On a dresser next to the bed, a small electronic box is helping Ovelet Coates stay healthy.

Twice a day, the device instructs Coates, 91, to step on a scale and then to take her blood pressure. The scale and pressure cuff are connected to the box, which, in turn, is connected to the phone line in her spotless Bethesda Orchard apartment.

After Coates takes her vital signs, the information is transmitted to her home health nurse, who monitors the data daily to look for problems or patterns.

"It took a little while at first until I got used to it," Coates said. "It doesn't take but a couple of minutes."

Heralded as both time and money savers, telemonitoring and telehealth services are gaining a greater foothold in the increasingly costly health care market.

Telemedicine, which combines traditional health care services and telecommunications technology, can range from a surgeon operating on a patient hundreds of miles away to a nurse checking vital signs from the comfort of her home, according to the American Telemedicine Association.

The burgeoning field has spurred a growing interest in home-health strategies that can help curb costs by minimizing office visits and hospitalization — and may lead to better patient outcomes.

Nationally, telemedicine is being used to treat a wide array of patients, from those suffering from congestive heart failure and diabetes to mental health patients and complex maternity cases.

More than 200,000 Americans are using telehealth home-monitoring services, according to estimates by the telemedicine association. There are another 200 dedicated telemedicine networks nationwide, involving close to 3,500 medical and health care institutions.

"It's getting a lot of attention now in mainstream health care to help cut down on costs," said Carol J. Bickford, a senior policy fellow in the department of nursing practice and policy at the American Nursing Association. "It's been very successful when it's done well in reducing the hospitalization of patients, because you can reach something early."

Monitoring systems allow physicians to constantly track the conditions of patients.

Coates is one of about a half dozen Cooperative Home Care patients using an in-home telemonitoring system. The St. Louis firm has used the technology for the last two years.

The box weighs less than two pounds and displays questions and information via a small screen. Some can run using only a cellular connection.

The system uses verbal cues to alert patients when it's time to weigh themselves, take their blood pressure or check their oxygen levels. The monitor also can be programmed by health care providers to ask a series of yes or no questions tailored to a patient's condition.

For example, Coates' monitoring station asks a series of seven questions after she obtains her vital signs, including whether she has fallen in the last day or is suffering from headaches or dizziness.

Most patients take their vital signs twice a day. Health care providers or patients can increase the frequency depending on need.

The data is transmitted through the telephone line and comes into the nursing station computer like an e-mail. Cooperative Home nurses check for reports at least once a day, although they can monitor results in real time if a patient's condition requires greater scrutiny.

They also receive a message if patients fail to take their vitals as usual.

Nurses forward the information to a patient's physician at least once a week, typically before a checkup. Providers can scan a month's worth of data before those office visits, allowing them to look for trends, said Lanora Barman, interim director of clinical operations at Cooperative Home Care.

"We're trying to keep them out of the hospital by keeping them healthier," she said. "It's an extra set of eyes and ears in the house. We know if something's going wrong."

Recent studies suggest telemedicine services reduce costs, office visits and hospitalizations by hundreds of millions of dollars a year.

Still, some people can be overwhelmed by the technology. Patients who might struggle to get on the scale or have difficulty getting to the monitor might not qualify, Barman said.

It's simple technology at heart, though, and rapidly becoming increasingly user-friendly, especially for seniors.

"The technology is becoming much more comfortable to them," Bickford said. "We've got to make sure that they're part of the solution."

She added that questions remain among some health care providers about who will be paid for which services in an age of telemedicine. Physicians and other health care experts may save time by using telehealth services, but skilled sets of eyes are required to analyze all of that data.

Grayce Callahan isn't sweating the revenue scheme. Callahan, vice president of emerging business at Cooperative Home Care, believes the technology provides a significant benefit for both physicians and patients.

"There are systems out there right now that monitor the heart, do EKGs and all of those things," she said. "It really just depends on how much detail you want to provide in the home. Even when we're not in the home, there's a supportive service that is there for the patient or their family."