Page 8 CaseStudiesinTelehealthAdoptionCenturaHealthatHomeHomeTelehealthastheStandardofCare

8 the commonweAlth Fund

key elements for the installers in teaching patients and increasing the volume of patients served through the
families. integrated telehealth program, CHAH made a decision
Traditional clinical call center nurses to change vendors to support more cost-effective scal-
require additional disease management education. ing of the program while meeting the broader patient
Clinical call center nurses also underwent specific dis- population’s needs. In particular, the new platform
ease management education that improved their prob- offers the ability to only monitor those patients who
lem-solving and critical-thinking skills while fostering fall outside established parameters, thereby placing
confidence. Among the challenges encountered, clini- the emphasis on those patients needing immediate
cal call center nurses who were previously accustomed attention.
to directing patients with symptoms to emergency Establish physician PRN orders for tele-
rooms required training on the new paradigm, which health patients to maximize efficiency. Monitoring
emphasizes chronic disease management at home. nurses are able to react to trending and monitoring data
Streamline the discharge planning process more quickly by utilizing physician PRN orders. To
to incorporate enrollment into the telehealth pro- operate on a larger scale, physicians should establish
gram. Centura’s experience indicates that attention to the orders when patients are initially enrolled into the
coordinating home care services is a key factor to pro- program.
gram success. As part of the program, the home service Provide real-time education to patients to
coordination discharge planning process was restruc- increase patient self-management. The monitoring
tured in the hospital. Case managers were trained to nurses can connect with patients in real time, helping
identify patient eligibility and enrollment criteria for patients understand the relationship between cause
patients discharged without home care. Before dis- and effect of lifestyle-related behaviors. For example,
charge, patients are introduced to the telehealth inter- if nurses observe data such as missed medications or
vention in the hospital. Within 48 hours of discharge, meals high in salt, they have the opportunity to educate
a personalized telehealth algorithm is created and tele- the patient and make the correlation between actions
health technicians install devices and train patients on and outcome.
how to use them. This streamlined process encourages
patient and caregiver engagement as they begin to fol- DISCUSSION
low their treatment plan at home. The current program was designed to demonstrate
Patient telehealth program enrollment is the impact of a telehealth-based program on 30-day
most effective when introduced by a trusted clini- readmissions, particularly in light of looming policy
cian. Patients were most likely to enroll in the tele- changes that will penalize hospitals for what are
health program when they were introduced to the deemed to be excessive rates of avoidable readmis-
program during the hospital stay by a home care nurse sions for congestive heart failure and other conditions.
or physician or by a primary care physician after dis- The project demonstrated that the use of remote patient
charge. Once patients were enrolled, repeat visits from monitoring technologies combined with a 24/7 tele-
the telehealth device installer were required to train health clinical call center benefited older adults’ health
elderly adults on using the technology. while making more effective use of existing health care
Select a technology that will work in the resources and extending the reach of nursing staff. The
long term. The original program design involved use results support the sustainability of the intervention,
of either two-way video technology, to meet the needs with plans to extend the telehealth component within
of patients’ with a very high acuity level, or remote CHAH and to senior living communities to reach 1,000
patient monitoring technology, to more routinely moni- adults by 2012 and 2,000 patients by 2013. At the state
tor patients with chronic conditions. As a result of level, CHAH used the emerging evidence base in its