patient monitoring stations with or without video capability.

Telehealth video patient stations (our eventual choice) are located in the home and come with standard attachments: a blood pressure cuff clients put on themselves and a stethoscope they place on their bodies when instructed to do so. Also, as needed, we add a scale, glucometer, pulse oximeter, and an attachment to measure the protime level for managing warfarin therapy. A digital camera is placed on top of the unit but can be moved to focus on any location. The unit includes a magnification lens that allows the telehealth nurse to see fine print or even the markings on a syringe. We are also able to take digital pictures of skin conditions.

Monitoring stations with no video are less expensive, and require patients or caregivers to complete certain tests on their own and enter the information into the monitoring unit. Patients are prompted to answer a series of questions to see how they are doing. At specific times, the telehealth nurse reviews these results at a secure Web site. The nurse will quickly recognize any abnormal results and call the patient and/or physician for follow-up.

To start a telehealth program like ours, you need access to a provider station. This is a computer with special software and hardware to enable video visits. Client records are maintained on a server, permitting secure Web-based access to qualified individuals. Patient stations can be purchased or leased. Although we use only video units, many organizations have a mixture of both video and nonvideo monitoring stations. The unit plugs into an electrical outlet and a regular telephone line. We provide an adaptor that allows clients to use their regular phones for personal calls.

Video units have a small screen that provides a good-quality picture. It is not television-quality-motions appear jerky, and the audio is delayed a little, because of the phone line connection. Special wiring needed for higher-quality video would have been cost-prohibitive and unnecessary for our purposes.

One provider station can call any number of patient stations, limited only by the telehealth nurse's time for visits. One visit is expected to take about 15 or 20 minutes, allowing three or four visits an hour. This is quite an improvement for home care, where travel time may allow only one visit an hour.

Will Seniors Use It?
Since the average age of people we serve is over 75, we wondered if they would accept this technology. We arranged for a focus group of local seniors to test the video equipment for us. As it turned out, they loved the video unit and told us they would love to be able to have access to the equipment. During the focus group we were able to direct one of the volunteer testers to see her physician about her elevated blood pressure reading. She was unaware she had high blood pressure. All 10 people attending the focus group wanted to try out the video telehealth unit. One man said he found it very easy to use, noting it was "easier to use than a telephone." After conducting our focus group and researching products, we chose a vendor and partner. Expanding Into Facility Care

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