Wednesday, July 15, 2015 12:01 am
Telemedicine connects patients with care
Growing telehealth programs take several different forms
More and more central Illinois residents are seeing their health care providers through a TV screen. “Patients love it,” said Nina Antoniotti, the executive director of telehealth and clinical outreach at Southern Illinois University School of Medicine. Patients rate telemedicine services better than receiving care in person. “There’s something about talking to a clinician on TV that levels the playing field,” she said. “Patients are more willing to divulge information.”
Seniors like telemedicine the best. It’s convenient and they don’t have to travel far. Antoniotti said it’s a myth that seniors aren’t comfortable using technology, when, in fact, seniors are the fastest growing segment of the population embracing technology.
The American Telemedicine Association defines telemedicine as the remote delivery of health care services and clinical information from one site to another using electronic communications. The terms telemedicine and telehealth are used interchangeably.
Antoniotti was hired in January to examine ways SIU can utilize telemedicine to fulfill the school’s mission. The school has agreements with five service sites – Thomas H. Boyd Memorial Hospital in Carrollton, Carlinville, Carthage, Mason District Hospital in Havana and Sarah D. Culbertson Hospital in Rushville. Antoniotti hopes to have agreements with 20 additional sites within her first year.
The site must be telehealth-enabled and have a trained telepresenter, who is a registered nurse or licensed practical nurse. The patient travels to a service site where the telepresenter checks them in and calls the provider. The provider logs on, sees his patient is “there” for their appointment and calls the site.
A national expert on telehealth, Antoniotti spoke at a telehealth conference sponsored by SIU. The school asked her to set up its new program. There are currently 150 trained clinicians out of 250 faculty and 200 residents. The first services to go live will be dermatology, endocrinology and pediatrics, with plans to extend this to all clinical services.
Dr. Jeffrey Bennett, division chief of adult psychiatry, was one of the early adapters at SIU. He established a telepsychiatry clinic for residents. There were two service sites enrolled initially; today the only site is Mason District Hospital in Havana.
It took a year to establish the clinic. “It was a great learning experience,” said Dr. Bennett. Part of the problem was billing and reimbursement. “Reimbursement is a thorny issue,” he said.
Patients often had to wait a long time to see a psychiatrist and the clinic met that need. Clinicians treated patients with anxiety disorders and depression. In its first year, the clinic reduced the number of visits to primary care physicians.
“The program was a success,” said Dr. Bennett.
Doc at bedside on weekends
Capitol Healthcare and Rehabilitation Centre has partnered with TripleCare, a telemedicine physician service that provides scalable, high-quality care at the patient’s bedside after hours and on weekends. The nursing staff can reach a clinician when a patient’s condition changes.
The program was implemented in May and went operational in June. Patients are seen by a board-certified physician while avoiding a trip to the emergency room. The patient and physician can have a two-way conversation in real time and the physician can make diagnoses and write prescriptions.
The majority of patients are age 65 and older. Among the common conditions a nurse might call about are chest pain, shortness of breath, fever, change in mental status, worsening pain or gastrointestinal problems.
The system is easy to use. The nurse wheels the telemedicine cart into the room, pushes a button and the physician controls the video screen. The nurse serves as the doctor’s hands and information is transmitted to the physician.
“The first time we used it, the nurses were very excited,” said spokesperson Molly Hannon. When a nurse calls, they are immediately connected to a physician.
It gives patients piece of mind knowing a nurse can reach a physician immediately. “Families can rest assured knowing this technology is available,” said Hannon.
Data at one facility showed that out of 42 calls placed in one month, 36 were successfully treated without readmission. “This saves money,” said Hannon.
“It provides a high success rate of patient recovery,” said Hannon.
Remote monitoring is another component of telemedicine. Memorial Medical Center and St. John’s Hospital offer remote monitoring services to patients with heart failure.
Heart failure occurs when the heart cannot pump enough blood and oxygen to support vital organs. Brandy Dennis, a certified heart failure nurse at Memorial Medical Center, said there are 670,000 new cases diagnosed annually. Risk factors include diabetes, high cholesterol, hypertension, obesity and smoking.
Tracy Kesinger started the Cardiocom Telescale program around 2000 and it now has eight nurses, five of whom work specifically with the program. It is administered by the Outpatient Heart Failure Disease Management Program under the coordination of Marilyn Prasun. “Remote monitoring has been proven to improve the outcome for patients,” said Dennis. “It’s another tool patients have to manage the disease process.”
There are currently 28 patients enrolled and the average age is 69. Patients weigh themselves daily and answer a series of yes and no questions relating to heart failure symptoms. The data is collected electronically and transmitted to Memorial, where a trained nurse reviews it. Close monitoring is important to prevent hospital readmissions.
A student did a retrospective analysis of 100 patient charts between 2007 and 2012. The results showed a decrease in the number of emergency visits by half and the readmission rate was 61.5 percent 30 days post-enrollment.
The patient’s post-discharge weight is critical. “If a patient is gaining weight, it tells us there is fluid retention that exacerbates heart failure,” said Dennis. If a patient gains three pounds overnight or five pounds in a week it’s a red flag that something is going on.
The scale provides a bridge for self-care. “It helps patients manage their heart failure,” said Dennis. The goal is for the patient to graduate from the program after three months and move forward.
“We’re watching out for them,” said Dennis.
HSHS St. John’s Hospital received a $205,564 grant from the AstraZeneca Healthcare Foundation with a matching $50,000 grant from the Hospital Sisters of St. Francis Foundation for its Tele-Heart Pathway program at Prairie Heart Institute. Dr. Mark Stampehl leads the program.
The program manages high-risk and fragile heart failure patients with the aim of avoiding hospital readmission. There are 18 patients currently enrolled with a goal of having 120 by the end of the year.
Patients receive a free scale that connects remotely and automatically provides data to nurses who monitor and guide patients in the management of heart failure. Data is collected for nine months following enrollment. Nurses educate patients on their disease process and symptom management skills.
“Patients with heart failure have a progressive disease,” said Dr. Gurpreet Mander, chief medical officer. The program’s success depends on patient engagement. The goal of the program is to teach patients to manage their care.
In the original program, clinicians reduced the number of readmissions for heart failure significantly.
Not all telemedicine services are covered by insurance. In Illinois, pending legislation would require insurers to pay for telemedicine services. “As telemedicine becomes more widely accepted, most experts are of the opinion that it is a matter of time before reimbursement becomes universal,” said Dr. Mander.
Telemedicine will become an integral part of how we deliver health care in the future. “It is one of the solutions to improving access and health care delivery,” said Dr. Mander.
The third component of telemedicine is patient information. This October the Springfield Clinic telenurse program celebrates its 20th anniversary. This no-cost program handles phone calls from the public and the emergency room from within a 12-county area.
The program employs 40 full-time and part-time nurses and is staffed around the clock. It receives between 5,000 and 6,000 calls monthly. Nurses have a minimum of five years of experience. Patients are able to call and speak with a nurse, who has access to a computerized triage program. “Emotions can run high,” said Patty Anders, director of telecommunications. It’s important for the nurse to keep a calm head.
“We want to provide patients with the right level of care,” said Anders. Nurses have got to be able to talk to patients. They have to ask the right questions to get a clear picture of what is going on to triage the patient to know if their condition can be managed at home, whether they should wait till the next day when they can get into their doctor’s office or whether the condition requires immediate attention in the emergency room.
Patients should call before going to the emergency room. An emergency visit can cost around $500.
Nurses never know what the next call will bring them. “They have to use their clinical experience and judgments to evaluate the call,” said Anders.
“Our nurses are passionate about what they do,” she added.
Roberta Codemo is a health and wellness writer and frequent contributor to Illinois Times. She can be reached at email@example.com.