Home Healthcare Telemedicine relies on placing a nurse in the nontraditional role of managing a patient’s care over a video unit and computer system. Presbyterian continues to staff traditional home health nurses who will also visit telehealth patients in person.
When the telemedicine program receives a referral from a hospital discharging a CHF or COPD patient, a home health nurse will conduct two in-home visits during the patient’s first week at home. The home health nurse also initiates the telehealth program. The telehealth RN does an introductory video encounter with the patient during that first week, and then visits the patient by video on a weekly basis. The home health RN continues on a weekly basis as well, but just one visit per week.
Telemedicine patients are instructed to do daily measurements. The software incorporates disease state-based algorithms and is set up to alert the nurse when a measurement is outside of the norm for a patient as well as if any questions are answered incorrectly or are indicators for concern (For example, if a patient answers no to the question, “Did you take you medications today?” Presbyterian nurses receive a “high alert” signal). Patients are called for all high and medium alerts and if they do not respond daily.
Presbyterian uses three different types of telehealth units: video units, non-video telehealth monitoring units, and a unit that is able to do both video and non-video. The skilled video visits are scheduled by the nurse and occur 1-3 times per week depending on patient need. Both the field nurse and the telehealth nurse instruct the patient on when to contact the office for problems and when to seek emergent care.
The Home Healthcare Telemedicine model relies on placing a computer terminal and a video unit in a patient’s home. With the video unit, the nurse and patient can see and hear each other during the visit. The resolution on the video is super-crisp and allows nurses to examine a wound, for example, in great detail. The device also includes a high-resolution stethoscope, blood pressure monitor, scale, and pulse oximeter. These tools can take patient measurements and transmits vital signs, weight and oxygen saturation measurements to the telehealth Nurse back in the office.
Home Healthcare Telemedicine staffs telemedicine technicians who go into patient’s homes and set up the telehealth system.
Presbyterian also uses non-video telehealth to monitor patients after they have been discharged from home care. In these cases, Presbyterian places all of the technology except the video unit (e.g. high-resolution stethoscope, blood pressure monitor, scale, and pulse oximeter) in a patient’s home. The data from these devices is inputted into Presbyterian’s IT system so that if a patient parameter is abnormal, the RN is alerted and often reinitiates home care in an effort to prevent a hospitalization.