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The virtual doctor visit
New technology is helping elderly patients and those with chronic diseases monitor their condition from the comfort of home.

By Elizabeth G. Olson
Kaiser Health News
Tuesday, November 17, 2009

Every morning at 10 a.m. sharp, Juanita Wood, 87, taps "okay" on a screen to start up a device that takes her blood pressure and transmits the information to her medical clinic. At 10:30 a.m., her husband, Arthur, 91, touch-starts his own device, neatly lined up next to hers. The machine calculates his blood pressure and weight and sends them off, along with a blood sugar count that he enters by hand.

The Woods, of Catonsville, Md., are participants in one of several pilot projects that home health-care providers, retirement communities and others are conducting to see if high-tech but simple devices can help doctors closely monitor aging patients at home in a way that will help control problems before they escalate and cut back on the need for costly long-term care and hospital admissions -- especially repeat hospital visits for chronic conditions.

Although proponents of health-care reform tout its potential for improving efficiency, often missing from the national debate are specific examples of how changes in the system might improve patient outcomes and reduce costs. These pilot projects are exploring some easy-to-use technology that might make a difference to patients and doctors.

"This helps us detect harbingers of a bad event for patients," said William Russell, vice president and regional medical director for Baltimore County-based Erickson Retirement Communities, which is running the pilot program in which the Woods are participating. "Early detection systems are important because more often than not, elderly patients do not come out of hospital stays with a better outcome."

Preventing problems

Seniors and others with chronic health problems such as diabetes, congestive heart failure and high blood pressure often wind up in hospital emergency rooms after forgetting to take their medication or when their condition deteriorates at home without anyone noticing. When that deterioration is severe enough, patients can be forced to move out of their homes into assisted living or nursing facilities, a costly and emotionally wrenching transition. The hope is that by closely monitoring patients at home, some of these events can be avoided or managed better.

Medicare spends more than $12 billion a year on "potentially preventable" repeat hospital admissions, according to the Medicare Payment Advisory Commission, an independent agency that advises Congress. And that number, according to the commission, is likely to grow, given that the Census Bureau projects that by 2025 there will be nearly 64 million Americans older than age 65, an increase of more than a third over today's total.

The pilot projects are not designed to have doctors diagnose illnesses remotely or to substitute for hands-on care. Instead, they are intended to allow elderly or infirm patients to get ahead of changes in their chronic conditions that could tip them into a medical emergency.

Juanita Wood, a retired secretary, had some fainting incidents possibly related to blood pressure problems. She hopes that keeping track of her blood pressure and transmitting the readings to her clinic in real time will help her avoid future episodes.

So every morning she straps on a blood pressure cuff attached to her monitoring machine, presses a button to start it up and waits for the cuff to inflate. Her pressure is recorded and then transmitted to the clinic at Erickson's Charlestown community, where the Woods live.

Arthur Wood, a retired architect, takes his blood pressure and weighs himself. Because he is a diabetic, he also is learning how to register his blood sugar levels, using a separate finger-prick device and then manually entering those numbers into his touch-screen unit. The Woods send in their info every morning, and employees at their clinic monitor the readings and alert them if something seems amiss, hopefully before anything major goes wrong.

The monitors that the Woods use are only one of the devices being tested in the pilot programs. Others are simple scales, to monitor sudden weight gain, which is a warning sign for those with congestive heart failure. There are also motion sensors placed under a bed, to make sure a person has gotten up in the morning, and wall sensors that can tell whether a person is moving around the house normally.

The Woods' devices feature a smallish computer screen that comes awake when a patient taps it, displaying his or her personal information. The device is set to blink with a blue light at the same time every morning to prompt patients to do their monitoring. There's no log-in or complex system for the device, and each machine is programmed to deal with one patient's specific medical issues.

The devices are built by Intel, which has been working to develop technology to bolster home health-care services. Last spring Intel and General Electric Healthcare announced they would jointly commit $250 million to develop wireless products to connect the patient to the physician.

The companies are focusing on such products because of research showing that "more than 80 percent of health-care spending focuses on patients with one or more chronic diseases," according to Louis Burns, vice president and general manager of the Intel Digital Health Group.

A matter of money

Right now, the biggest impediment to high-tech monitoring is that Medicare and private insurers generally do not reimburse for it. And the devices can be expensive. As part of a pilot project, Juanita and Arthur Wood get their devices for free; normally patients would have to pay about $100 a month to rent them.

Also, insurance plans typically do not reimburse doctors for treating patients based on data sent remotely, only for face-to-face care. Some patient advocates also worry that electronically conveyed data might be substituted for direct medical care, which the organizers of the pilot projects say is not the goal.

Instead, they say, the devices will allow doctors to accumulate data on a patient over time; this information can then be used in a face-to-face visit with the patient.

This approach allows the doctor to "spend more time with patients so they are able to plumb the depth of the patient's problem," Russell said.

And if the digitally sent data show that something may be going wrong, medical professionals can step in immediately rather than wait for the patient's next routine appointment. "We set up thresholds, and anything above or below that, then the doctors get notified," explained Kelley Gurley, project manager for the Erickson study. "If the blood sugar is low, the patient would receive a call [from the clinic] that says, 'Please call your doctor,' " she said.

The device itself also is programmed to remind patients, in a friendly computer voice, about their medications and food consumption if a reading falls outside the parameters set by their doctors. In addition, a "Learn More" prompt on the touch-screen is linked to informational videos related to the data he or she has transmitted. If, for example, a blood pressure reading is high, the machine offers the patient the option of watching a short video in which a doctor explains how to bring the pressure down, such as by sitting down and relaxing for 30 minutes.

The device that the Woods use is known as the Intel Health Guide. Other companies, including General Electric, have their own home health monitoring systems. GE QuietCare is a sensor system most often used in assisted living and similar facilities to track patient activity.

Eric Dishman, general manager of Intel's Research and Innovation Group, said these devices perform an increasingly important function: "You just can't crank out enough medical students to solve our personnel shortage in this country. You need to rely on other means, especially technology, to bridge that gap."

At their home one recent morning, Arthur and Juanita Wood were reminded by the flashing lights on their machines to start their monitoring process. The prompts were delivered by a female voice, which Arthur Wood noted was "sweet," but added, jokingly, "But I love it when she says goodbye." Because then it means he's done for the day.

This story was produced through a collaboration between The Post and Kaiser Health News. KHN is a service of the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente. Comments: health-science@washpost.com.

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