The attack on the World Trade center has caused many business firms to consider de-centralizing operations. That is certainly feasible. Communications technology now cost-effectively extends all manner of services to nearly anywhere. A case in point is rural healthcare.
In 1999, it cost an estimated $36 (B) billion dollars to take care of 8 (M) million patients in their home. The cost of home health care includes the travel time of nurses driving from their offices to patients' homes. In rural areas, the travel is more of a challenge. If a patient is having difficulty, it is not so easy for a traveling nurse to reach that patient in a timely fashion.
But "technology" is coming to parts of rural America to help nurses keep tabs on patients between visits without leaving the office. Producer Nancy Crowfoot reports.
SLUG (on phone) "Good morning. Are you ready? Okay, I'll connect us."
Deb Zacharias is a Home Health Care nurse in north central Minnesota. She routinely travels to patients' homes to check their overall health.
SLUG video conference call. Deb: " Good morning. How are you this morning" Joel: "Fine." Deb: "Good."
But on this day, she is checking-in by way of a video conference call from her office in Wadena, Minnesota … to a patient in his apartment 35 miles south in the small community of Parkers Prairie.
It is a "virtual visit" … where both the nurse and the patient see each other on a television monitor while talking to each other over the telephone.
The video quality and overall telecommunications system may not seem as "high tech" as many of the systems on the market today … but this particular operation is designed to be low cost, and to bring TeleMedicine home health care to rural and underserved urban areas where high-speed data transmission lines are not always available.
With grants and matching funds totaling $1.27 (M) million dollars, The University of Minnesota developed and tested the system. The Project Manager is Jan Marie Lundgren.
Jan Marie Lundgren, University of Minnesota project manager: "The via- TV unit that we're using for video conferencing is designed to work with the patient's own telephone and TV set. So it's a little set top box and works with plain old telephone service called POTSline. This is usually available across the country."
For the past 2 years, the University has conducted a demonstration project with 65 patients in four Minnesota Home Health Care Agencies. Three of the demonstration projects were in rural areas.
SLUG virtual visit call, Deb: "Have you done your oxygen level this morning?" "Can you, do you still have it there Joel so you can put it up to the camera and show me?"
For Joel Swenson in Parkers Prairie, the virtual visits mean more contact with a nurse. He also monitors his oxygen and blood pressure more often and the nurse has the ability to take a still photo of the reading.
In some cases, TeleHomeCare visits have led to early detection and intervention when a patient became ill.
Deb Zacharias, Tri-County Hospital Home Health Care nurse: "We've caught a couple of people who had pneumonia. The have went all weekend not feeling well and were going to wait ‘til late week for the nurse to come out and see them and we did like a virtual visit on like Monday and they weren't feeling well.
You could see they weren't feeling well. Their oxygen level was dropping so we sent the to the doctor and they had pneumonia, which got treated as an outpatient instead of having to be in the hospital which probably three days later would've ended up in the hospital."
Avoiding a costly hospital stay for their patients has earned TeleHomeCare the seal of approval from the home health care nurses in Wadena. But it was a system that did arrive with some doubts, not so much whether virtual visits would be beneficial … but concerns that patients with chronic health problems would be willing or capable of using the equipment placed in their homes.
Caren Winkles, Manager, Tri-County Hospital Home Care/Hospice: "I am so happy with this program and the respect that we've got 80 and 90 year olds who are using the virtual visits and I thought once you got to that age you would not be interested in technology.
I was wrong."
Being "wrong" may just be the "right" answer the University of Minnesota and its major funding source -- the US Department of Commerce … wants to hear, as they determine whether technology can improve the delivery of home health care in rural America.
Jan Marie Lundgen, Univ. of Minnesota "They are most excited to be able to get an evaluation of how well telemedicine works through plain telephone service and then be able to recommend to the government what additional services need to be provided to our rural areas in order to guarantee good health services to all of our citizens." SLUG insert videotape, Deb says: "Today is August 22 and doing a virtual visit with Esther Krause."
The expansion of "good health services" by Tele-communications is already on the minds of those who participated in the demonstration project. Under the guidelines of the demonstration project, only patients with one of three specific diseases could participate. So the Wadena home health/hospice program could have just 10 of its 200 patients equipped for virtual visits.
Now that the demonstration project is ending, the program in Wadena can not only keep the equipment, but plans to buy a yet undetermined number of additional units to expand use of virtual visit to more patients.
Caren Winkles, Director, Tri-County Hospital Home Health Care/Hospice: "We're going to prioritize, we're going to set up a system as to who needs it first of all and who is more seriously ill. We've even thought about taking it into the Hospice patients homes towards that last week or so of their lives so that the nurse can monitor when she's at home."
While Winkles and her nursing staff are enthused about the potential of TeleHomeCare, they say virtual visits will never completely replace nurses traveling to visit patients in their homes … nor do they want technology to take priority over hands-on healing. SLUG virtual visit: Joel: "yep. Thank you, bye."
Deb sync 2:19:38:13 "Well, we do blood draws. We can't do that over the TV. You can't get the hands on, listening to their lungs. There is something about being able to touch your patient that nurses like, too."
"It'll never completely take away the nursing visits because there's things you do on a personal level you can't on TV. But it will help. It will enhance them."
TeleHomeCare visits may enhance the treatment of the patient … and in many cases, allw them to stay in the community in which they live. And by staying in their community … they can remain close to their local health care providers … which in the big picture of rural economics, can help keep local physicians and rural hospitals in business.
For Market To Market, I'm Nancy Crowfoot.