House call of the future taking shape in Informatics project for Diabetes Education and Telemedicine

New York 26 March 2001One year ago, Columbia University College of Physicians & Surgeons (P&S) at Columbia Presbyterian Medical Center (CPMC) and SUNY Upstate Medical University received a $28 million grant from the Health Care Financing Administration (HCFA) to bring health care into the homes of underserved rural and inner-city residents with diabetes. This project is known as the largest telemedicine effort ever, funded by the federal government's Department of Health and Human Services. Today, 280 patients from Northern Manhattan including Washington Heights, Inwood, and North and Central Harlem; the Bronx; and rural areas of central and upstate New York are enrolled in the project.


Traditionally, Americans living in rural and impoverished inner-city areas have low levels of primary care and high levels of isolation from consistent specialised high-quality medical care. Columbia and SUNY Upstate join five other sites in the effort, called Informatics for Diabetes Education and Telemedicine (IDEATel), which serves as a test bed for the national use of Internet technology to increase access to health care for all Americans.

"In a doctor's office, care of diabetes takes place for a few minutes every few months. But in a patient's home, diabetes care occurs every day. Telemedicine gives people the tools which they need to take control of their diabetes. We reach into patients' homes and empower them to take better care of themselves through monitoring, access to information, and education", stated Steven Shea, M.D., Hamilton Southworth Professor of Medicine at Columbia University P&S and director of the division of general medicine at Columbia Presbyterian Medical Center of New York-Presbyterian Hospital. "This house call of the future allows patients and clinicians to reach out across any distance for care."

Computers with devices to read blood sugar, take pictures of skin and feet, and check blood pressure, have been placed in half of the enrolled patients' homes while the other half, the control group, continues with the care they usually receive from their providers. Participants receive Internet service, training in equipment use, and maintenance support. Patients check their blood sugar, blood pressure, and other factors that affect diabetes and are able to view their own medical information, learn more about diabetes, and receive recommendations and instructions on how to manage their disease.

Decision support systems play a crucial role, as an automated care guideline system analyses each patient's data. If information recorded on the computer varies from predetermined values, an automated alert is sent to the doctor or nurse. The system equally provides suggestions and reminders to patients about what steps they need to take to maintain good health.

In New York state, approximately 1,6 million people suffer from diabetes. The complications from diabetes cost the United States economy $45 billion each year, with an additional $47 billion which is attributed to indirect costs from diabetes-related disabilities. It is estimated that the federal government can save $247 million per year through early intervention in diabetes treatment, which could rise to $457 million if telemedicine can expand the reach of that treatment.

The four-year grant will eventually reach 1500 diabetes patients and enable researchers to study the efficacy of telemedicine in improving patient quality-of-life and reducing overall health care cost. The Columbia Department of Medical Informatics pioneered the use of the Web in providing clinical care. Two million patient records are computerised at CPMC and are available for secure access on-line by more than 4000 clinicians. SUNY Upstate's Joslin Center is pre-eminent in providing state-of-the-art diabetes care in urban and rural settings, and Columbia's Naomi Berrie Diabetes Center is one of New York City's leading centres for diabetes care and research.

The IDEATel project will serve as model to develop more effective treatments for other diseases such as depression, obesity, asthma, and heart failure. Led by Dr. Shea, the diabetes telemedicine programme is a collaborative effort with the Joslin Diabetes Center of SUNY Upstate Medical University, the American Diabetes Association, Harlem Hospital Center, the Harlem Renaissance Network, Arnot Ogden Hospital in Elmira, the Olean General Hospital in Olean, the Good Samaritan Hospital in Watertown, the Bassett Healthcare System in Cooperstown, the Hebrew Home for the Aged at Riverdale, and HCFA. More news about this project is to be found in the VMW November 2000 article IDEATel study to monitor diabetes patients at home with advanced telemedicine equipment and services.

Leslie Versweyveld

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