Nurses across Maine are using telecommunications to change the face of healthcare delivery.
Rather than work in hospitals or doctors' offices, a growing number of nurses are working out of home offices or call centers to dispense advice over the telephone to patients who are sometimes hundreds of miles away.
IntelliCare and Health Dialog, both founded in 1997, have 24-hour call centers in the Portland area and employ several dozen nurses who assist in emergency care and long-term disease management over the telephone.
Boston-based Health Dialog, which works mainly for insurance companies and corporations, set up a call center in Portland 18 months ago. It is in the process of adding about 20 more nurses to a staff of 45 that also includes registered dietitians, company officials say.
A smaller but more established operation is run out of York Hospital. For nearly a decade, nurses there have provided triage care to callers from Maine and beyond.
Although some might question whether the inability to see a patient could lead to mistakes, telenursing is widely accepted in medical circles as an efficient way to enhance physician care. Besides Maine Medical Center, IntelliCare counts among its clients Eastern Maine Medical Center in Bangor, Central Maine Medical Center in Lewiston and Martin's Point Health Care.
Calls go into a central database and are diverted to nurses across the country, depending on their availability, expertise or knowledge of a particular patient. So it's not uncommon for after-hours calls to Maine Medical Center, for instance, to be forwarded to IntelliCare's call centers in Dallas or St. Louis.
Telenurses say they always err on the side of caution, and the companies running call centers aren't taking chances either, says Susan Newbold, a registered nurse in Maryland and co-editor of several books on nursing and technology.
"The nurse might look up a protocol and give advice based on what protocol is already blessed," Newbold said.
Nurses licensed in Maine can work with patients in 21 other states that belong to the Interstate Nurse License Compact, such as New Hampshire, North Carolina and Texas. Gaining a license in any other state is relatively easy, usually amounting to some paperwork and a fee.