Real-time Health Monitoring Will Revolutionize Patient Home Care in 2015
Founder and CEO, Robert Herzog of eCaring describes how tailoring programs for special patient populations will improve patient home care while reducing risks of hospital readmissions.
Real-time health monitoring including the patient’s home continues to gain importance as pressures come from a variety of sources to reduce risks and costs of readmissions and hospitalizations. The Centers for the Medicare and Medicaid Services (CMS), enforcing the 2012 Medicare Readmission Reduction Program, the States and managed care organizations have to deal with tighter budgets, rising costs of service, and stricter capitation rates.
Until recently, home care reporting was archaic at best. The home was a “black box” where no information was generated when a home aide entered the residence and closed the door. Well-intentioned aides and nurses visited a patient’s home, administered care, and documented their visit in piles of paperwork that were often not reviewed or actionable.
Data input was first “modernized” to record home aide hours and minimal data about care by telephone. Such systems are used primarily for time and attendance. Aides visit the patient’s homes and use the patient’s home phone to document that their work shift has started. When the shift ends (and only when the shift is over), the home aide dials the phone to report the end of their shift, and with all the limitations inherent in pressing numbers on a dial pad, report that they had administered a few elements of care. Since they cannot see the output of what they entered, such data entry is error prone and of limited value.
To move home health care forward and to reduce costs requires a new approach. Forward thinking home aide agencies, health care providers, managed care organizations and hospitals are looking for innovative solutions that leverage the proliferation of tablets, smartphones and the ubiquitous Cloud to improve care at home, where patients spend most of their lives and where so many significant health events occur.
Thanks to technology, the “black box” of healthcare monitoring can be transformed into a sea of data where home health aides can gather 500-1,000 data points per month. The real-time collection and utilization of data from the home will offer these ten key benefits for specific patient populations, their families and every member of the patient’s care team in 2015:
1. Bringing the Internet into the home sheds light on the “black box.”
Often overlooked in a country where 58% of Americans have smartphones is that the neediest and often costliest health care users often fall below the poverty line and have no Internet access in their homes.
Bringing the Internet to the homes of America’s costliest users, who are often low-income seniors that qualify for both Medicare and Medicaid assistance (“dual eligible”) quickly transforms the home into a rich sea of meaningful data. With Internet access, seniors and their caregivers can transmit important patient data to care managers and doctors, as well as open the world of the Internet to the homes of the many that the “Information Super Highway” still passes by.
2. Using icons promotes simplicity of use.
Just as important as the establishment of the Web in the home is functional access to technology by creating systems that can be quickly understood by the home aide and patient, who have various levels of computer skills and English literacy limitations. Traditional text-based systems have much more limited utility.
Using icon-based systems dramatically increases the ability of aide and patients to enter significant and actionable data. Caregiving shouldn’t be about spelling and grammar — icons easily communicate information, overcome language barriers and technophobia, as well as are enjoyable to use.
New York’s Beth Israel Medical Center, as one example, saw the value of an icon-rich software system for reporting real-time results of patients with congestive heart failure (CHF). As one of the nation’s leading cardiovascular care providers, Beth Israel enrolled a group of its patients with CHF in a real-time monitoring post-discharge program to assess the impact on reducing readmission within 30 days. Beth Israel requested CHF-specific easy-to-understand icons, care management tools, and a tracking component for each patient participating in the trial.
Beth Israel learned that the system’s new icons eliminated any language barrier, while ensuring quick input of key data on the patient’s weight, medication regimen, behavioral patterns and vital signs.
3. Improving communication and sharing of information means constant dialogue among patient’s home, care managers and doctors that focuses on generating the best results for the patient. The virtuous cycle of communication provides the best means to engage the patient, who is more likely to provide data input if doctor, nurse or care manager respond in timely way. Knowing that “someone was there” and “I am not alone” helps patients to cope and better manage their plan of care.
Remote patient monitoring can serve as the communications hub of a continuum of care. As part of the post-discharge process, remote monitoring care managers can quickly:
- View vital signs
- Ensure that instructions related to plan of care, medications, diet, exercise, appointments, etc., are being followed
- Respond quickly to situations requiring immediate attention.
4. Monitoring can be modified to the critical needs of a particular patient population, as was shown in the Beth Israel study. One of the leading causes of readmissions is heart failure, followed by pneumonia, chronic obstructive pulmonary disease (COPD), urinary tract infection, and diabetes. Heart failure can often lead to comorbidities, including dementia, renal failure, and hypertension.
Heart failure affects nearly 6 million Americans annually, with 550,000 new patients diagnosed each year. Four of five cases of heart failure occur in older adults. Each year, congestive heart failure (CHF) is associated with 1 million hospitalizations. The majority are readmissions or re-hospitalizations. CHF is in part responsible for close to $35 billion that is spent on heart failure each year. To reduce the risks associated with CHF, real-time monitoring can be utilized to track sudden weight gain, swelling of ankles, shortness of breath, chest pain, severe fatigue, loss of appetite, frequent nighttime urination, rapid heartbeat and other critical factors.
5. Tracking critical activities, vital signs, medications, mental and physical state, on a daily basis from the home, ensures continuity of care and the best possible outcomes for patients.
Using real time data, members of the care team can quickly spot changes or new trends that require immediate attention, keeping small problems in the home from leading to visits to the ER.
In the case of Beth Israel, data inputted by the home aide or the patient was quickly uploaded to the Cloud where information was evaluated by a care manager. The program showed significant, quantifiable reductions. Beth Israel saw its average rate of 29% CHF patient readmissions drop by 60% to 10.5% for this trial population.
“As a low-cost tool that could save us hundreds of thousands of dollars a year, eCaring was brilliantly situated to be an extremely valuable new tool as healthcare transforms into more preventative and ambulatory care,” said Dr. David Bernard, former Beth Israel chief medical officer, who oversaw the trial program.
6. Customizing alerts with tailored thresholds that require prompt attention, which are communicated to the care manager, family member, physician or other members of the care management team via text message or e-mail, enables overburdened care managers to focus their time and resources where they will have the greatest positive impact. Serious problems, like a rapid change in a vital sign, sudden weakness, slurring of speech, depression, excessive fatigue, failure to take medications, loss of vision, or sudden shortness of breath can be quickly addressed.
7. Configuring data into customizable care reports can be sorted by fields, such as mental and physical state, vital signs, sleep, eating, etc., enables better care management review and oversight. Longitudinal data can be evaluated on an hourly, daily, weekly or monthly basis to determine anomalies and trends requiring further analysis, leading to changes in long-term plans of care.
Data points can be tracked by time entry of the event and by the home aide to assess care quality and to ensure best practices. Having a historical timeline of the patient’s data points can show key inflection points or events that are outliers and indicative of preventable future problems.
8. Sharing information, through 24/7 Web access, can lead to lower stress for patients, caregivers, and families, who can have greater peace of mind by getting control over the situation and measuring progress. Patients not maintained in a stable condition cause stress, which can lead to rapid heartbeat, immune system compromise, fatigue, and time off from work. Longer stays at home increase comfort and lower stress as well as costs for patients, families, and caregivers.
9. Using analytics by patient populations can improve risk stratification and assessment.
Most risk stratification programs are based on prior history and in-hospital experience, with generalized risk factors. Real time post-discharge and care data can substantially enhance assessments for determining readmissions and utilization risk. Analytics can also help predict outcomes of recovery while pointing to outliers that may need further attention. Harnessing analytics can also determine best next steps in a particular patient population.
10. Improving Time Management of Activities and Expenses is essential for proper distribution of limited resources. Tracking of actual vs. budgeted or reimbursable time is demanded by today’s payors. Using technology rather than telephone or, even worse, paper time sheets, can lessen time associated with time entry and increase accuracy. Resources can be better managed, which is essential under capitated rate and value and performance payment systems.
The success of real-time monitoring in reducing readmissions for patients with CHF at Beth Israel has led to the development of different modules for the needs of other special patient populations. Among the patient populations being considered for real-time data monitoring modules are patients with developmental disabilities, chronic obstructive pulmonary disease (COPD), diabetes, acute myocardial infarction, and other likely causes of readmission.
One module showing particular promise is the day-to-day work being performed by a home for people with developmental disabilities. Have a Heart, a home for people with developmental disabilities in Wisconsin, is using real-time monitoring to report on therapy progress, physical activities, medication adherence and eating habits.
As evidenced by Have a Heart, Beth Israel Medical Center, select managed care companies, and patients with CHF, real-time monitoring is at the dawn of a new technological revolution with profound implications for the millions of patients and caregivers coping each day. Technology has revolutionized real-time monitoring and reporting to the point where it can generate big data from the home to deliver on its potential for CMS, state governments, hospitals, home health aide agencies, managed care organizations, providers, accountable care organizations, medical and health homes and even families providing care. Utilizing real time actionable health care data from the home can enhance the quality of care while reducing costs and risks, thus improving health outcomes for potentially millions of elderly and chronically ill patients.
Featured Source: HIT Consultant