The vision for this blog is to create a community of harmonious professionals across the care continuum who encourage each other in exploring digital media as a way to support businesses and families dealing with elder care.
Written on August 17th, 2010 by tasha
For me, the most exciting session at the Boston NHPCO care continuum conference was on telehealth. (That’s saying a lot, because the conference included presentations on some truly innovative programs. You could see the creative sparks flying between presenters and members of the audience. I go to several conferences a year and have to say these were really fun sessions!)
What struck me in particular about the telehealth session was the discussion of video conferencing. New regulations and cheaper technologies make this medium worthy of a second look, even in the high touch sectors of hospice and geriatric care management.
Certainly as we strive to increase access (especially in rural areas) and discover greener ways to deliver care (less travel time) responsible leaders will need to consider how to leverage technology to meet these goals. (P.S. I am also getting the very strong feeling that productivity goes up with telemedicine because staff do not need to spend so much time in transit. Staff cost per patient goes down, making this also a worthy option to consider financially.)
If, after reading this blogpost, you are interested in promoting telehealth, consider commenting to CMS on your views about allowing this option in the context of the “Face2Face” meeting for hospice recertification at 180 days. (Search for “proposed Rules” within submissions “Open for comment” using the keyword “telehealth”. You’ll want to comment on Docket ID: CMS-2010-0213, Medicare Program: Home Health Prospective Payment System Rate Update; Changes in Certification Requirements for Home Health Agencies and Hospices. The site closes for comments September 14, 2010.)
Deborah Randall, of Deborah Randall Consulting, and Kathy Duckett of Partners Home Care in Waltham, MA were the presenters of this session. If you participate in my.nhpco.org, then you know Deborah Randall as the very astute attorney who generously responds to a wide range of questions with very well-thought-out replies.
Most professionals think of telehealth as the remote gathering/storage and reporting of data such as weight, bp and pulse. There is significant cash outlay in setting up home monitoring systems for this, and training time needed to teach patients and families how to use the equipment. While “store and forward” technology such as this can be useful for home health, and longer-term conditions such as congestive heart failure, hospice involves so many emotional and emergent issues, not to mention short lengths of stay, that professionals have been resistant to considering it a viable medium.
Video conferencing, sometimes called “telemedicine,” is the real gem for high touch care. With a provider at one video camera, and a video camera in the home, real-time communication can occur between the patient/family and the staff (e.g., nurse, social worker, gcm…). In Kathy Duckett’s preliminary survey of telehospice providers around the country, she found that the patients and families LOVED having access to the professionals when they needed it.
Contrary to the professional’s fears of a cold delivery service, patients and families felt very connected and very well-cared for. To borrow a phrase from commerce, this was “just-in-time care,” i.e., the right care at the right time, available when they needed it and not cluttering up their lives much beforehand. I have also heard this reported at other sessions I have attended at other conferences. The resistance, sadly, seems to be on the part of providers.
Telehealth for low literacy folks. I was at the NAHC conference last fall where Mary Ann Rosa and Kathleen Pecinka of North Shore Long Island Jewish Health System talked about their low literacy CHF telemedicine demonstration program. They used an elegantly simple video patient station created by American Telecare, that had a detachable, round, handheld camera the size of a softball mounted on the top of the monitor. They could use it to look at edema, walk the patient through taking his/her blood pressure, etc. (The presenters stressed the advantages of a high resolution camera as it allowed them to do things like the read labels on the patient’s medicine bottles, or confirm the patient had drawn up enough medication in a syringe.) Simple instructions and a determined LACK of frills make this kind of telemedicine a promising approach for seniors and low income/education patients who have limited tech and literacy skills.
Other uses for the video option include the ability to deliver instructional videos on topics such as body mechanics and infection control in the home. You can certainly purchase professional videos, but there are other options. As Kathy Duckett pointed out, if our teenage kids can make videos in minutes, why can’t we? And the time and production costs do not need to be high.
For instance, consider turning on the camera when you teach the family caregiver specific home care skills. Set the web cam on a table with generally good visibility and record the session when you teach the family member how to use a draw sheet to turn the patient, or lift him/her higher up in the bed. You can leave that video for them to review again and again, whenever they need it. (We do these things in our sleep, but for family members, it’s all new information. Wouldn’t it be nice to have access to a refresher whenever they want? And it’s really no extra time on your part. Might even save a phone call down the line.)
Other times one might use video conferencing is to reduce hospital admissions. Let’s say the patient is having trouble breathing. This is a situation where family members often decide to go to the ER, resulting in costly hospital charges. Families report great anxiety and frustration trying to describe the symptoms over the phone. A handheld web cam could be taken to wherever the patient was sitting and the professional at the other end of the line could see and hear what was going on, offer suggestions, and watch/give feedback as family members implemented initial home-based strategies.
The potential for reducing hospitalizations/readmissions is not just wishful thinking. The team at the North Shore Long Island Jewish Health System reported a wonderful reduction in 30 day readmits, from 26% when they first started to 16% two years later.
Especially as we position ourselves to collaborate in the reduction of unnecessary hospitalizations, video conferencing has the potential to save money on several fronts. When you factor in the cost of penalties for hospitals and doctors, I believe it will be a cost-effective option for managing care at home, particularly for those at high risk for re-admission. If you are not yet partnered with a hospital or physician group willing to share the cost, consider approaching them. Bundled payments and accountable care organizations are on the horizon. Best to insert yourself as a partner now so you will be well-ensconced when the time comes.
And keep your eyes on Kathy Duckett and Partners Home Care. She has applied for a grant to study video conferencing and its ability to reduce hospitalizations in particular. The future is coming!
What are your thoughts about telemedicine?
Telehealth as you write here could be divided into two segments. Remote monitoring and communication. The use of any technology for “aging-in-place” circumstances requires a strategy (i.e. a criteria for effectiveness). The technology is the easy part, leveraging it for good is the hard part. An organization must have effective service delivery processes in place to support the use of either of these segments. The ability to enter the communication segment has a lower cost of entry, but requires a higher level of process/people definition. So study carefully your needs, evaluate the benefits, consider if your agency/organization can support these models and review if your clients have what is needed (electronically and skills) to benefit.
I agree completely! Any tips or resources you would recommend for helping folks to evaluate/strategize and set up their processes?
Tasha,
I will preface my comments that these recommendations are focused on home care/hospice agencies and senior living providers. Within these organizations hiring a consultant who has background in service design and process flows would be helpful. You are using a “systems” approach service delivery here.
You will also want someone who has experience deploying technology to assist with business processes. One option if you are working with nonprofit hospice or home care providers is to partner with business school to assist an organization. Some MBA programs with course work in systems engineering or Six Sigma could assist. The business skills will assist the customer segmentation and cost/benefit analysis.
Larger health care providers will often have staff with experience in these areas. The skills I reference are often a blend of training and experience. Sorry I cannot recommend a specific book or website. It is a blend of experience and training.
Thank you, Glenn, for your suggestions.
I did a quick Google search on “telemedicine infrastructure” and found this position paper, “Telemedicine Infrastructure Development,” from the Journal of Medical Systems: http://www.springerlink.com/content/7830645146001180/
Here’s the abstract:
While there are significant technical and regulatory barriers to developing an adequate infrastructure for telemedicine, even more fundamental organizational and financial infrastructure issues must be addressed if this technology is to realize its potential. The lack of good evaluative data on telemedicine consultations has been a further major stumbling block to its acceptance by both practitioners and policy-makers. This paper discusses these issues and suggests approaches for overcoming many of the impediments to telemedicine.
I’m not readily able to find a date on it. It costs $34 and appears to be only 4 pages long. But, if someone is serious about starting a telemedicine service, I think this might be a good first step to outlining the process side of the picture.
Anyone else have suggestions?
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