Remote care, direct assistance

The Baltimore Sun

Army veteran Eugene Rice, who is living on his own with emphysema, low blood pressure and the effects of several slight strokes, gives much of the credit for his well-being to his health care coordinator at the Perry Point VA Medical Center in Cecil County. He even thanks Dee Jones for helping him reach a milestone.

"I turned 80 last month, and I did it all with her help," said Rice of Abingdon. "She has been a godsend to me."

Rice is one of 90 patients whom Jones cares for daily, with the help of technology known as Care Coordination Home Telehealth. Through this program, Jones monitors patients in their homes using vital information, such as blood pressure and oxygen level, that they transmit over the phone. The data enable her to assess a patient's wellbeing.

"It's technology, but I still feel like I am nursing hands-on," said Jones of Bel Air, who recently earned a master's degree in nursing. "Eugene is being proactive with his health and playing a major role in his success."

Since the seven Veterans Affairs hospitals and clinics in Maryland put telehealth in place four years ago, officials said, emergency room visits, hospital admissions and the length of hospital stays have dropped.

"Telehealth saves money, while improving the quality of life for our veterans," said Patricia Davis, director of care coordination for the home telehealth program at the Baltimore VA Medical Center on Greene Street. "It decreases the amount of money spent on avoidable admissions and complications."

Nearly 400 chronically ill veterans across the state participate, with at least 130 of them avoiding institutionalized care because of telehealth, Davis said. One 50-year-old veteran, suffering from debilitating heart problems, has shortened his hospitalizations and cut them from six visits a year to two.

Patricia Abbott, director of the Collaborating Center for Nursing Informatics at Johns Hopkins Hospital, said that telehealth demonstrates "team-centered patient care" at its best.

"This is the health care industry working together to achieve optimal health for patients," Abbott said.

"The only downside is that the only people who can participate are those who have the capacity, technically and intellectually, to do so."

Telehealth would work well with HIV patients and recovering addicts, Abbott said, but those patients rarely have the resources to start the program.

The VA supplies the veterans with an electronic monitor - there are several that range in price from $800 to $1,300 - and gives them instructions on basic procedures, such as how to take blood pressure or check blood sugar.

"We can set up the questions we want them to answer every day," Davis said. "And it all works over a plain old telephone line."

Rice has mastered the procedures and data input. He might also answer a few questions about his overall health before transmitting the information to Jones' computer at Perry Point.

"Every morning, the machine says: 'Good morning, Eugene,' and the next thing I know, I am talking back to it," he said.

Telehealth is helping to care for nearly 30,000 veterans at VA hospitals nationwide, officials said.

"This is really good technology that is expanding both the level and the quality of care for our patients," said Michael E. Dukes, spokesman for VA Maryland Health Care System. "It is like having a nurse in your home."

Although there is no physical contact, the technology allows nurses to assess patients and intervene, said Sandy Summers, director of the Center for Nursing Advocacy, an international nonprofit agency working to increase public understanding of the nursing profession.

"The nurse is still able to educate and advocate for the patient," Summers said. "And with a patient's history readily available, the nurse can know what went on yesterday and months before."

By comparing daily data to patient history, the telehealth nurse can spot any irregularities, such as sudden weight gain or fatigue, that might signal problems.

"I know from the history and the data when something is going wrong, and I will try to figure what and why," said Sheryl Batten, senior care coordinator at the Baltimore VA hospital. "You do your detective work, like nursing CSI, and figure out what they need to change."

Davis, who expects to add three telehealth nurses to the staff of four at the city VA facility, said ease of use and reassurance for patients make the program successful.

"Patients like the system and they feel that someone is looking out for them and that someone is only a phone call away," she said.

"Nurses can get around to more patients than if they were calling on them one-on-one."

Telenursing is used primarily in the VA hospitals, but Davis, who has been nursing for 32 years, envisions it moving into the private sector.

"It is technology that is continually evolving," she said. "I used to think if you were not touching your patients, you were not nursing them. But as long as we are working to improve our patients' lives, we are nursing."

Jones, too, sees telenursing as "the wave of the future in preventive medicine."

Rice, 18 months into the program, has become a staunch supporter.

"Since I have been with Dee and the VA, I have not gotten better, but everything has been better for me," he said. "I feel really great. If I could sing, I would."

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