Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org.

Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts. In this entry, we cover what caregivers should know about telemedicine, a growing trend in the medical world. Providing insight is Judith Boyko, MBA, MS, RN, who has served as the CEO of Century Health Systems since it was established in 2001.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007.

Caregiving MetroWest: What is telemedicine?
Boyko: Telemedicine is, according to the American Telemedicine Association, “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.”

Telemedicine is an ideal method of care for patients whose vital signs must be monitored to ensure that if there is a significant change, the patient’s medical team can be informed and provide the appropriate level of care. Telemedicine prevents unnecessary hospital visits, increases patients’ confidence in monitoring their own health and provides patients with peace of mind in knowing that their medical team has current information about their health.

Some use the terms “telemedicine” and “telehealth” interchangeably.

CGMW: How prevalent is the use of telemedicine in MetroWest? In Massachusetts? In the United States?
Boyko: The American Telemedicine Association indicates that there are about 200 “telemedicine networks, with 3,500 service sites in the US. Nearly one million Americans are currently using remote cardiac monitors and in 2011, the Veterans Health Administration delivered over 300,000 remote consultations using telemedicine. Over half of all U.S. hospitals now use some form of telemedicine. Around the world, millions of patients use telemedicine to monitor their vital signs, remain healthy and out of hospitals and emergency rooms. Consumers and physicians download health and wellness applications for use on their cell phones.”

Natick VNA utilizes telemonitors as the standard of care for patients whose diagnoses call for regular monitoring. Conditions that these patients have include hypertension, congestive heart failure, chronic obstructive pulmonary disease, diabetes and more.

CGMW: What types of care can be conducted by telemedicine?

Boyko: Natick VNA patients in the telehealth program have their vital signs monitored regularly and receive education about their conditions so they can remain an active participant in their own health.

However, there are additional services available through the use of telehealth technology.  The Mayo Clinic, on its website, says that telehealth “includes a variety of health care services, including but not limited to online support groups; online health information and self-management tools; email and online communication with health care providers; electronic health records; remote monitoring of vital signs, such as blood pressure, or symptoms; video or online doctor visits.”

CGMW: Who benefits from telemedicine?
Boyko: Telemedicine is multi-faceted and benefits a number of groups: the patient, the caregiver and the medical team. It also benefits our greater healthcare system by reducing healthcare costs.

The patient: As we stated earlier, negative trends in a patient’s vital signs readings will be transmitted to the patient’s healthcare team for analysis and response. Additionally, the patient receives training on how to use the machine, thereby adding a layer of comfort for them in managing their own health. Finally, telehealth eliminates the need for patients (and their caregivers) to make multiple visits to the doctor for vital signs monitoring and visits to the ER in the case of emergency.

The caregiver: Imagine someone with a chronic condition who lives in a rural area. Utilizing telemedicine enables that patient to be monitored in the comfort of their home, and the caregivers do not have to take time off of work or be with the patient in person for a simple reading. A caregiver can have the peace of mind in knowing that a loved one’s health is being monitored – even if the caregiver cannot be there- and will be responded to in real-time should that need arise.

The medical team: Telemedicine makes it easier for a medical team to monitor a patient’s health status, and as a result, keep patients out of the hospital. Additionally, the medical team has a unique opportunity to educate its patients on managing their own health by identifying trends in their vital signs readings. Telehealth also fosters collaboration among members of the medical team who can relay real-time information to each other.

CGMW: Is telemedicine covered by Medicare, MassHealth or most private insurance?

Boyko: Not typically. However, as the value of telehealth is increasingly understood by insurance carriers, strides are being made in coverage. We recommend that patients and their caregivers find out if there is a telehealth program offered by any one of their health care providers, like a home health agency or hospital, for example.

Each state has its own reimbursement policies; visit the American Telemedicine Association’s “State Telemedicine Gaps Analysis” page to learn more.

CGMW: What role can the caregiver play in telemedicine? Can they participate in the call, along with their loved one and the healthcare provider?
Boyko: When telehealth is utilized, caregivers are alleviated of the burden of having to measure and monitor their loved ones’ vital signs on their own. They – and their loved ones – have the benefit of not having to provide transportation to doctor appointments. Many caregivers also bear the financial burden of their loved ones’ medical needs; telehealth reduces costs for certain specialty services the patient may have needed.

CGMW: Why should doctors or other healthcare providers use telemedicine?
Boyko: Healthcare teams provide better care to their patients via telehealth. How? By working with other providers and specialists to review or discuss findings and readings, thereby reacting to any issues before they become larger health events.

CGMW: Why should patients use telemedicine?
Boyko: Patients can take an active role in their health by utilizing telehealth. It reinforces positive behavior and fosters stronger participation in their plan of care.

CGMW: What else should caregivers and their care recipients know about telemedicine?
Boyko: First, depending on the monitor type, there may be additional components necessary for in-home use. Before starting on a telehealth program, patients and caregivers should find out if they will need to make technical accommodations to their home before they are able to utilize a telemonitor. For example, a cell connection, a land line or the internet are three very different ways to transmit the information, and each has its own requirements.

Second, because many insurance providers do not cover telehealth services, a patient’s finances should be considered. Charges can accrue quickly when bringing in medical equipment; supporting the patient if any problems arise; charges for monitoring the data the patient is transmitting; and more.
Telehealth offers myriad benefits to patients, caregivers and the healthcare team. It enables physicians to care for more patients without need for patients to travel to see them. It increases access to medical care for patients who need specialty services and reduces healthcare costs for all of us.

(Judith Boyko can be reached at infonvna@natickvna.org. For additional information, visit www.centuryhealth.org or call (508) 651-1786.)