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Telemonitors can provide 'virtual assisted living'

Warren Wolfe, Star Tribune
Published December 1, 2003

WINDOM, MINN. -- In the space of a year, Bob Erickson, 75, had been whisked 11 times to the hospital from his home in Pipestone, Minn., for severe stomach pain or congestive heart failure.

Since June, it's been just once.

The difference: a $5,000 computer-video connection with a home-health nurse 60 miles away in Windom.

Telemedicine that links patients with doctors in remote clinics is not a new concept. But it is a new tool in creating "virtual assisted living" that can help frail people avoid unnecessary hospital or nursing home stays.

The Windom project uses just five telemonitors and 11 video telephones and was begun two years ago with a $120,000 Bush Foundation grant administered by the state. It's one of a handful of such programs in Minnesota.

The program is operated by Good Samaritan Communities of Windom, a campus with a nursing home, senior apartments and home health care. Twice a week, nurse Bobbie Bush comes face to face with Erickson over the telephone line, checks his blood pressure, pulse, weight and blood-oxygen levels and listens to his lungs.

"Overall, I'm not in great shape," Erickson said one morning last week at the conclusion of his video checkup. "But I'd be a wreck without that little screen. Bobbie's kept me in my home and pretty much out of the hospital."

Telemonitors are most often being used with older patients who have chronic diseases that need careful monitoring, and the technology is changing how patients are treated.

For example, sudden weight gain is now a matter of increasing Erickson's diuretic medication rather than making a trip to the hospital.

Each telemonitor unit can be hooked up to equipment that checks blood pressure, blood oxygen and weight as well as to a stethoscope. The equipment is made by American TeleCare of Eden Prairie, which supplies many of the other telemonitor programs in Minnesota and elsewhere.

With periodic video visits that supplement in-home nursing care, officials with several of the experimental programs say telemedicine clearly benefits some patients. And it can help a patient's spouse as well.

"I feel so much safer," said Erickson's wife, Marj, a retired first-grade teacher. "It's awful when Bob tells me at 3 a.m. he's got to get to the hospital. With the monitor, I know they're watching him closely. But I know I can call them up anytime and ask for advice if things don't seem right -- and I have."

Saving money?

Home health agencies using the equipment say that supplementing in-person visits with the virtual ones means they can see their patients more often, giving better care. And they think they're saving some money in the process.

"We know that we're making a difference in the lives and health of some patients, and with people like Bob we know we're saving the health-care system thousands of dollars," said Joyce Doughty, who manages the project in Windom.

"But how much does it help? How much does it save? We just don't know," she said.

That's what a new study by the University of Minnesota will try to answer.

With a $550,000 federal matching grant, the university will set up an experiment involving about 50 people in Minneapolis and Wadena County to measure the effects of telemonitor home health care in the inner city and in rural central Minnesota. About half of the participants will have traditional in-home visits, and half will have those visits plus the two-way video monitors.

"About 85 percent of older people say staying in their own homes as long as possible is very important, and we want to measure how this kind of technology can help," said project leader Stanley Finkelstein, professor of laboratory medicine and pathology at the University Medical School.

"We think that telemedicine technology in the home can provide better care to patients, extend the reach of nurses and, perhaps, save money both for patients and the health-care system," he said.

Thousands of older people around the country are benefiting in their homes from telemedicine experiments funded mostly through grants, said Dr. Eric Tangelos, a Mayo Clinic physician and founding board member of the American Telemedicine Association. Mayo is in the second year of a telemedicine project with Alzheimer's patients.

"We're applying high-tech solutions to a lot of life for people of all ages -- microwaves, cell phones, palm pilots, fetal monitors for newborns, hand-held devices for diabetics to check their blood sugar," he said.

"There is a lot of technology we're beginning to explore to help older people in their homes," he said, "but so far we don't have the widespread 'killer' applications that will really bring down the costs, as we have with cell phones and palm pilots."

The Mayo project uses two-way video with as many as seven Alzheimer's patients to see that they take their medications correctly. That can improve overall health and make it more likely that they can function better and longer in their homes.

"Too often people focus on what Alzheimer's patients can't do. We focus on what they can do," he said. "With early stages of Alzheimer's, that's often quite a lot, even when they live alone as some of our patients do."

'You're looking good'

Last week, when Bush phoned Erickson, he punched a button on his monitor and waited a few seconds for the two-way video to click in.

"Good morning, Bob. You're looking good this morning," she said.

That was not just a polite greeting. Two weeks ago, when Erickson talked of feeling "just fine," Bush recognized from his posture and facial features that something was wrong. With polite but pointed questions, she found that he had stomach pains, a symptom that has hospitalized him before. By the end of the day, his pain medication had been changed.

But on this day, Erickson's virtual check-up showed he was doing well -- pulse good, blood pressure excellent, weight steady, lung sounds reasonable.

As she checked his vitals, Bush also received the readings that Erickson had taken daily since their last visit. Every week those signs are charted and forwarded to his primary health-care nurse and to his doctor.

If Erickson continues to do well, the nurses in Windom will consider replacing his telemonitor someday with equipment that doesn't include the camera.

"I don't think that would be a good idea," Erickson said. "I think that face-to-face visit with Bobbie is really important."

Even without solid answers about how effective the telemonitor system is, the Good Samaritan Society will expand the program early next year.

Using a $404,000 matching grant from the U.S. Department of Agriculture's Rural Utilities Service, Good Samaritan will buy 75 additional telemonitors and 100 new $485 video telephones. It will use them in home health agencies operated by four of its 43 Minnesota nursing homes, in St. Peter, Preston and Brainerd, as well as Windom.

"Not everybody takes to the monitors as well as Bob and Marj have," said Doughty, the project manager. "We've had one or two who found it too intimidating. And there have been a couple who tossed a towel over the camera when it wasn't in use, just to make sure it couldn't come on by itself.

"But most people find it really brings them peace of mind, knowing that Bobbie's face is just a phone call away," she said.

"I don't know where all of this technology will go, but it's getting easier to use and is helping us give patients better care," Doughty said. "We're discovering a whole new world."