Hays Medical Center: Your Nurse is as Close as Your Television
Set
Hays, Kansas
The Hays Medical Center in Hays, Kansas, is giving new meaning to the term "outreach."
Hays uses telecommunications tools to give homebound elderly and disabled patients a chance to have daily contact with health-care providers without ever leaving their homes. The result is more than better care at an affordable cost. For some patients, the service has meant being able to stay at home rather than having to move to nursing homes.
Located about half way between Denver and Kansas City, Hays received a $300,000 TIIAP grant in 1995 to link medical centers in Rawlins, Wyandotte, and Ellis Counties, Kansas, and Jackson County, Missouri, with 100 home health patients over two-way, cable-television connections. With this tool, nurses now can "visit" these patients regularly in their homes, monitoring their general health, medication, diabetic condition, blood pressure, diet, hygiene, and mental health.
Electronic Connections Improve Health Care Efficiency
For the medical center, that adds up to a considerable gain in efficiency. A nurse using the system can see twice as many patients as before even during a blizzard, notes Robert Cox, Hays' Medical Director. Patients gain as well: the lower cost and ease of making connections translates into more visits a big advantage for patients who need frequent attention.
Kathy Rupp, a home health nurse at Hays, tells of one diabetic woman who often refused to get out of bed in the morning. Because she failed to take her medicine on the correct schedule, she frequently became ill and had to be admitted to the emergency room. After Rupp began paying her two electronic visits a day including one wake-up call the woman found herself feeling so much better that she became motivated to take better care of herself. Eventually, Rupp was able to cut back to one visit a day.
Rupp also worked with an elderly man fighting depression. He too failed to take his medication on the prescribed schedule, and as a result was often belligerent. When the telemedicine project began, he was about to be evicted from his apartment. But his mood and behavior improved markedly after Rupp began paying him regular telemedicine visits, and he was able to stay at home rather than being admitted to a nursing home.
Cox believes regular electronic visits from nurses also have helped patients with emphysema and other chronic pulmonary problems. For such patients, anxiety can bring on an onset of symptoms or significantly worsen their conditions. Simply knowing that somebody will be checking up on them regularly eases their concerns and substantially improves their physical condition, he says.
Clearer Communication with Patients
Still, how good can care be if delivered over a television set? In some ways, it can be better than care provided in person, Cox and Rupp contend. "You learn to communicate better because you can't see everything," says Rupp. "You learn to ask the patient more and to put your questions in terms you are sure they will understand."
She believes patients also learn to communicate more effectively too. "Some learn to tell me what I should be looking for," says Rupp. She recounts the case of a woman suffering heart trouble who told her during a routine visit that she had a lot of swelling in her legs and ankles and found herself short of breath even when walking a short distance. Rupp immediately arranged for the woman to see a doctor, who promptly prescribed new medication. "Her swelling quickly went down, and she said she had more energy," says Rupp.
Cox is convinced that telemedicine will grow substantially in the future. For example, he says, patients could receive physical, occupational, and speech therapy via telemedicine systems. "I foresee a mushrooming of applications for this technology," he says. Even some skeptics are starting to agree. Once reluctant to back the Hays project, the medical center's own administration has agreed to pick up the cost of continuing the salaries of two nurses, and it has helped pay for some new equipment now that the TIIAP grant has run out.
Moreover, Kansas Blue Cross-Blue Shield and the state of Kansas Medicaid program both have concluded that telemedicine is cost effective. They now cover the long-distance health care services the Medical Center provides. As yet, the Federal Medicare program does not cover telemedicine, although advocates hope it eventually will.
In the meantime, Hays is experimenting with ways to make telemedicine services even more widely available. The current system, which operates over local cable-television networks, was limited to cable providers' service areas. But Hays plans to test the use of regular telephone lines. If successful and preliminary indications are encouraging that will enormously increase the medical center's reach while bringing down the cost of the service.
Robert Cox
Medical Director
(913) 623-5104
Source: U.S. Department of Commerce
National Telecommunications and Information Administration
Office of Telecommunications and Information Applications
Last Modified: 18 Dec 97