But every day for the past several weeks, they have started each day with a state-of-the-art program that has saved Clyde Benoist at least one trip to his physician's office, and his home health nurse numerous trips to his home.

Benoist, a Rockingham resident who recently had part of a leg amputated because of diabetes complications, is enrolled in FirstHealth Home Health's telehealth program, a service that allows distance monitoring of patients needing chronic disease and/or wound care management.

The program recently received a $250,000 grant from The Duke Endowment.

"I love the machine," says Betty Benoist of the telehealth monitor. "I can't say enough about it. It keeps the nurse from having to come out here, and it doesn't take much to do it in the morning. The first day, I made a couple of boo-boos, but it's really easy. It really is a piece of cake."

Each morning, Benoist attaches her husband to a monitoring station, called a "turtle," that measures his blood pressure, pulse, temperature, weight, pulse oxygen and blood sugar. After answering a series of program-posed questions about her husband's condition, she presses a button and transmits his medical information to the home health nurse monitoring his progress.

If any of the measurements are abnormal, as Clyde Benoist's blood pressure was on a couple of recent days, the nurse follows up with a phone call or a home visit. Otherwise, the Benoists go about the rest of their day secure in the current status of his condition.

"It's just nothing to work it," Betty Benoist says. "Both of us are computer illiterate, but this was very easy."

FirstHealth's telehealth service, which uses equipment provided by ViTel Net of McLean, Va., began with a pilot program funded by the Moore Regional Hospital Foundation. The pilot worked so successfully that FirstHealth and the Foundation partnered to purchase 18 telehealth units as well as four digital camera kits to be used for wound assessment.

Just after the program got off the ground, The Duke Endowment announced that it was seeking applications for grants related to technology use in improving health care.

"The timing was right to expand our programs," says Patty Upham, director of FirstHealth Home Health. "Because we already had an established program, we could demonstrate to Duke that we had the know-how to be successful. Duke was very enthusiastic about what we had done so far."

'Powerful Tool'

The Duke grant will allow FirstHealth to acquire 70 additional monitoring units and four additional high-resolution digital cameras, and to hire a full-time telehealth nurse coordinator to manage the program, which is available in Moore, Richmond, Montgomery, Anson, Scotland, Lee, Hoke and Harnett counties.

"Right now we have a waiting list for the monitors," Upham says. "This will allow us to offer the service to a greater number of our patients who could benefit from the program."

According to Upham, the telehealth program helps nurses make more informed decisions about patient care.

Instead of visiting a patient's home two or three times a week to obtain medical information, the nurse gets the same data by way of telehealth technology. That way she can make a home visit when the patient really needs a home visit.

"It's a more efficient and more effective way to care for patients," Upham says.

The high-resolution cameras are especially helpful to the work of home health's central wound nurse specialist, Shirley Goldsmith, who can now pay "virtual" visits to her patients daily. A home health field nurse routinely takes the pictures and transmits them to Goldsmith, who reviews them to determine if the wound is healing properly or if additional treatment is needed.

Goldsmith can then e-mail the pictures to the patient's physician so they can collaborate on the patient's care.

"This takes our wound care program to a whole new level," Upham says.

Goldsmith is the only wound nurse specialist for the eight counties that FirstHealth Home Health serves, and these "virtual" visits allow her to consult with her patients more often.

"The nurses' decisions are much more data-driven," Upham says of the overall telehealth program. "Telehealth gives them more information to help them make better decisions. It's a very powerful tool, and the nurses love it."

'Baby Steps'

Telehealth monitoring also helps keep patients at home, where they prefer to be.

"One of the main things we look to do is reduce emergency room visits and unplanned hospitalizations," Upham says.

And that's working. According to Upham, for the first six months of the program, the overall agency rate for home health hospitalizations was 25 percent while the FirstHealth telehealth rate was 18 percent. For emergency room visits, the overall average agency rate was 20 percent while the rate for telehealth patients was just 14 percent.

"That's just baby steps into the project," says Upham. "We're just getting started, and we plan to reduce those rates even further."

Telehealth participation also makes for better-educated, more compliant patients who, because they learn what to look for -- good and bad -- in their conditions, become more involved in their own care.

Every patient who is admitted into FirstHealth's Home Health program is appraised for telehealth eligibility. Once in the program, patients stay as long as they are eligible for home health services. The average length of participation is about 40 days, and there is no additional charge for patients to participate in the program.

Despite its success, the telehealth program does not replace face-to-face nurse/patient interaction, however.

"The nurse/patient contact will always be the most important part of what we do," Upham says. "We cannot replace that. This technology simply gives the nurse another tool, a very powerful tool, to improve the quality of patient care."

For more information on FirstHealth Home Health or the telehealth monitoring program, call (866) 213-9828 toll-free or (910) 255-3636 for the Moore County office or (910) 997-5800 for the Richmond County office.