LeadingAge Magazine · July/August 2014 • Volume 04 • Number 04

How Telehealth Can Improve Efficiency, Convenience and Outcomes

June 24, 2014 | by Dianne Molvig

Telehealth technologies are key to the more decentralized, community-based provision of care that will define the future of aging services. Here is a look at how some providers are using telehealth to streamline operations and better coordinate care.

Technology is having an enormous impact on where and how people live out their older years. Indeed, technology is what’s enabling many seniors to even have such choices.

Last year the LeadingAge Center for Aging Services Technologies (CAST) published a report, “Telehealth and Remote Patient Monitoring: Provider Case Studies 2013,” that examined the use of telehealth and remote patient monitoring technology in six organizations. Here is a look at how things have progressed for three of those organizations.

People who use telehealth and remote patient monitoring at home are big fans of the technology, according to the experiences of Centura Health at Home, Englewood, CO. Telehealth and remote monitoring provide older people “an emotional safety net,” says Erin Denholm, senior vice president of clinical transformation for the Centura Health system.

“Some people even give names to their monitors,” she adds. “They’ll say, ‘Harry doesn’t like what I’m doing today.’ They especially love being able to talk to a nurse whenever they have an issue. They like everything about this technology, especially if they live alone.”

About 300 Coloradans residing in Denver, Colorado Springs, Pueblo and Durango now benefit from having the smaller-than-toaster-sized Cardiocom® COMMANDER FLEX monitors in their homes.

Originally, the program issued monitors solely to people who met the eligibility requirements for home health care. The goal was to reduce rehospitalizations and improve patients’ quality of life.

Results were positive. For instance, a study found that patients receiving telehealth home care had a 6.28% rehospitalization rate, compared to an 18% rate for traditional home care patients.

Since then, the telehealth program at Centura Health has expanded its focus to cover more people. Now the remote monitoring devices also go out to individuals who don’t qualify for home health care, but who may be at risk for having a serious health-related episode. Telehealth thus becomes a tool for preventative care.

“We can do risk stratification and predictive modeling to identify people who are at risk for emergency room visits or hospitalization,” Denholm explains. “We can say to them, ‘Based on the information we have about you, we think you may be at risk for a downward spiral in your health.’ We can be proactive and put the monitor in people’s homes to help them stay healthy and continue to live independently.”

In another development, Centura Health has worked with the Colorado Center for Nursing Excellence to design nursing education. This includes telehealth training modules targeted to home care nurses.

“Technology and virtual nursing are not taught as a rule in typical nursing education,” Denholm says. “So this kind of training has to be provided on the job to home care nurses.”

Success with WoundRounds®, a telehealth wound documentation and reporting system, has led Presence Health, Mokena, IL, to expand its use from one 51-bed nursing home to all 20 of its skilled nursing communities, or “ministries” as Presence Health prefers to call them.

Residents are at extremely high risk for pressure ulcers, says Beth Florczak, director of quality assurance and performance improvement. “They have multiple risk factors,” she explains. “WoundRounds makes a big difference in their quality of life.”

She reports high satisfaction with the system. “Some vendors try to ‘boil the ocean’ and do too much,” she says. “But this is a highly targeted solution for a particular area of great clinical concern and risk.”

Resistance to using the technology was an issue at first among nursing staff when Presence Health did a beta test of the system in 2005. But that has lessened greatly as people have become more comfortable with various technologies in their lives. For instance, “they have embraced their smart phones,” Florczak says, “and that’s made a big difference for us.”

Nurses have seen proof of how WoundRounds guides them, not dictates to them, in meeting the desired standard for wound care. “And from a corporate perspective,” Florczak says, “we get a picture of how we’re doing. Are we cost-effective per wound? What’s our time to healing? The technology gives us a much better understanding of what’s happening at the bedside.”

The system gathers data that not only helps guide treatment, but also spots problems early. “We can see how we’re doing globally in our organization,” Florczak says, “and drill down to the individual resident.”

In addition, WoundRounds reduces the staff’s wound documentation burden, which used to devour many hours. That has “decreased precipitously,” Florczak says, to allow nurses more time for other important duties.

A key lesson learned in using this technology is that it shouldn’t be put in the hands of just anyone. Clinicians “must have demonstrated competence in its use,” Florczak says, “and they have to be passionate about caring for pressure ulcers. Otherwise, they might misclassify or mis-stage a wound. That puts everyone at risk, and the resident might get the wrong treatment.”

Each nursing home has at least one wound-care-certified nurse who is in charge of using the system in that facility. He or she can train others who are motivated to learn. “We call them champions,” Florczak says. “They’re nurses who are high performers and do a good job. They want to get that additional skill set.”

In roughly four years, telehealth and remote patient monitoring have averted 1,858 hospital readmissions, for an estimated savings in hospitalization costs of at least $10 million, for Lee Memorial Health System, Fort Myers, FL.

Preventing a rehospitalization episode is termed a “save.” As just one example, remote monitoring indicated that a patient at home had normal blood pressure readings for several days, but then those started to climb. He began testing himself repeatedly day and night, and his readings continued to rise.

He seemed to be working himself into a state of anxiety prior to his upcoming doctor visit. The telehealth team intervened, advising the man to stop testing until he saw his doctor. They also sent the man’s blood pressure data to his regular doctor. The latter ultimately referred the man to a cardiologist, who prescribed a new medication.

The patient’s blood pressure “was back to normal the next day,” reports Cathy Brady, clinical manager of lifeline and telehealth for Lee Memorial Health System Home Health. “Before we intervened, he was on his way to a stroke.”

Lee Memorial has 250 Honeywell HomMed remote monitors that get distributed to patients with cardiac problems, chronic obstructive pulmonary disease (COPD) and other conditions. About 11,750 people have benefited from using this technology in the program’s four-year history.

Initially, clinicians in the field had to refer patients to the telehealth program. But the program since changed its approach in order expand its patient base.

“Now our telehealth nurses look at the home health admissions on a daily basis,” Brady says, “to determine which patients have a diagnosis that indicates the need for telehealth. We will install the equipment in the patient’s home unless the field clinician feels it’s not a good idea.”

A key challenge is to do a better job of explaining telehealth and remote monitoring to patients. “Some may think they have to wear something like a monitor on their chest,” Brady says. “They get confused and don’t want to fool with it.”

Plus, Brady explains, patients admitted to home health who have just been in the hospital are eager to go home and not be bothered. “We can do better at explaining the equipment, and do it sooner, so people will be more receptive,” Brady says.

Also critical is communicating enough with field clinicians about the successes of the telehealth program. Brady has started doing presentations at staff meetings to share stories about results. “I think that’s been helpful,” she says, “because then people feel proud of what we’re doing in the program.”


From the editor: LeadingAge’s Center for Aging Services Technologies (CAST) has developed a pair of Technology Selection Tools to help aging-services providers learn more about—and choose—telehealth and remote patient monitoring (RPM) tools or electronic health record (EHR) packages.  Each tool is a portfolio that includes: a white paper on planning and choosing products; a selection matrix of systems available; a selection tool to help narrow choices in keeping with an organization’s needs; and a set of case studies.  A similar portfolio of tools on medication management technologies will be released this fall.

 

Imagine if an ordinary television set could be transformed into a remote health care management system. This idea has gone beyond the imagining stage with the introduction in January of the Pathways to Health system.

In this pilot program, a home gateway solution from Panasonic is connected to regular televisions in people’s homes. The television then becomes a portal to monitor patients’ health and communicate with them from a remote location, where health care providers receive an ongoing stream of patient information.

The pilot is a collaboration of Panasonic Corporation of North America and Jewish Home Lifecare, which serves older New Yorkers residing in Manhattan and the Bronx.

Health care providers remotely monitor vital signs, conduct interactive clinical dialogues with patients and provide health education. Preliminary results show reductions in hospitalizations and emergency room visits.

What’s more, the system has gained highly positive reviews from patient users. Regina Melly, senior vice president of business development at Jewish Home Lifecare, says more than 97% of participants reported positive experiences with Pathways to Health. And 100% said the system helped them to better manage their health and feel safer at home.