Each day, nurse Susan Lehrer cares for 20 diabetes patients, many of whom also have cardiac problems related to the debilitating condition. They’re mostly high-risk, low-income patients who have struggled for years to control their diabetes.
But Lehrer doesn’t wear scrubs to work, and some of her patients have never met her. She can treat them using just two pieces of equipment: a wireless phone headset and a computer screen.
Lehrer directs the telehealth program for diabetes at New York City Health and Hospital Corp., a public agency that provides low-cost or free medical care. Lehrer and her team of five nurses care for the hundreds of diabetic patients enrolled in the program without ever leaving the office.
Each day, the patients upload information on their vital signs to a website. The nurses watch the site for any alarming signs.
“Pulse, blood pressure, blood sugar, weight,” Lehrer said. “Any of those that are outside a safe parameter trigger an alert to a nurse.”
When nurses spot an alert, they call the patient and find out what’s going on. It could be that the patient hadn’t eaten lunch yet. Or the patient could be in serious danger.
Lehrer once used a blood sugar reading and a phone call to determine that a 55-year-old woman who played the organ at a church was having a stroke. The patient had noticed a little numbness in her hands, but hadn’t given it a second thought. Over the phone, Lehrer told the woman’s sister to get her to lie down and then call 911.
“The faster you respond to a stroke, the better your chances of recovery,” Lehrer said. “She was treated immediately.”
The patient made a full recovery. When she met Lehrer for the first time, the patient sang her a gospel hymn as a thank-you note.
“I was in tears,” Lehrer said.
The diabetes program is part of a drive toward using the Internet to transmit and manage patient information. It allows physicians to treat multiple patients and use real-time information to get a detailed, up-to-date picture of each patient’s health.
“It lets physicians monitor patients differently, in a way they never could before,” Marcia Testa, a professor of biostatistics at Harvard University, told AOL News. “You don’t need to wait till something occurs, or for a scheduled visit, to see what’s going on.”
The American Telemedicine Association estimates that about 200,000 patients nationwide receive treatment via mobile monitoring units in their homes, many of them through the Department of Veterans Affairs. There are also more than 200 telehealth networks, where a regional hub such as a hospital shares electronic health information with smaller clinics.
Lehrer says the New York diabetes program is now attracting interest from other public health services at the federal and local levels as a template for how to use telehealth to control costs and improve care.
The program began in late 2006, with just two patients. Each patient was given a glucometer that either connected to a landline phone or could communicate wirelessly.
The patients take their vital signs several times a day. At the touch of the button the information is uploaded to the health agency’s website. The program is fully reimbursed by MetroPlus, which provides cheap and free health insurance to low-income patients in New York City. Since patients can check their signs without having to pay any extra, or even leave their homes, they can take multiple readings on any given day.
Patients learn how vital signs like blood-sugar levels respond to different types of food and exercise, helping them regulate their lifestyle and control the condition. When they have a question, they can ask the nurse during a routine call.
“We’re diabetes educators,” Lehrer said.
The results of the telehealth program are impressive. Seventy percent of the diabetic patients have seen an improvement in their blood glucose levels in the first year of the program, vastly reducing the chances that they will suffer from complications such as heart attacks, Lehrer said.
Alton Dewar, a 49-year-old living in New York City, says the program has changed his life. With regular feedback from nurses, he has learned to improve his diet and integrate exercise into his daily routine. He no longer feels the pain and lethargy that diabetes used to inflict on him.
“My doctor feels good. He’s surprised. He says, ‘You’re doing good,’ ” Dewar told AOL News. “I used to eat meat, junk food. I leave those alone now.”
Today, there are more than 200 diabetic patients enrolled in the telehealth program. In January, it launched a similar program for patients with heart failure. The patients received a blood-pressure monitor and bathroom scale, both of which upload readings to nurses.
Elsewhere, the federal Department of Health and Human Services awarded $4 million to use telehealth to improve health care for underserved rural and urban communities in August. In September, the California Telehealth Network received $14 million in grants and donations for telehealth equipment and training.
To be sure, this trend faces one familiar obstacle: money. Most insurance plans don’t cover telehealth, which means that a doctor can’t bill for treating a patient over the phone or Internet. So for many doctors in private practice, that’s a reason to shun telehealth completely.
“There’s sometimes a conflict of interest, let’s be honest,” said Jonathan Weiner, a professor of health services research and policy at Johns Hopkins University.
Then there’s the difficulty of convincing doctors that they can improve their care of a patient by reading more e-mails and seeing their patient less often.
“Doctors in their 50s and 60s are a lot less likely to pick up an e-mail and act,” Lehrer said.
Still, the technological aspect could very much work in the system’s favor.
According to the Pew Center, more than two-thirds of Americans have a broadband Internet connection at home, and more than half of the adult population regularly uses either a laptop or a smart phone.
Such technological penetration could be a boon for physicians treating chronic conditions like diabetes, heart failure and hypertension. These afflictions force patients to constantly assess their condition, which is a lot easier if they are used to uploading and downloading information over the phone.
“It’s no longer something foreign,” Testa said. “It’s the use of mobile technology that’s pushed this.”
For now, Lehrer and her team of nurses use their personal computers and phone lines to deliver personalized medical care to patients who don’t even know what they look like. Most phone calls start with a chat about what’s going on that day, whether it’s a visit from a grandchild or a soccer game on TV.
These relationships can be powerful factors for patients struggling with a chronic case of diabetes. One patient takes the relationship so seriously he calls his nurse at least twice a night to leave messages and draw encouragement from hearing her voice message.
The program “is a connection,” Lehrer said. “The sound of her voice is his touchstone.”
AOL