Benefits of Using Home Telemedicine To Manage Congestive Heart Failure
Presenter: Nina Schneider BSN, RN

OBJECTIVES

1. Demonstrate the benefits home telehealth offers for management of Congestive Heart Failure (CHF).
2. Substantiate how a CHF telehealth program can dramatically improve patient outcomes and decrease skilled nursing visits, without sacrificing quality care.
3. Display data and results of unplanned CHF hospitalizations prior to and following implementation of a home telehealth program.
4. Describe cost savings per episode for cardiomyopathy patients, using data and results of decreased need for skilled nursing visits.

Since Medicare initiated the Prospective Pay System (PPS) in 2000, our Home Care agency has had to seek creative ways of improving patient outcomes while decreasing the number of skilled home nursing visits-all without compromising the same level of quality care. Home telemonitoring has enabled us to accomplish this goal and to succeed despite a strained financial and scarce nursing market.

This presentation focuses on Congestive Heart Failure (CHF) which remains the primary reason for re-hospitalization and loss of revenue for both Home Care and our healthcare system. The data provided represents the outcomes measured by our Home Care Cardiac Management Team over the past 3 years since incorporating telemonitoring into our CHF disease management program.

CHF Telehealth Alexian Brothers Home Health
Presenter: Daya LaCavera RN BSN

CHF Program started July 2003. Goal: Decrease recidivism, ER visits, improve medication compliance, decrease home visits and improve patient satisfaction. CHF patients divided into telehealth and control 6-month data: Home health LOS 101 days vs. 62 showing tele patients were able to be kept at home longer avoiding readmissions to hospital. Tele showed improvement of 34% in oral medication management as well as 5% rise in stability in oral management. Medication interventions made 22% more in tele group; interventions made quickly. 68% less nursing visits in tele saving agency time and cost. 83% less admissions to hospital in the telehealth group.

Home Health Technologies for Congestive Heart Failure Patients
Presenter: Betty Levine MS

Almost 5 million Americans currently live with Congestive Heart Failure (CHF) and 550,000 new cases are diagnosed annually. As part of a CMS-funded demonstration project, Georgetown University initiated MindmyHeartTM, a comprehensive care management program designed to improve clinical outcomes, quality of life, and satisfaction with care for CHF patients, while reducing hospital utilization.

Patients are recruited through referring physicians, discharge planners at local hospitals, and patient self-referral. Those randomized into the treatment group receive a HomMedTM Sentry Monitor to use at home. Patients take their blood pressure, weight, and pulse oximetry measures daily along with answering two short questions regarding their health compared to a normal day via the Sentry. The results from these sessions are immediately transferred (via a wireless two-way paging network or through standard telephone lines) to a central monitoring station where their care manager reviews the data for alerts.

Care managers also use a secure online assessment tool to perform regular assessments on patients to determine functional, cognitive, social, and behavioral levels and assign interventions as necessary.

As of July 2004, 199 patients are enrolled in MindmyHeartTM. Preliminary results are not yet available, however, care managers have intervened with problems as they review vital signs daily and perform their assessments.

In-Home Monitoring Improves Outcomes for Elderly Veterans with Heart Failure
Presenter: Sheri Kline GNP, APRN, BC

The Veterans Health System is congested, making heart failure (HF) management by primary care providers a challenge.

Methods: We designed an outpatient care coordination program to augment care for veterans with systolic HF. Elements of the program included daily patient monitoring, as-needed phone calls by a HF nurse specialist and multidisciplinary meetings. Goals were to reduce inappropriate utilization of resources, increase access to health care and improve adherence to HF guidelines. 100 patients were followed for the first year. Average age was 67, mean New York Heart Association class was 2.9 and average Left Ventricular Ejection Fraction was 22%. Most (83%) patients had 3 or more co-morbidities. Results were collected locally and by the office of care coordination: Hospital admissions were reduced by 66%, bed days of care by 71%, emergency visits by 40%. There was significant improvement in weight from 202 to 197, BP 131/73 to 119/67, pulse 76 to 70, and shortness of breath rate from 4.2 to 2.9. Medication doses improved such as metoprolol increased from 60mg to 110mg a day. Conclusion: Telehealth surveillance, intensive care coordination and aggressive guideline-based management of HF reduce hospitalization rates; improve outcomes, and increases access in elderly veterans.

Remote Telemonitoring CHF Disease Management Protocol Cost-Benefit and Quality Outcomes
Presenter: Kathryn Votava PhD, RN

Purpose: examine the cost benefit and quality outcomes for high cost Congestive Heart Failure Disease Management patients pre-post intervention using an in-home remote telemonitoring application. Intervention: In-home vital sign measuresment and symptom observation protocol for patients and caregivers with immediate feedback to consumers. Remote data is transmitted to a central nurses station for clinical review and action as indicated. Consumers maintain on-going communication with the nurse and focus on achieving in-home CHF diesease management. Vital sign and clinical data is trended and relayed to other health care providers as needed. Design: pre-post intervention cost benefit and quality outcome analysis with subjects serving as their own controls. Inclusion Criteria: CHF Disease Management Patients with high medical expenses, i.e., physician visits, E.R. visits, and hospitalization, in the six months prior to intervention. N=33. Results: Data demonstrates statistically significant decreases in high cost health care services and overall health care expenditures. Quality outcomes as measures by ER and hospitalization rates improved significantly. Implications: Remote telemonitoring applications for high cost Congestive Heart Failure Disease Management patients are effective in reducing health care expenditures and improving patients outcomes. Remote telemonitoring models of care need to be incorporating into routine disease management programs

Mobile Telerehabilitation Evaluation (MTE II) Increasing Access to Rehabilitative Services
Presenter: Jacob Burk BS

The Mobile Telerehabilitation Evaluation II (MTE II) can be a cost-effective and reliable instrument for clinicians providing rehabilitative services to individuals whose homes, schools, or workplaces are located in rural and medically under-served areas.

The MTE II is a set of integrated technologies that allows rehabilitation professionals to remotely evaluate a person's home, school or workplace. The MTE II uses computing technologies to connect staff performing the evaluation at a distant site to specialists at rehabilitation and assistive technology center. The MTE II is a telemedicine solution composed solely of off-the-shelf technologies. All communication between the two sites is transmitted using the plain-old telephone system (POTS), which is available in most locations. Currently the MTE II is being used by eight different State Operated Comprehensive Rehabilitation Centers. Preliminary results show the MTE II to be cost-effective and reliable; evaluations utilizing the MTE saved 63.4% of staff costs, resulting in a savings of $12,100 in two and one half years and reduced the number of staff required to travel for the evaluation from 2.67 to 1.67 clinicians.

The MTE II is an effective means for archiving evaluations, improving therapist and client satisfaction with telecommunications technology, and increasing therapist and client communication.

Innovative Advanced Illness/Palliative Care Project
Presenter: Jeannie Keene MSN, ARNP

In the Florida-Puerto Rico Network of the Veterans Health Administration, approximately 25% are 75 years old or older. These veterans access healthcare two to three times more often than other age groups. The likelihood of chronic, debilitating conditions or cancer diagnoses is substantial. Approximately 50% of Americans age 65 years and older die in hospitals, and another 20-25% die in nursing homes. While more than 70% would prefer to die at home, only about 25% do so. Moreover, roughly 25% of the 2.3 million patients who die yearly receive hospice care. The Advanced Illness/Palliative Care Project's goal is to implement care coordination combined with audio-video and messaging devices to facilitate a multidisciplinary approach to home-based palliative care for the patient with advanced illness. Care coordinators collaborate with the primary and specialty care providers to provide immediate access for symptom and pain control, psychosocial and spiritual support, and in-home hospice or inpatient palliative/hospice care referrals when indicated. The team consists of a Nurse Practitioner, Chaplain, Social Worker, and program assistant. Since its implementation in May 2004 the project has served 40 patients.

Extending the Hospital into the Home
Presenter: Krisan Palmer RN

A unique home telehealth monitoring project has been successfully transitioned and sustained into an effective acute care management program for post-op cardiac surgery patients. The objective of this presentation will be to demonstrate how to successfully incorporate remote monitoring into a disease management program. Discussion will begin with the identification of the clinical issue to be addressed and take the attendee through the rigorous process mapping required to implement and evaluate the telehealth initiative. Based in a Canadian tertiary cardiac care hospital, the program currently spans three provinces. Clinicians have virtually visited over 2000 patients in their homes. This has enabled them to facilitate both appropriate, and timely clinical interventions when necessary so as to prevent the onset of emergent symptoms. Early intervention by way of increased clinician accessibility has positively affected the quality and timeliness of care offered this patient population and their families.
Though this particular example deals with an acute versus chronic patient population, the processes and solution to be presented are both applicable and scaleable to chronic disease management programs.

Boston Breathes: A Patient Education and Physician Communication Web Interface for Kids with Asthma
Presenter: John Wiecha MD, MPH

Teamwork among health care providers is an essential component of the care of patients with chronic disease. To date, remote patient communication and monitoring systems have not taken adequate advantage of the capability of electronic technology to promote interaction, communication, and coordination among clinicians caring for patients with chronic illness.

We have adapted a web-based asthma education and monitoring system, designed and currently in regular clinical use in Germany, to also support interaction and coordination of care between a patient's primary care physician (PCP), asthma specialist, school nurse, and asthma nurse specialist.

In a randomized clinical trial, we are enrolling children from inner-city Boston with persistent asthma into one of three groups: either usual care (no intervention), or use of the asthma website with communication with their PCP; or a full team group consisting of the patient plus PCP, plus asthma specialist and asthma and school nurses.

This design will allow us to isolate the impact of clinical teamwork supported virtually via interactions using asynchronous discussion supported by the website.

The presentation will review the data demonstrating effectiveness of the web system in use in Germany, and the preliminary results from our RCT here in Boston.

Wired and Wireless, POTS to Broadband
Presenter: Peter Haigh FHIMSS

The rate of change and of improvement in telecommunications technology is faster now than at any time. Its hard for full-time professionals to keep up, much harder for those whose professional skills are in healthcare. Peter will take on the challenge of explaining today's wide range of choices. He will then "crystal ball" future developments. Both wired and wireless technologies and services will be included. The general thesis is that no single technology/service is universally superior, so that most networks will include more than one, which makes the selection even more difficult. Attendees can expect to leave this session better able to make the best choice for their situation.

Consumer Acceptance: Incorporating Remote Monitoring/Home Telehealth into Disease Management Programs
Presenter: Eric Lichtenstein

OBJECTIVE: To examine the state of remote patient monitoring and look at its adoption and integration, as well as the latest technologies.

SYNOPSIS: Remote patient monitoring is growing in popularity as an essential part of an effective disease management program. As the technology becomes easier to use, patients and doctors are beginning to integrate these applications into existing programs. However, the transition has been slowed by the misconceptions associated with telemedicine. Many healthcare providers believe the technology to be complex and difficult to use, and some patients see it as an impersonal approach to the practice of medicine. Despite this, providers are beginning to integrate these applications into disease management programs as the technology becomes more reliable and easier to use.

This presentation will explore and answer the following questions:
- What technologies are available today?
- How can they be utilized and integrated into disease management programs?
- Are these devices/applications accurate?
- Are they easy to use (in terms of installation, operation and recovery)?
- What does the future hold for remote patient monitoring?

The Intergration of Disease Management and POCT
Presenter: Holly Russo RN, MS

Aim: Discuss the value of integrating POCT in disease management programs (diabetes and cardiac).
-Discuss factors to consider when thinking about implementing a disease management program/POCT.
-Provide partcipant with an outline of off the shelf disease management programs available (free and at a cost)
-Provide information on current POCT products available (blood glucose testing,and others).
-Provide participant with information on software available to gather data from devices, facilitate self care, and aid clinicans in managing care and costs.
-Discuss findings in implementing programs and managing data.

Integrating Home Telehealth into Disease Managment Programs
Presenter: Bonnie Britton MSN,RN,C

Historically, Home Telehealth programs have been implemented within Home Health Agencies with patients in their homes resulting in quality patient outcomes and lowered health care costs. As a result, in-patient and out-patient disease managment and case management programs are embracing Home Telehealth technologies to provide quality patient care, lower costs, and increase nurse productivity. This presentation will discuss ways Disease Management and Case Managment Programs are implementing Home Telehealth programs with patients in their homes, assisted living facilities and work environments. The use of Interactive Home Telehealth and Telemonitoring will be highlighted. In addition, outcomes from disease managment programs will be discussed.

Improving Clinical Outcomes Using Home Telehealth Technology
Presenter: Karen Utterback RN, MSN, CNA, CHCE

As occurrences of chronic illness become more common--132 million Americans suffer from chronic illness and the number is growing--care providers must find a way to target care and help patients improve their health maintenance and knowledge to create more positive outcomes. Telehealth is uniquely positioned to help care providers achieve these goals. A telehealth system that consists of bi-directional disease management programs can significantly impact patient health. In this session, attendees will learn about telehealth technology and its role in promoting care coordination, disease management in patient health maintenance, and improved patient outcomes.

Learning objectives:
Discuss applications for home telehealth
Identify ways to target and improve care using telehealth technology
Discuss the impact of disease management on patient outcomes illustrated by a disease management case study conducted by Mercy Health Center.

Rural Telehealth and Chronic Disease Management by a Home Health Care Agency
Presenter: Mia Millefoglie MSW, MPA

HomeHealth--Visiting Nurses of Southern Maine was the first health care organization to introduce Telehealth to Southern Maine, focusing first on patients with a primary or secondary diagnosis of congestive heart failure and then expanding to other chronic disease patients and wound care. Although based on a small sample, a pilot study showed a reduction in hospital admissions of 88.2% for congestive heart failure and 74.5% for admissions due to non-related diagnoses. Results for a larger patient population will be available by September 2004.

In addition to hospital admissions and readmissions, HomeHealth--Visiting Nurses has also monitored quality outcomes for telehealth patients in contrast to traditional home health patients. The agency has experience working with clinicians and referral sources to promote acceptance of this innovative technology. Telehealth is now incorporated into the care plans of the majority of chronic disease patients. HomeHealth's protocols for cardiac and COPD patient management have been adopted by other organizations. Survey results indicate that at-risk, rural patients are particularly pleased with increased clinician contact. Depending on available funding, HomeHealth will be expanding Telehealth use throughout its service area and to coordinate with Maine Medical Center's systemwide chronic heart failure management program in the fall of 2004.

Creating Successful Health Screening Programs: What Is In It for Your Organization?
Presenter: Holly Russo RN, MS

Aim: Educate particpants in elements of successful health screenings programs in the community.
-Who are requesting health screening and why
-Avail particpants on the USPTF guidelines and other relevant guidelines.
-Discuss elements that should be in consent forms.
-Discuss budgetary considerations.
-Equipment selection
-Brochures and health education information
-Follow up when there are abnormal findings

A Successful School-based Asthma Telehealth Program
Presenter: Rhonda Chetney MS, RN

The ability to incorporate Telehealth into existing disease management programs is essential to the future success of home care. Creative programs to attract children who have asthma to participate in their care can be accomplished by the use of Telehealth technology. Sentara Home Care Services has utilized a successful school-based telehealth program that combines creativity with effective disease management. The TeleCoach®, is a telehealth unit dressed as an athletic coach that is used by an asthma specialist nurse to visit children at school to assess, educate and encourage them in their struggle with asthma. The TeleCoach® resides in the office of the school nurse and children have regularly scheduled appointments with the home care nurse through the two-way video monitor. Over the past two consecutive school years, the TeleCoach® program has dramatically reduced missed school days by 61%, reduced ER visits by 70% and reduced hospital readmissions by 86% in a group of 19 middle school children. The speaker will present information on getting started with your own program, unique aspects of collaborating with school administration, and how to succeed using technology to reach a school age population of children with asthma.

The Virtual Hospital: Treating Acute Infections at Home with Telemedicine
Presenter: Lawrence Eron MD

We have utilized telemedicine to monitor, in the home setting, acutely ill patients with infections who would otherwise have been hospitalized. 50 patients with infections, multiple comorbidities, and low Karnofsky performance status, were entered into a case control trial, in which 25 telemedicine patients were compared to 25 closely matched hospitalized patients. Each group consisted of 16 patients with community-acquired pneumonia, 6 with cellulitis, 2 with pyelonephritis, and one with endocarditis. Clinical outcomes were equivalent between the two groups, although one patient in the hospitalized group had to be rehospitalized and another patient developed a nosocomial infection. Telemedicine patients returned to their normal activities of daily living in 9 days, compared to 22 days for hospitalized patients. Overall the use of telemedicine saved 150 hospital days. The use of telemedicine to treat patients with moderately severe infections resulted in a more rapid convalescence while averting extra days of hospitalization.

Improving the Outcome of Emergent Care for CHF Patients
Presenter: Barbara Costa RN, MSN

The Visiting Nurse Services of Newport & Bristol Counties (VNS) began an OBQI project in January of 2003. The target outcome was Emergent Care. Baseline outcomes data indicated that the incidents of emergent care at the VNS was 23.3% compared to a national average of 20.7% from July, 2002 through June, 2003. Analysis of agency data indicated that CHF patients were the most likely to receive emergent care. Therefore, the focus of the OBQI project was CHF patients. The goal was to improve the management of CHF patients and decrease emergent care episodes. The key components of the project were the establishment of a Cardiac Care Team and daily telemonitoring of all CHF patients. Other interventions included development and implementation of a patient teaching guide, clinical path, cardiac care protocols, documentation forms, and policies related to the team's functions. By June, 2003, staff training was completed, and the patient teaching guide and clinical path were implemented. By September, 2003, the Cardiac Care Team was meeting weekly to discuss patients. Outcomes data for 1/03 - 2/04 showed emergent care incidents at 14.0% for the VNS compared to a national average of 20.9%.

Care Coordination/Home-Telehealth Diabetes Care: Daily versus Weekly Monitoring
Presenter: Neale Chumbler PhD

We examined the utilization of health care services and clinical outcomes in 267 veterans with diabetes enrolled in two Veterans Health Administration (VHA) care coordination/home-telehealth programs. Over the one year study period, the veterans with diabetes were either monitored weekly (n=167) or daily (n=100) by a nurse care coordinator. We compared the inpatient and outpatient resource use as well as clinical outcomes between the two groups. We discovered that hospital admission rates, both for all-cause and for diabetes conditions, were 51.9% (p=.003) and 58.0% (p=.002), respectively, lower in the daily monitored group than in the weekly monitored group. Hospital bed-days of care, both for all cause and for diabetes conditions, were 44.0% (p < .0001) and 39.0% (p < .0001), respectively, lower in the daily monitored group than in the weekly monitored group. The unscheduled primary care clinic visits were 48.8% lower (p = .001) in the daily monitored than in the weekly monitored group. We did not find any significant differences in the clinical outcomes between the two groups. In conclusion, we found that veterans with diabetes receiving daily monitoring had fewer hospitalizations, hospital bed-days of care, and unscheduled primary care visits than those receiving weekly monitoring.

Mid-Appalachia Telehealth Diabetes Project
Presenter: Susan Dimmick PhD

Preliminary results of a three-county rural Appalachian diabetes program using store-and-forward technolgy and nurse tele-consults to improve patient self-management and glycemic control will be reported. The goals of the program were to:

1.Recruit 15 diabetics for six months for each county, for a total of 30 diabetics per county per year.
2.Expand diabetes management program to 30 diabetics per six months for each county, for a total of 60 diabetics per county per year.
3.Increase number of diabetics who get two HbA1C readings per year; reduce HbA1C readings to acceptable norms; document self-management goals; increase eye and foot screenings; increase depression screenings; document in the Diabetes Relational Database.

Development of a relational database to track results and use of blood sugar monitoring software also will be used to illustrate how to monitor and make timely interventions in diabetes management at the primary care clinic level.

Using Internet Technology to Treat Diabetes in Pregnancy
Presenter: Betty Levine MS

Abnormal maternal glucose levels occur in about 3-10% of all pregnancies. Better management of maternal glucose levels will produce healthy babies. MyCareTeamTM, a diabetes management program developed at Georgetown University, has been shown to be an effective Internet tool in managing type 1 and type 2 diabetes in adult populations. The educational and presentational components of MyCareTeamTM were modified to support a study focusing on pregnant women with diabetes (gestational and preexisting) followed in a high risk obstetrical clinic at the National Naval Medical Center (NNMC) in Bethesda, Maryland. Patient enrollment was scheduled to begin in the summer of 2004.

The goal is to help these women maintain better glycemic control and thus deliver healthy babies. Pregnant women with diabetes seen in this clinic at NNMC are invited to participate. They are given glucose meters, modems that transmit their blood glucose readings to a secured Internet database, and access to the MyCareTeamTM program. They are asked to transmit their blood sugar readings twice a week and to communicate with the study nurse via MyCareTeamTM in between office visits. Infants' birth weights, the number of hypo and hyper-glycemic events, and the frequency of blood sugar testing and transmitting of results will be collected and analyzed. These patients will be followed until they deliver.

Effectiveness Evaluation of Home Telehealth for Older Adults
Presenter: Charlene Quinn RN, PhD

The objective of the presentation is to present current research, operational approaches and outcomes for designing home telehealth interventions for older adults. Specific issues relevant to older patients and effectiveness evaluation studies will be discussed using self-management of diabetes as an example. Patient and health system-level tools and measures will be identified which will assist health care providers to screen, target, and implement home telehealth systems for an older population. Methods for designing effectiveness evaluations of outcomes for clinical indicators and quality of telehealth interventions will be presented. The presentation will provide a framework for evaluation which could be operationalized for chronic diseases specific to a older and disabled populations. Data from a pilot study of multiple sclerosis patients will provide an example of using exploratory data to design effectiveness studies of telehealth programs for young disabled populations.

Expanding Home and Community Care Through Partnerships, IT and Telehealth
Presenter: Peggy Ryan-Dykes RN

VHA is committed to expanding home and community-based care using health informatics, disease management and home telehealth to improve patients' access to care and self-mangement. Three veteran integrated service networks (VISNs) - VA New Engand Healthcare System, VA Capital Healthcare Network and the Northwest Network have partnered to support the VHA's core values of patient safety and patient-centric care and its mission in the use and developement of innovative IT-based improvements using remote monitoring applications for congestive heart failure, diabetes and chronic obstructive pulmonary disease. This was accomplished by designing network-specific toolkits; contracting with DME companies to deploy equipment, providing remote monitoring to State Veterans Home and Assisted Living Facilities; integrating telehealth data into VHA's computerized patient record system (CPRS); using technology that offers disease management surveys, 'advice' messaging to provide positive reinforcement and a 'scheduling' feature to provide an audible reminder to take a medication or perform a measurement; and integrating care coordination/home telehealth into the organization's existing infrastructure. A study conducted at a VA New England facility revealed reduced BDOC (85%), urgent visits (26%), and RN home visits (21%), a statistically significant improvement in HgbA1c values, improved patient and provider satisfaction, and overall reduction in overall healthcare costs.

Leveraging the Cable Network for Home-based HIV Disease Management
Presenter: Charles Winchell MPA

Barriers to advancement of home-based telemedicine include the cost of equipment and connectivity to patients. A limitation of chronic disease management is the failure of detecting early the development of disease complications, sometimes due to systematic delay in patient access to caregivers. These challenges have been partially overcome through lower cost store-and-forward technologies for monitoring, and the utilization of computer-based interfaces for patient education and patient-caregiver communication. Unfortunately, PC-based home telemedicine solutions remain relatively expensive and unstable, have non-intuitive interfaces for patients and are limited in support of real-time video.

We have developed, in conjunction with a cable technology partner (TeleHealth Broadband, LLC), a home telemedicine pilot research project directed at HIV disease management. The multiphase study utilizes a broadly available network infrastructure - cable TV/broadband - and a widely understood user interface - standard television and remote control - to create a new interactive health care service (Healthium). Phases I and II of the study, which consist of testing and maximizing the acceptability and functionality of equipment, technical protocols and user interfaces, represent critical preliminary steps toward evaluating clinical outcomes. The presentation will discuss findings of this preliminary research and outline a strategy for effective delivery of home healthcare using this technology.

A Nursing Model: Sociotechnical Influences on Telehomecare Quality Outcomes
Presenter: Kimberly Shea RN, MS

The purpose of this presentation is to examine a new nursing model for quality outcomes in telehomecare. The proposed model examines the relationship among patients', caregivers' and nurses' needs, technology integration and quality outcomes in telehomecare. Sociotechnical thinking provides a basis for examining the telehomecare process using principles that emphasize both the social needs and the degree of technical integration. Social interdependence among patient, caregiver and nurse that was important in traditional home health services becomes complicated when telehealth technology is integrated. Traditional health care roles change. Telehomecare patients and caregivers rely on the nurse to instruct and administer care effectively from a distance, while nurses rely on patients and caregivers to do "hands on" care. They must work together to comprise a successful clinical care triad. The goal of quality patient home health care remains, yet additional technical interdependence among the triad members creates a need for complex analysis. Compilation processes of analysis will include weighting the integration of technology use for both individual and triad quality outcomes levels. Proposed model quality outcomes will not only reflect the impact of multilevel social needs but will also demonstrate the impact of the degree of integration into home health care.

Home: The New Medical Center
Presenter: Kenneth Harper

New and emerging products: In order to address a growing need of the home health care industry, an increasing number of companies are developing products that enable the physician and home health care nursing staff to monitor patient progress from basic vital signs to 12-lead ECGs. Most of these systems capture patient data on demand then upload it to the health care practitioner. This works well in cases where moderate delays are acceptable in reviewing the data. However, when access to patient data is required on a real-time basis for adequate care, it implies that the data be captured, stored and available for presentation without delay. An additional complexity is encountered when the practitioner needing to review the results is mobile or in a location other than the upload site. This presentation focuses on products that have the ability to acquire vital sign and ECG data in real-time and web-enable that data for viewing via both standard web browsers and mobile devices such as cell phones and PDAs. Challenges discussed include real-time data acquisition from thermometers, sphygmomanometers, pulse oximeters and electrocardiographs, implementing multi-tiered web-based architectures for 99.999% availability and securing patient data traveling across the Internet.

Customer Acceptance of Home Telehealth Technology
Presenter: Nicole Nedd MSN, ARNP

Purpose: To determine older patients acceptance of telehealth technology.

Method: T-CARE is a care coordination program using an in home messaging device to collect daily responses from older patients with diabetes, congestive heart failure, hypertension and chronic obstructive pulmonary disease. A modified version of a survey tool from the University of Maryland was used. Trained interviewers collected data over the telephone from 75 enrollees /caregivers who agreed to participate. Outcome measures were patient perceptions technology and process over one-year.

Results: All respondents easily understood the telemedicine device. Approximately 95% of the respondents felt the device was easily used, and rated it as "good" or "better". 92% perceived that the program helped them stay healthier and feel more secure. 95% stated the program provided education regarding health needs and helped them manage their health needs better. 91 % reported the program helped improve their communication with VA providers. 99 % stated they would recommend the program to others. 95% perceived their health as being better than pre-program enrollment.

Conclusion: Older veterans have a high degree of satisfaction with telehealth technology. It appears to improve perceived health.

Financial Success with Home Telemonitoring and Marketing Strategies That Ensure Home Monitoring Success
Presenter: Liz Powell RN, MN, CRNP

As a home health agency in Western Pennsylvania our home monitoring program has grown dramatically in the past two years and currently over 200 patients are receiving daily vital sign monitoring. Over that same time period we have gone from losing money within our organization to being very profitable. We attribute our success to the implementation of our monitoring program. Utilizing careful selection of monitors, some entrepreneurial strategies, thoughtful and sound clinical design and measurement of results we have shown solid return on investment (ROI) within the Medicare Home Health Care Prospective Payment System. This presentation will present the specifics of how we did this and how we measured our success.

Learning Objectives: At the conclusion of the presentation the attendee will be able to:
1. Identify components to evaluate when computing your ROI in a home health monitoring program.
2. Describe how one home health organization was able to clearly demonstrate the profitability of a fully implemented home monitoring program within the Medicare Prospective Payment System of reimbursement.
3. Identify multiple outcomes that are necessary for the financial success of home telemonitoring.

As a home health and hospice agency in Western Pennsylvania our home monitoring program has grown dramatically over the past two years and currently over 200 patients are being monitored daily. Much of our success and growth can be attributed to our effective, targeted marketing strategies and implementation creating a marketing advantage. Marketing efforts have been directed toward physicians and other referral sources, patients and care givers in the private pay market and our own nursing staff to maximize use of monitors with our home health and hospice patients. Essential marketing considerations include adequate budget, appropriate staffing, professional materials and prioritizing marketing targets. The success of the program is measured by the increase in the number of agency wide referrals, number of physicians with standing orders for monitor use, monitor use overall and by home health branch office as a percentage of average daily patient census.

Learning Objectives:
1. To identify three major targets for telehealth marketing.
2. To discuss components critical in a successful marketing program.
3. To identify ways to quantify the success of marketing efforts within a home health telemonitoring program

Business Planning for Home Telehealth
Presenter: Mark VanderWerf

Success in Home Telehealth is much more than monitoring technology. Successful implementation and the realization of the full benefits depend on effective planning, implementation and measurement. The successful business plan outlines the needs, objectives, methods, measurements and incentives that make it work. This session will include a review of the essential elements of a successful business for tele-home monitoring. It will include: definition of market and need, financial planning and ROI, marketing/sales to key constituencies, technical options and implementation, internal implementation and training, user implementation and training, incentives to drive performance, outcomes and financial result measurement.

Analyzing the Financial Implications of Telehome Care: Does it Hurt?
Presenter: Andrea Battcock RN

Determining the appropriate approach for implementation of telehome care, whether by region or on a much broader scale, requires detailed planning from the perspective of the clinical, operational and technical components. Even with these components carefully researched and detailed, too often programs are implemented without sound business analysis. Telehome care, as with telehealth, has far reaching benefits and provides value in delivering health care services using technology as a tool. That said, administrators require information on the return on investment (ROI) before engaging in the implementation of telehome care activity on a large scale. ROI does not have to be seen as financial savings to a program, but should demonstrate more efficient use of resources to the program or to healthcare delivery in general.

Telehome care should be integrated into service delivery, rather than as a stand-alone program. However, integration requires a review of workflow and operational process, as well as a review of the financial implications. In order to determine the requirements for implementation, the service must be needs driven.

This presentation will focus on the components of analysis required in implementing telehome care service. Emphasis will be placed on the process required for cost benefit analysis and ROI.

The ABC's of Vendor Selection For A Successful Telehealth Program
Presenter: Marie Mann MPS-HSA, BSN, RN

Telehealth is shaping future healthcare systems world-wide and influencing health care outcomes. Rapid developments in telehealth and the explosion of innovation in telecommunications have fostered an evolution in home-based Teleheath systems. The unique nature of Telehealth requires unparalleled collaboration between vendor and client partner. Partnerships are the core of successful Telehealth systems and networks. Collaboration and trust are the key elements required in partnership initiatives where industry, government, medical entities and consumers are involved. Innovative partnerships shape the unique business models that are required as healthcare stakeholders begin to evolve from traditional mandates. Industry and the public sector can enter into innovative, symbiotic and successful alliances to promote the use of Telehealth technology. Non-traditional client-vendor relationships must now become the 'gold-standard' in healthcare.

This presentation details the vendor perspective on successful vendor-client partnering in Telehealth. It will identify key factors for the successful creation and building of a client-vendor relationship, including:
networking
ground rules
vision
mutual goals
technological knowledge-base
program design
organizational acceptance
success stories
ongoing collaboration

This presentation will further discuss why the above elements are critical to industry, government agencies, and healthcare organizations considering Telehealth initiatives. Attendees will leave with insight and tools for vendor selection and development of a successful technology vendor partnering plan.