PORTLAND (AP) – Nurses across Maine are using telecommunications to change the face of health care 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 Greater 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.

John Henkel provides nursing services over the phone from his Wilton home for IntelliCare, which is based in South Portland.

The names of elderly patients from Texas flash on his compute screen, waiting for him to call and check on their health as part of a federal disease management program.

“They know my voice, my lack of accent,” said Henkel.

“Before I can finish saying hi, they say There’s that John, that Yankee from Maine.”‘

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.

Telenurses – or health coaches, as they are sometimes called – like the flexible hours and making a difference in the lives of patients from all over the country.

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.

But telenursing is not the type of work that appeals to most nurses, says Joe Niemczura, president of the American Nurses Association in Maine.

“I do think the average nurse views themselves as someone who actually touches the patient or speaks to them face-to-face,” Niemczura said. “I know for me, that’s the piece I really enjoy. “

Henkel, a nurse for 26 years, agrees the “adrenaline rush is not there anymore.”

“But it’s a whole lot more fun trying to keep people healthy and out of the hospital than it ever was taking care of sick people in the hospital,” he said.

Henkel’s work involves monitoring people with congestive heart failure for a Medicare pilot program.

Each day, the patient gets on a digital scale that Henkel can read from his computer, and sends him answers to a series of questions about the severity of symptoms such as shortness of breath, increased coughing or swelling in the ankles.

In between assignments, Henkel participates in conference calls with other IntelliCare nurses to discuss software changes and sometimes shuffle patient assignments.

He also schedules breaks to pick up his young son from school and makes a snack whenever he wants.

AP-ES-07-12-04 0216EDT