BayCare HomeCare has expanded its telemonitoring programme by adding an interactive video component and syncing home-based patient monitoring devices such as blood pressure monitors, scales and pulse oximeters to the system.

The focus of the programme is on patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) who are at high risk for readmissions to the hospital. "Patients with these conditions require close observation of their health," said Jeffrey Held, MD, chief medical officer of BayCare's ambulatory services division. "A weight gain of just a few pounds can be an early sign that a CHF patient's disease is getting worse. Our goal is to give patients the opportunity to manage their care independently at their home rather than being readmitted to the hospital."

BayCare HomeCare has been using telehealth since 2005, monitoring a patient's weight, blood pressure, and oxygen saturation and transmitting these vital signs to an office. The difference in the new programme is the added capability of video and the use of a software program to help monitor the data, allowing for virtual home visits or teleconferencing.

St. Joseph's Hospital patients were the first to use the new telemonitoring system, in the pilot programme in September. The service is now available to qualified patients from Winter Haven, Morton Plant, St. Joseph's-North, St. Anthony's, Morton Plant and Morton Plant North Bay hospitals. It is expected to expand to patients cared for at all BayCare hospitals by the end of May.

Each morning, the patient is prompted by the system to take their vital signs and answers several questions about how they are feeling. The information is automatically transmitted to a program. A cardiac critical care nurse at a BayCare HomeCare office then reviews each patient's information. If a patient's vital signs or the symptom screening questions are not within normal guidelines, the nurse can call the patient, to ask additional questions. With video conferencing, the nurse can go one step further and set up a virtual visit to actually see the patient while evaluating their condition.

If the patient's condition warrants a doctor's attention, the nurse can teleconference the doctor, a pharmacist or anyone on the care team who needs to be consulted. The patient's family also can be linked in so that everyone is seeing and discussing the same information at the same time. "With the monitor, we have the ability to improve care and have the family participate even if they are in another state,'' said Dr. Held.

Telemonitoring is considered a supplement to care and does not replace home visits. Patients continue to receive home visits by a nurse which are interspersed with virtual visits to help monitor their progress.

Patients are initially evaluated to determine their level of interest and ability to use the telemedicine device. When the nurse first meets with the patient, the patient is assessed to determine their acceptance/capability with the technology. A dedicated installer will go out to the home to set up the system and help the patient with the first virtual visit. On the following day, the RN will visit the patient in person have the patient participate in the second virtual visit with the telestation nurse. If the tablet isn't the best option for the patient, the non-interactive equipment can still be used.