Sometimes patients living with serious chronic illnesses, such as congestive heart failure, could avoid trips to the emergency room if their medical conditions were monitored daily for warning signs so that nurses or doctors could intervene sooner, before situations get out of hand.

The Centers for Medicare and Medicaid Services is trying to kick-start that type of early intervention, and learn where it works best, with a new home-health-monitoring telemedicine project that will launch in January.

The project will involve 2,000 chronically ill Medicare beneficiaries who receive their care from one of two large medical groups, Bend Memorial Clinic in Bend, Ore., and Wenatchee Valley Medical Center in Wenatchee, Wash. The patients chosen by the centers for the project are under care for conditions such as congestive heart failure, chronic obstructive pulmonary disease, or diabetes.

The medical groups will soon begin contacting those patients to voluntarily participate in the program, which also will feature "a lot of front-end education," about their illnesses and preventive care, says Justin Wray, a clinical research coordinator at Bend Memorial Clinic.

With earlier intervention for chronically ill patients experiencing health problems, the hope is that serious complications and expensive trips to the hospital can be avoided. A CMS goal for each of the two medical groups is to cut by 5% the total Medicare costs for the patients assigned to them. Often, patients don't realize they're having symptoms that indicate an impending, but preventable, health crisis until they actually get very sick, Wray says.

For instance, a sudden weight gain by a congestive heart failure patient could indicate retention of fluids. Serious problems could be avoided by that patient if a doctor or nurse is aware of the situation. However, often patients neglect to monitor themselves or report symptoms to their doctors until a crisis occurs -- or until their next scheduled office visit.

For the project, the patients will use home-monitoring devices, such as glucose tests or blood-pressure cuffs, to collect readings. The readings are collected by "Health Buddy," which is an appliance from vendor Health Hero Networks that provides an interface between the patient's home and the care provider. Depending upon the device, readings can be either electronically collected and transmitted to Health Hero, or keyed in to Health Hero by the patient.

Health Hero includes monitoring technologies, clinical databases, Web-based decision-support tools, health-management programs, and content-development tools. The home-health-monitoring medical devices that hook up to the Health Buddy, such as blood glucose testing devices, are available in many pharmacies and other retailers.

Those devices feed data into the Health Buddy, which plugs into a home phone line and dials-up to send data and information about patient symptoms to a secure remote database. The Health Buddy serves as a "home hub for health," says Geoff Clapp, chief technology officer of Health Hero Network.

Individualized health information and programs also can be downloaded to the Health Buddy.

Health Buddy features four large keys that automatically get labeled electronically, based on text questions the patient is asked to answer about his or her symptoms and behavior.

The Health Buddy screen can display several lines of text, and is programmed to ask specific questions based on the individual patient's responses. So, for instance, if a blood-pressure reading is high for a heart patient, the Health Buddy could ask a series of questions to help determine the cause, such as whether the patient recently has eaten foods with high sodium content.

The data is sent to remote clinical information databases. At the provider's end, authorized doctors and nurses can access the data via the Internet. Decision-support tools are provided to review a patient's status to detect problems earlier. The system also gives health-care providers a list of patients having symptoms or other problems, and can rank the list based on the severity or type of problems, so that nurses or doctors can intervene by calling the patient or changing treatment.

The system also can be programmed to provide emergency alerts to nurses or doctors, so that ambulances can be called in serious situations. The goal of the three-year project -- called "Advancing Chronic Care Through E-Health Networks And Technologies" project, or Accent -- is to determine whether a project involving 2,000 patients is beneficial and can be scaled to a much larger population, Clapp says.

In addition to this latest project, Clapp says Health Hero is participating in three other government telemedicine projects, including one with the Veterans Administration.