VA improves telehealth access

Providing medical care for elderly and chronically ill military veterans can be expensive and hard on patients, but the Department of Veterans Affairs hopes to change that with a computerized, Web-based device the VA helped develop through its own research and development programs.

The Tele Homecare System, manufactured by consumer electronics giant Panasonic, takes routine hospital care into the patient's home, cutting the cost of transportation and the wear and tear on patients who must return to a VA hospital for regular check.ups and monitoring. In turn, the system also reduces the number of times a patient must be uprooted, an often distressing experience. A pilot project using the system is scheduled to wrap this month.

"We need to provide care in the least restrictive setting possible, and we wanted to take the care to the home and build a proactive patient care model," said Donna Vogel, director of case management at the VA Connecticut Healthcare System and manager of the Home Telehealth Project.

A 1997 pilot study used the then top-of-the-line Home-Assisted Nursing Care (HANC) unit, a 600-pound giant that helped a home nurse or patient monitor vital signs and transmit data via a phone line to a central nursing station at a hospital. If clinical data fell outside pre-set limits, or if it showed the patient was not following a prescribed care plan, HANC sent an alert to the nursing station.

The modern version is a tabletop unit weighing less than 17 pounds that provides data about a patient's condition directly to his or her doctor via a secure, Web-based system. The system also helps patients better manage their own care.

"From the pilot [program], we quickly learned that providers are very busy all of the time, and easy access to the data was critical," Vogel said. "For that reason, we needed it to be Web-based so that anyone with secure access to the Internet could get to the data."

The unit has a range of sensors that patients monitor, with an audible alert reminding them when to do so. The sensors use infrared signals or sound waves to take readings, which reduces the errors that commonly occur when patients take their own readings.

It also includes a touch-screen display so that the patient and doctor can read the trend charts generated from the data. Hospital nurses can use the display to send positive feedback or advice to patients about such things as weight or glucose levels and how they can better care for themselves. The unit also has a camera so that a health care provider can visually check a patient's condition.

Not everything went smoothly when the pilot project began in 1997. Security was an obvious issue from the start, and when the medical staff at VA Connecticut connected the system to their intranet, "they didn't realize all the security [measures] that were involved," said William McCasland, VA Connecticut's information security officer.

Officials put the project in a "contingency mode" until all of the concerns were addressed and eventually hired an outside security contractor.

Another factor was the difficulty in integrating the system with VA Connecticut's Healthcare Information System, which gives homebound patients access to medical education facilities. Experience has shown that the more access patients have to education, the better the patient and caregiver are able to manage diseases, Vogel said.

However, she added, although other vendors have demonstrated their products and new technology continues to be evaluated, so far only Panasonic has proven it can integrate its unit with the Healthcare Information System.

Tsutomu Hosomi, director of Panasonic's Telecare Solutions Group, believes his company's size and its experience with such systems will continue to give it an edge, especially its ability to address security concerns as the Tele Homecare System moves into situations in which access is needed via the public Internet.

Robinson is a freelance journalist based in Portland, Ore. He can be reached at hullite@mindspring.com.

"Illinois throws line to small hospitals" [Government E-Business, Sept. 3, 2001]

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Good bedside manner

The Tele Homecare System Patient Terminal, produced by Panasonic, enables doctors to monitor patients in their homes. Its features include:

* Sensors for measuring blood pressure, blood sugar and blood oxygen, plus a thermometer, an electrocardiograph device and a scale.

* Audible alert to remind patients to check vital signs on schedule.

* Digital camera for visual assessment by doctors.

* Secure Web-based access for doctors to examine patient data.

* Touch-screen display for easy operation by patients.