Earlier this week I attended a meeting of the New England Health Information Management Systems Socitey (NEHIMSS) about use of mobile technology in health care, including home care. The session, delivered by Dr Fernando Martinez, focused on hospital systems and issues of security and cost as well as quality of care. But I was again struck by the importance of the data collected by home care workers and the potential to improve health outcomes, reduce cost, raise patient quality of life, and lower the stress of family caregivers if the data is documented and followed by either an educated lay person (family member or non-medical case worker), so that earlier intervention can eliminate hospital stays.
Hospitals are heavily focused today their 30-day readmission rates. If patients have to return to the hospital within 30 days of discharge, hospitals lose a lot of money, due to regulations that have recently gone into effect via the Afforable Care Act (ACA, or Obamacare). But sending nurses to patients for follow up is expensive, and often the relevant data can be collected (not diagnosed, but collected and reported) by family members or home care workers, especially CNAs. This doesn't even need to be biometric data (blood pressure, insulin levels, etc.).
Readers of this blog know that we have for years been using the Connected Home Care family web portal, which we developed precisely so that we can improve care by getting more data to family and agency decision-makers faster. Caregivers post reports after every visit, and can easily document many factors that indicate a need for early intervention that can avoid a hospitalization. Here is a list of factors we watch so that we can escalate quickly rather than allow health to deteriorate:
- Lack of compliance physician’s with Plan of Care
- Failure to follow prescribed med regimen
- Increased difficulty with mobility
- Changes in appetite or energy
- Unresolved skin conditions or respiratory ailments
- Confusion, sleeplessness, or mood changes
- Increased rising from bed at nighttime for bathroom trips
- Reduced capability with Activities of Daily Living (ADLs)
Without remote, mobile access, these conditions typically go unreported to a decision-maker for a week or more. But posting this in a secure report allows family and case managers to monitor conditions far more closely. Accountable Care Organizations (ACOs) and hospitals should press their software system suppliers to include features like this that allow the patient, family, and other authorized users to post data on patient status for review and, when indicated, action by the health care provider. The benefits are clear, the cost is low, and the technology is available -- indeed, we have been using it in the field since 2009.
