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Pilot Project Uses Video, Voice to Deliver Home Care

Editor's Note: The following article is reprinted from the Toronto Star, March 5, 2004, courtesy of Torstar Syndication Services.

Chronic care may just be the start

When John Langworthy gets short of breath, he doesn't worry the way he used to.

Langworthy, 73, has chronic obstructive lung disease. That makes shortness of breath a major concern. But a pilot project that could change the face of home care is giving him almost instant access to a nurse and peace of mind.

"I govern my health now," says Langworthy, who monitors his own oxygen intake.

As part of a $2.3 million, three-year experimental telehomecare program in the East York area of Toronto, Langworthy's home is equipped with a compact two-way voice and video system linked to nurses who provide home care.

If the system fulfils expectations, it could dramatically ease pressure on a seriously overstretched system, saving trips to emergency and allowing home care nurses more flexibility.

Before he got the system, Langworthy had to go to his doctor's office just to have his blood pressure taken. Now he has a blood pressure cuff, stethoscope and pulse oximeter in his home. When he uses them, the information is fed into a computer located with the nursing group. The readings are stored and reviewed regularly.

Online sessions are held once or twice a week.

Depending on how things have been going, Langworthy has a scheduled face-to-face live video consultation with nurse Kristen deSouza of Comcare Health Services. They talk about how he has been doing and go over his vital signs.

At any other time, day or night, if he's feeling short of breath, he can contact a nurse on call by phone. By asking what he was doing and how he was feeling just before the incident, the nurse can assess the seriousness of the situation.

Just knowing he can contact someone "gives us a great feeling of comfort," says Langworthy's wife Joan, who recalls only too vividly the build-up of anxiety before her husband became part of the telehomecare pilot.

"Anxiety makes anyone's oxygen intake even less," says deSouza, who finds the high-tech system allows her much more flexibility in caring for patients.

"It will never replace nurses and the personal visits many people need," she notes. But for many seniors, people with disabilities and those with chronic, manageable conditions, such as diabetes, congestive heart disease or chronic lung obstructions, "it's the way of the future," deSouza predicts.

That's certainly the hope of Centennial College, which developed the equipment Langworthy is using and is leading the East York pilot project. By 2006 the group hopes to have 200 homes with hi-tech health care links that should relieve pressure on seriously overburdened services, reducing trips to emergency and delivering quality care more efficiently.

Major partners on the project include: Comcare, which supplies nursing services; Toronto East General Hospital; the East York community care access centre; Clinidata, which operates Ontario's 24-hour Telehealth phone consultation service; and Montreal's Centre Hospitalier Anna-Laberge, also running a pilot project.

"We hope to demonstrate that it's sustainable and that the ministry of health will support it," says Renee Kenny, Centennial's dean of applied arts and health sciences. The college, already known for its online nursing telepractice post-graduate program, aims to expand E-learning related to health care, she adds.

Telehomecare isn't new. It's up and running in St. John, N.B. And it is a growing phenomenon in the U.S., where American TeleCare says it pioneered the concept a decade ago and the Mayo Clinnic is even testing it to help people with Alzheimer's.

The East York project is focusing on chronic care but it's also got an eye on ways of expanding the concept, says Barb MacFarlane, manager of service operations at the East York Access Centre.

"We hope eventually to use it to help some cancer patients whose immune systems have been repressed," MacFarlane says. "For them, a trip to a clinic in flu season can be dangerous and it's tiring at the best of times.

"And we might be able to use it in the area of mental health, when clients may not want to go to a drop-in clinic."

Telehomecare also could help streamline case management, MacFarlane says, allowing doctors, nurses and pharmacists to access data and communicate via the internet.

"We are expecting cost savings," MacFarlane says.

The high-tech voice, video and monitoring units placed in homes cost about $5,000; the units at health care offices are double that, she notes. But with trips to emergency running at $500 and a day in hospital costing $600 to $1,000, savings should add up.

"Just knowing they can call someone really helps our clients," she says. In homes where the systems have been set up, "we haven't had any after-hours calls or trips to emergency."

For more information, check: www.telehomecare.ca