Telehealth is often touted as a potential cure for much of what ails healthcare today. At Indiana’s Franciscan Visiting Nurse Service (FVNS), a division of Franciscan Alliance, the technology is proving that it really is all that. Since implementing a telehealth program in 2013, FVNS has seen noteworthy improvements in both readmission rates and efficiency.
I recently sat down with Fred Cantor, Manager of Telehealth and Patient Health Coaching at Franciscan, to talk about challenges and opportunities. A former paramedic, emergency room nurse and nursing supervisor, Fred transitioned to his current role in 2015. His interest in technology made involvement in the telehealth program a natural fit.
At any one time, Fred’s staff of three critical care-trained monitoring nurses, three installation technicians and one scheduler is providing care for approximately 1,000 patients. Many live in rural areas with no cell coverage – often up to 90 minutes away from FVNS headquarters in Indianapolis.
Patients who choose to participate in the telehealth program receive tablet computers that run Honeywell LifeStream Manager* remote patient monitoring software. In 30-40 minute training sessions, FVNS equipment installers teach patients to measure their own blood pressure, oxygen, weight and pulse rate. The data is automatically transmitted to LifeStream and, from there, flows seamlessly into Franciscan’s Allscripts™* electronic health record (EHR). Using individual diagnoses and data trends recorded during the first three days of program participation, staff set specific limits for each patient’s data. If transmitted data exceeds these pre-set limits, a monitoring nurse contacts the patient and performs a thorough assessment by phone. When further assistance is needed, the nurse may request a home visit by a field clinician or further orders from the patient’s doctor. These interventions can reduce the need for in-person visits requiring long-distance travel.
FVNS’ telehealth program also provides patient education via LifeStream. For example, a chronic heart failure (CHF) patient experiencing swelling in the lower extremities might receive content on diet changes that could be helpful.
Since the program was implemented, overall readmission rates have been well below national averages. In 2014, the CHF readmission rate was 4.4%, compared to a national average of 23%. The COPD rate was 5.47%, compared to a national average of 17.6%, and the CAD/CABG/AMI rate was 2.96%, compared to a national average of 18.3%.
Despite positive feedback, medical staff resistance remains the biggest hurdle to telehealth adoption. Convincing providers and even some field staff that, with proper training, patients can collect reliable data has proven to be a challenge. The telehealth team is making a concerted effort to engage with patients and staff to encourage increased participation.
After evaluating what type of device would best meet the program’s needs, Franciscan decided on powerful, lightweight tablets. The touch screen devices with video capabilities are easily customizable and can facilitate continued program growth and improvement.
In the evolving FVNS telehealth program, Fred Cantor sees a significant growth opportunity. With knowledge gained from providing the service free to their own patients, FVNS could offer a private-pay package version of the program to hospital systems and accountable care organizations (ACOs).
Is telehealth a panacea? No. Should it be a central component of any plan to reduce readmission rates and improve workflow? Just ask the patients and healthcare professionals at Franciscan VNS.
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