HOUSE CALL OF FUTURE WIRED IN : TELEMEDICINE RISES AS MEANS TO CUT COST OF HOME CARE.

Byline: Milt Freudenheim The New York Times

Every Tuesday, a nurse greets J.L. Atteberry, a frail 73-year-old cancer patient recovering at his home in Orangevale, Calif.

``How are you feeling this morning?'' she asked last week.

``Pretty weak,'' he said. ``I'm kind of tired out.''

The nurse, Ann Richard, studied his appearance and demeanor, and then asked, ``Did you take your blood pressure yet?''

Atteberry placed a blood-pressure cuff on his arm, pushed a button and read the result: ``112 over 78. Pulse is 102,'' he added.

``That sounds nice and normal for you,'' she said. ``Are you ready for me to listen to your lungs?'' As she watched and listened, he moved a stethoscope around his chest.

It was a routine exchange between nurse and patient, except for one thing: The two were 10 miles apart, communicating over a two-way video hookup with a few medical devices attached.

Richard and Atteberry are among a number of people throughout the United States who are testing a new approach to home health care, an alternative to the time-consuming process of having a nurse or other health aide drive to each patient's house for a checkup.

A miniature television camera and microphone allow the nurse to see and hear the patient, and other equipment measures blood pressure and pulse, listens to heart, lung or bowel sounds, reminds patients to take their medicine, and even takes electrocardiograms. The results are transmitted to the medical center over a phone or cable television line.

The approach, called telemedicine, is being tried by many health plans and agencies in an effort to reduce the number of costly home visits without depriving the patient of necessary checkups.

The equipment can be expensive, though, and whether it can pay for itself over time has yet to be determined. And while some advocates say telemedicine can improve patient care, critics say that it erodes the quality of care, because a nurse's image on a screen can never replace the human touch.

In recent years, as insurers and managed-care providers have pushed to limit hospital stays, the amount spent on home health care has soared. Nurses and other health aides made 500 million visits to patients at home in 1995, at an average cost of $63, for a total of $31.5 billion. Medicare alone paid for 236 million of those visits, up sharply from 63 million in 1990. A visit by a skilled nurse can cost $104.

The government's proposed remedy: Pay a lump sum for each Medicare patient's home care instead of shelling out for each nurse's visit. That would give HMOs, hospitals and independent agencies a powerful incentive to cut costs. And that's where telemedicine comes in.

Reliable home-monitoring equipment is now inexpensive enough to justify the approach, its advocates say. ``When home health agencies are forced to provide care at the lowest cost, that's when home telemedicine will explode,'' said Loretta Schlachta, clinical director for telemedicine at the Eisenhower Army Medical Center in Augusta, Ga.

Not that the idea is totally new. Telemedicine has for years linked doctors in hospitals, satellite clinics, and rural and overseas sites, but tests of systems for home care have proliferated only in the last 18 months.

Telemedicine is helping nurses monitor patients with heart and lung problems, diabetes, serious skin disorders, wounds, anxiety attacks, hemophilia and spinal-cord injuries. Of course, nurses still visit such patients regularly as well.

One unit in a home in a Chicago suburb monitors the lungs of a low-birth-weight infant to guard against pneumonia. It allowed the baby to go home after eight months in an $1,800-a-day neonatal care unit of Northwest Community Hospital in Arlington Heights, Ill. In Boston, Beth Israel-Deaconess Medical Center plans to start testing home telemedicine for neonatals later this year.

Some devices offer such nagging robotic voice messages as: ``Excuse me, it's time to take your medication. Are you ready?'' The patient then touches the ``yes'' square on a screen.

Otherwise the machine asks again and finally alerts Nurse Central, where a nurse dials the patient to make sure the pills are swallowed on schedule.

Researchers have shown that failure to follow the doctor's orders on taking medicines is a leading cause of costly hospital admissions.

But in addition to the issue of the economics of telemedicine, skeptics say there are unresolved questions about breaching patients' privacy by transmitting information about them; whether manufacturers and doctors could be sued if a patient's health deteriorates; medical malpractice liability; and operating without a state license, when telemedicine hookups cross state lines.

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Photo: Norma Langfurd checks her blood pressure on a telemedicine machine at her home in Orangevale, Calif. The data will be transmitted to a nurse, who can interact with Langfurd through a video unit hooked up to a phone or cable line.

New York Times Photo Service