Tele-home care.(HOMECARE)

As reimbursement continues to decline and demands for services and costs associated with providing a respiratory therapist in the home continue to escalate, the DME provider is being forced to search for alternatives to the traditional delivery of home respiratory care. The loss of productivity due to the time spent driving from one patient to another is a major cost. One such alternative, which improves patient care, increases productivity and reduces costs, emerging not only in home care but also in medicine in general, is the use of telehealth. Telehealth refers to the use of information and communication technology to deliver health care services, expertise and information over a distance.

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The feasibility for a DME provider to utilize tele-home care has grown in recent years. The cost of the technology has decreased and continues to become more user friendly. Once more, there is little to no start up costs for the majority of these services if the provider can use a PC already owned by their organization.

CPAP, Auto-Titration and Bi-level Airway Pressure systems have an assortment of options to apply tele-home care and have shown tremendous potential over the past few years. Compliance data has gone from a luxury to an essential component of home care sleep program in many parts of the U.S. Higher end systems can also provide hyponea and apnea data as well. Some systems can send the data through the Internet via a modem and provide an email to the clinician if compliance falls below a predetermined level. Changes in settings can also be accomplished over the Internet. One manufacturer is using technology to send data and parameter changes on a data card the size of a credit card. After obtaining compliance data, the card is returned to the home care provider by mail and downloaded by the clinician at the office. With either Internet or data card systems the patient does not have to be tracked down to have a home visit made. This improves productivity because a majority of CPAP patients are working during the day making contact and home visits difficult.

Infant apnea monitoring programs have had the capability to provide tele-home care for several years. The cardiopulmonary monitor can be interfaced with a modem and the necessary downloads can be obtained without any travel. This can be especially beneficial when a caregiver is unsure whether or not an Apparent Life Threatening Event has occurred or not. By being able to obtain this data in a more timely manner than traditionally possible the physician is provided with this data faster and can aid in determining if the infant requires hospitalization or not.

Liquid oxygen systems can be equipped with technology to monitor the amount of product in the patient's home. This information can be electronically transmitted thorough a modem to the DME provider. This allows for more cost-effective delivery systems to be put into place. Instead of routinely filling liquid vessels at a specific interval, such as once a week, a vessel potentially can be filled with longer intervals between fills. This equals fewer visits to the patient's home over the coarse of the year.

This is just the beginning of tele-home care for the respiratory therapist. As America's baby boomers age and life expectancy increases, there will be a significant rise in the number of patients requiring home respiratory care. Tele-health makes good sense because the appropriate use of this technology will improve the quality of care for the patient. Cost savings can add up very quickly with the average home care visit estimated to cost a DME provider fifty dollars (sure to go higher in the future.)

While the use of tele-health has benefits, there are still questions which need to be answered. As privacy, security and confidentiality have become major issues, health care must also be aware of these issues as well and be vigilant of the potential problems which can occur if a program is not set up and managed properly. Confidentiality is the status given to information, which indicates the information is sensitive and must be protected and access, controlled. Security is the safeguards used within the information system to protect the system and its contents from unauthorized disclosure of information. Congress has realized that these are real issues for tele-health and has passed multiple pieces of legislation to aid in ensuring that privacy will be maintained for everyone. The Federal government has regulated that the FTC will be in charge of overseeing privacy protection online. Working with the manufacturer of the equipment and software will aid in insuring that all systems protect the patient's rights and the organization.

As tele-home care moves forward, additional research will be required to evaluate and quantify the effectiveness and efficacy. To date there are some anecdotal and almost no scientific studies documenting the benefits of tele-home care. I was unable to find a scientific data relating directly on how home respiratory care programs have benefited from tele-home care. Further study is needed to determine the impact on quality of care, cost, patient and health care provider satisfaction. The use of tele-home care has only just begun and as technology improves further these and other new applications will become part of the standard of practice for home care. The use of video imaging is already being applied to home care and may be a reality as well in the future. We must remain aware of changes in technology in order to provide the best possible care to the patient in the future.

by James Stegmaier, RRT, RPFT, CCM