An Introduction to Telehome Care

Dr. Rod Elford, BPE, MD, CCFP, MSc

Introduction

Home care and community based health services are becoming an increasingly important part of the healthcare service continuum. There are many reasons for this including: patients are leaving hospital sooner and need some additional care at home while they recover, treating patients at home is less expensive than treating them in the hospital, many patients prefer to stay in their homes as long as possible before moving onto a higher level of healthcare service, e.g. nursing home, hospice. It is estimated that there are 1.5 million home care visits every day in the United States. The Canadian numbers are estimated to be 6-8% of the American numbers.

Telehome care is an emerging field that will benefit home care providers and their patients. Telehome care is defined as,

The use of communications and information technology to deliver health services and exchange health information to and from the home (or community) when distance separates the participants.

Telehome care does not replace in person home care visits, but is used primarily to augment current services.

Figure 1. is an example of a telehome care product. This device allows a nurse at one location to see and talk to a patient in their home. It can also be used to capture and transmit other health information e.g. vitals, heart sounds, EKG.

Figure 1. American TeleCare telehome care product

Patient Unit	Central Unit

Types of Telehome care

Telehome care services can be divided into two major areas: 1) electronic housecalls, and, 2) healthcare call centres. Electronic housecalls are similar to in person home care visits, however instead of travelling to the patient’s home, the health professional visits electronically. Electronic house calls are usually clinician initiated, scheduled, and often utilize an interactive video system so that the clinician and patient can see and talk to each other in real time. A number of peripheral devices can be added to the equipment at the patient’s end to facilitate the capture of still images, vitals, cardiac tracings, pulmonary function, or blood chemistry. Healthcare call centres on the other hand, serve a bit of a different purpose. Patients often initiate interaction with a healthcare call centre, usually on an urgent or non-scheduled basis and the primary technology is telemetry. For example, a patient with a arrhythmia that is difficult to capture could wear a small cardiac telemetry device and when they experience the arrhythmia could simply push a button on the device to capture the rhythm. The patient would then plug the device into a telephone line or hold it up to a telephone mouthpiece to transmit the tracing to a central receive site where it would be analyzed by trained health professionals.

Benefits of Telehome care

The benefits for the patient include:

• Improved access to health professional
• Can be seen quicker
• Can be seen more often
• Leave hospital sooner
• Stay home longer before becoming institutionalized
• Increased confidence that they can get care when they need it

The benefits for the health professional include:

• Decreased travel time
• Can see patient quicker
• Can see patient more often

The benefits to the healthcare payer include:

• Decreased reimbursement for clinician travel costs
• Patients can be kept in the community -> less expensive
• Patients do not go to ER as often -> decreased costs
• More efficient use of staff; home care providers "see the patient not the road"
  

Evidence Supporting Telehome care

A few studies have compared telehome care to in person home care visits. A research project initiated by Kaiser Permanente in 1997 found that telehome care allowed home care nurses to "see" more patients in a day, decreased the visit time and ended up costing 33-50% less than the traditional home care visit. See Table 1. for details.

Types of Patients in Successful Programs

Telehome care is not useful for all patients, therefore it is important to select patients properly. For example, telehome care will not benefit a patient that needs a dressing changed. However, it could be used daily to observe a wound site to see how it is healing, or even to simply make sure that a patient takes their medication. Patients in successful programs include:

• "Frequent flyers"; patients who present to the ER more than once a month
• Patients requiring more than 2+ home visits / week
• Chronic conditions (asthma , CHF, COPD, diabetes, HIV, HT, chronic renal failure, stroke)
• Palliative conditions