NYCHHC Telehealth Success Strategy: One Hand on Heart, the Other on Phone

Thursday, July 31st, 2014
This post was written by Patricia Donovan

"We transform a conversation of chronic disease into something patients can look forward to." Susan Lehrer, RN, CDE, NYCHHC House Calls.

Guided by the philosophy, “Be real to your patients, and let them be real to you,” the New York City Health and Hospitals Corporation (NYCHHC) House Calls telehealth program is as committed to participants’ “life bottom line” as it is to its own program ROI.

In the House Calls telehealth program for diabetics, patients’ blood sugar, blood pressure and weight are transmitted via hand-size wireless modems to a team of specially trained nurses who provide feedback and education during pleasant telephone conversations at scheduled intervals.

“We transform a conversation of chronic disease into something patients can look forward to,” explained Susan Lehrer, RN, CDE, associate executive director of telehealth care management. “If they’re not looking forward to the call, they won’t pick up.”

A digital dashboard provides the telehealth nurses with a quick view of patients’ vitals and individuals who may be alerting. The telehealth technology enables immediate feedback that prevents overcorrection on the part of patients, Ms. Lehrer notes, while facilitating dramatic clinical outcomes.

The telephonic exchanges augment regular patient visits and enhanced by the nurses’ use of motivational interviewing. The telephonic communications are “templated” to avoid long narratives.

“Establishing that trust with patients over the phone is essential, because information received from people they believe care about them, and from people they trust, is information that is remembered,” said Ms. Lehrer. “It’s information that influences behavior.”

Ms. Lehrer presented some of House Calls’ clinical outcomes for the 2,500 patients it has serviced since the program’s inception during a July 2014 webinar, Diabetic Telehealth Monitoring: The Impact of Real-Time Data on High-Risk Patients sponsored by the Healthcare Intelligence Network.

Most House Calls participants are diabetics who spend an average of two years in the program, she explained. Of a random sampling of 769 participants, 76 percent improved their A1C almost every three months. Additionally, of patients in that sampling with A1Cs between 11 and 13, 91 percent improved A1Cs by an average of 2.9 percent.

House Calls, which has experienced a side benefit of fewer appointment cancellations on the part of participants, has been so successful the program already has been rolled out for patients with heart disease; its use for the chronic obstructive pulmonary disorder (COPD) population is being discussed.

However, Ms. Lehrer is quick to point out barriers to telehealth still exist. Physicians who treat a patient with diabetes for years without seeing any real change can develop “clinical inertia,” she says, although this quickly dissipates once the doctor sees a patient engaged in House Calls.

There is also the occasional patient resistant to change, and the frustration of being unable to integrate patient data into an electronic medical record (EMR).

Still, despite the program’s focus on technology and results, the nurses remind themselves that at its core, House Calls is about the person at the other end of the line.

“The staff always talks about keeping our hands on our hearts so that when we speak to people, they don’t become the numbers.”

Listen to an interview with Susan Lehrer here.

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