Medical College of Georgia
Georgia Institute of Technology
Embargoed For Release
December 18, 1996
"Electronic House Call" System May Make Health Care As Accessible As Cable Television
The prototype for an electronic house call that could make health care as accessible as cable television has been developed and tested in a collaborative effort between two Georgia universities, the U.S. Army and a private cable company.
The prototype, developed by researchers at the Medical College of Georgia and the Georgia Institute of Technology, has been tested in the homes of 25 patients of MCG Hospital and Clinics and Eisenhower Army Medical Center at Fort Gordon.
It is also being tested at Westlake Manor, a 100-bed nursing home in Augusta, with links to a physician's office and his home.
The electronic house call's target audience is what developers call "frequent flyers:" people whose chronic health problems require constant attention that can lead to frequent doctor visits and hospital stays.
"This system is for people with chronic diseases such as asthma, uncontrolled diabetes or heart failure who require frequent care," said Dr. Max E. Stachura, Clinical Director and Interim Director of the MCG Telemedicine Center. "The way they become frequent flyers is when they can't quite manage their care and they fall off track. That's when they appear in the emergency room. What we want to do with this system is help them stay on track and out of the hospital."
He considers cable television, which already has a comfortable spot in many homes, a logical way to do that. "There are going to be multiple services brought into the home by the cable system. You are going to be able to do your banking at home. You are going to be able to get an education at home. You should be able to get health care at home, too," Stachura said.
Jones Intercable Inc., a Denver-based company which services the Augusta area, provided the unique cable service -- which not only brings a signal into the home, but also gets one back out -- at no cost to test patients.
Development and initial testing of the electronic house call was funded primarily by a $916,687 grant from the Department of the Army and a $950,000 grant from the Georgia Research Alliance.
Researchers fashioned the electronic house call prototype from existing computer hardware, with additions such as a multi- function patient monitor -- like one used in intensive care units -- into which blood pressure cuffs, stethoscopes and other medical devices are plugged, said Dr. John Searle, MCG Telemedicine Center's Technical Director. The patient's computer also is fitted with a videoconferencing camera that can be remotely controlled by the nurse.
Instead of using a keyboard or mouse, Georgia Tech's Biomedical Interactive Technology Center developed a system using a touch-screen monitor, said Michael F. Burrow, Senior Research Engineer at the center. For example, a patient touches a telephone icon on the screen to make the initial connection with the nurse practitioner.
The computer system uses a commercially available videoconferencing program that enables the nurse and patient to see each other and talk throughout the examination. But the electronic house call prototype also accepts data from a variety of medical devices, allowing patients to have their blood pressure and blood oxygen levels checked and their temperature and weight measured. The nurse can listen to their heart and lungs and perform an electrocardiogram.
Researchers are developing ways to alter the menu of measurements to meet the specific needs of a patient, Stachura said.
The system provides audio instructions and images on the screen to assist the patient as he moves through the exam, Burrow said. "The system gives the patients instructions on how to use the instruments. If they are not sure about something, they can touch a help icon to obtain more detailed information about using the instrument and the purpose of the test.
"For the most part, the patient feedback has been positive," Mr. Burrow said. "The patients like the idea of being monitored at their homes and interacting with the nurse frequently."
Visits via the electronic house call are scheduled, from every day to several days per week, depending on a patient's need. But patients can use the system more often to check their blood pressure, temperature or other parameters and that information also becomes a part of their database which the nurse reviews.
Jones Intercable Inc. provided dedicated cable channels not accessible to the public for use in the project, said George Paschall, Director of Public and Government Relations for Jones Intercable Inc. The company also installed a high-speed radio- frequency modem at each patient's home that translates computer language into something that can travel down a cable line to another computer, enabling communication with MCG Hospital or Eisenhower Army Medical Center, Paschall said.
Jones also installed two-way amplifiers at strategic points along the overhead cable system to ensure a strong signal in both directions. "We felt the opportunity for (both) service to the community and business-wise was worth the investment," he said.
"From our perspective, it's a visionary thing in terms of delivering services to patients at home," said Loretta Schlachta, Clinical Coordinator for Telemedicine for the Department of Defense's Center for Total Access. "That's the first level of care, self-care. When you get a cold, you are the first one to intervene. That's what the electronic house call does. It brings the level of care to where it makes the most difference, at home."
Sometimes 'home' is a nursing home where residents' health may be fragile and physicians are not always available. "This is what's needed in long-term care," said Phyllis Horton, Corporate Nurse Consultant at Westlake Manor. "Many times we have to send a resident to the emergency room for an adequate assessment." The electronic house call helps identify problems earlier so that some of those trips can be avoided.
"We wanted a system that could help patients take better care of themselves," Stachura said. "We also wanted one that could help address the very real issue of an aging population, wherever they might live. Now that we know we can do that, the next step is to look at how to make it as unobtrusive as our television set," he said.
Developers at Georgia Tech and MCG want to fine-tune the electronic house call into a more standardized, commercially- viable piece of equipment and they are seeking a company willing to do that.
"We can put together off-the-shelf technology and make it work; we've proven that," Stachura said. "But if it's really going to catch on and be easily do-able, it's got to be turned into a neat, small package."
As is, the prototype costs about $15,000 for each unit and, because it's off-the-shelf hardware, it has some unnecessary technical capabilities. "I'd like to see a system that would cost less than $10,000," Burrow said, and he thinks that's realistic.
As the technology is fine-tuned, the researchers also want to further explore the full potential of the electronic house call. "We've shown it can be used for these parameters: blood pressure, heart and lungs sounds, etc.," Stachura said. "But how far can you push it? How many different kinds of patients will benefit from this? If you really have it in a home over a long period of time, just how much does it prevent the frequent flyers from landing in the hospital?"
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