VA Tele-Nurse Reaches Out and Touches Someone

Telemedicine has arrived at the Tampa, Fla., VA Medical Center, and members of the Home Based Primary Care (HBPC) team are finding the new technology a valuable tool for monitoring patients with chronic medical conditions who live in outlying areas.

"This has tremendous potential for giving patients that live a distance from the medical center better access to our care," said Ofelia Granadillo, a board-certified social worker and program director of the HBPC team. "The increased access to care providers improves communication and increases the patient’s feelings of security."

How TeleHomeCare Works

The new system relies on a TeleHomeCare computer monitor installed in each patient’s home. With the monitor, a VA "tele-nurse" makes weekly telephone calls from the HBPC office to the patient’s home. When the phone rings, the patient answers by pushing a green button on the home monitor. Voice communications are established through a speakerphone, and after about 30 seconds, a video display allows both the tele-nurse and the patient to see each other. That’s when the examination begins.

Pushing the orange button on the monitor activates a diagnostic-quality electronic stethoscope, allowing the tele-nurse to listen to the patient’s heart, lung and bowel sounds. Pushing the blue button activates a blood pressure cuff, allowing the patient to check his or her blood pressure and pulse, and report the findings to the tele-nurse. A system is currently being tested that would allow tele-nurses to upload a patient’s vital signs directly into VA’s computerized patient record system.

The TeleHomeCare Program is reinforced with a comprehensive patient education program that emphasizes self-management of chronic illnesses. Patients learn about topics such as medication management, understanding the disease process, home safety, nutrition, and health promotion. In addition, a tele-social worker addresses such topics as end-of-life planning and emotional health. Patients are also asked to keep a daily diary of their symptoms, weight and vital signs. The diary includes standard yes-or-no questions specific to the patient’s illness.

TeleHomeCare Reduces Hospitalization

According to Dr. June Leland, medical director of the HBPC team, the program has yielded some surprising results – patients are spending less time in the hospital. Consider the case of 73-year-old veteran Norman Adams. Diagnosed with several medical conditions, including congestive heart failure (CHF), he was hospitalized seven times for a total of 29 hospital days during the year prior to joining the TeleHomeCare Program. Since enrolling in July 1999, he has yet to be admitted to the hospital. "This is one of the most wonderful things that has happened to me," said Adams from his Florida home, smiling as he looked through the video monitor during a live demonstration of the telemedicine technology in at VA Headquarters in Washington, D.C.

Adams is not alone. The 17 patients currently participating in the program required a combined 288 hospital days during the 12-month period prior to joining the program. Based on current trends, the HBPC team projects a 57 percent decrease in cumulative hospital days for the 12-month period following their admission into the program, from 288 to 164 hospital days.

"TeleHomeCare is complementing our entire HBPC program," said Dr. Leland. "Through reduced hospital patient days, this program is saving valuable federal funds, while increasing patient satisfaction."

To participate in the program, patients must have a diagnosis of CHF and/or chronic obstructive pulmonary disease (COPD), live more than 30 miles from the medical center and have had at least two admissions to the hospital for CHF and/or COPD, or two or more visits to the emergency room in the past year.

For More Information

For information on VA’s telemedicine program, call John Peters in VA Headquarters Tele-medicine Strategic Healthcare Group at 202-273-8508.

About the Author

Chris Scheer is in the Public Affairs Office at the Department of Veterans Affairs in Washington, DC. You may reach him at chris.scheer@mail.va.gov.

October 23, 2000