Electronic nurse' helps housebound patients stay out of hospital
13 January 2006
New York, USA. Montefiore Medical Center's Home Health Agency is using a
new hi-tech interactive disease management system, dubbed the "electronic
nurse," to supplement regular nursing visits to the homes of congestive
heart failure (CHF) patients to help monitor their vital signs. Evidence
already shows that increased proactive management of weight changes and
other vital signs can improve patients' quality of life and reduce
An "e-nurse" disease management system is assigned to each congestive
heart failure patient and attached to a regular push-button phone in
their homes. Every day patients use the system to monitor their vital signs
and transmit the data through the phone line to Montefiore, where it is
analyzed by the Home Health nursing staff.
An electronic scale measures changes in weight, a key indicator of
worsening heart failure; a peak flow meter checks lung capacity, an
indicator of worsening asthma or chronic obstructive pulmonary disease
(COPD); a glucometer measures blood sugar levels which are key to managing
diabetes; blood pressure levels are monitored for hypertension and a pulse
oximeter reads oxygen levels in the blood, key information to determine
interventions needed for patients with asthma and COPD.
"If anything is amiss with changes in their weight, blood pressure,
pulmonary function, blood sugar rate or heart rate, one of our doctors or
nurses contacts the patient and determines any necessary medical
interventions," said Sandra Selikson, MD, medical director of the Home
Health Agency. "We can repeat taking vital signs electronically any time of
the day and monitor disease processes more closely so we can treat problems
early, before they become more serious and require hospitalization."
Each day the interactive system asks the patient a series of self-help
medical questions concerning his or her health in English or Spanish. Other
languages are being added to the system for the future.
"This focuses our patients on a self-care strategy and helps with things
like medication adherence," said Dr. Selikson. "Since they must interact
with the system at least once a day, it makes them more aware of their
health and changes in their conditions. It prompts more interaction with our
medical team which leads to better outcomes whether the condition is
congestive heart failure, diabetes, asthma or hypertension."
"National data shows that using this new hi-tech disease management
system as an important tool in cutting-edge preventive medicine will help
improve patient outcomes," said Terry Goodwin, vice president of
Montefiore's Home Health Agency. "In one study, visits by CHF patients to
emergency rooms decreased by 61.7 % and readmissions to hospitals decreased
by 65.9 %," Goodwin said. "We are focused on treating sometimes subtle
changes in our patients' medical conditions so we can keep them from getting
to the point where they need more serious medical interventions."
Goodwin points out that this disease management system is not for
everyone. She says a patient must be fifty years or older, have a primary
diagnosis of congestive heart failure, have a touch-tone telephone and be
able to stand on the system's scale independently.