Presbyterian implemented Home Healthcare Telemedicine in 2001, starting with 9 video patient units and 1 nurse station. At the end of 2007, the Home Healthcare Telemedicine program was serving 81 patients through 39 video units, 33 non-video monitoring units and 9 combination units. The growth of the Home Healthcare Telemedicine model at Presbyterian has been supported by foundation grants due to their ability to prove cost savings. However, due to competition for funding, their growth has been limited to adding 10 to 20 new units per year.

Presbyterian estimates that it takes approximately four to six months to get a telehealth program up and running.

Presbyterian looks for nurses with the following background and skills.

• Home care experience
• Disease management experience
• Excellent computer skills
• Nurses who embrace technology
• Efficient work style to meet productivity standards

New staff are mentored by current clinicians; they first observe visits and then conduct joint visits with their preceptor to ensure support and correct procedure for telehealth equipment. New nurses also get oriented to the telehealth principles and goals as well as which types of patients are appropriate for telehealth. Finally, the nursing staff are oriented to the telehealth technician positions so that they understand the equipment and installation issues, which is important in the event that the nurse needs to install equipment.

Home Healthcare Telemedicine staff have completed demonstrations and in-services to discharge planners, physician offices and physicians providing an overview of the program, the benefits of using telehealth, and which patients are appropriate for referral. Telehealth is also incorporated into physician orientation.

All homecare patients are screened and referred for telehealth based on diagnosis. If a patient does not meet diagnosis criteria but the clinician feels they would benefit from its use, the patient is placed on telehealth.

In the last two years, the Home Healthcare Telemedicine has been replicated in four regional Presbyterian hospital home care entities in New Mexico.

In 2008, Presbyterian will implement non-video telehealth for statewide disease management of appropriate Presbyterian Health Plan members with CHF, COPD, and diabetes. One nurse in Albuquerque can work monitor between 150 and 200 patients throughout the state using non-video telehealth technology.

In addition, in 2008, Presbyterian will implement a pilot of the Hospital at Home model, that will include the use of telehealth for monitoring patients treated at home as an alternative to hospital admission.

The growth of the Home Healthcare Telemedicine model has been supported by foundation grants, due to Presbyterian’s ability to prove cost savings.

Presbyterian is currently on the Board of the New Mexico Telehealth Association, which has received a federal grant to expand the infrastructure to support broadband in New Mexico. Currently, telehealth data is transmitted over telephone lines.

In addition, Presbyterian is working to achieve recognition by Medicare and other payers of the cost savings benefit of the Telemedicine model in order to obtain reimbursement for telehealth services.

To date, Presbyterian’s use of the model has been limited by the amount of equipment they have, not the amount of patients who might benefit from the model. The Home Healthcare Telemedicine model could be applied to many chronic diseases; in addition to CHF and COPD, patients with diabetes, children with asthma, all cardiac conditions, chronic non-healing wounds and hospice patients could benefit from the model.