Home Telehealth Trial Produces Big Savings

This article is excerpted and adapted from Home Is Where the Health Is, published in 2014 by Great Lakes Caring Hospice and Home Health. For more see www.greatlakescaring.com.

To address the future of healthcare, traditional healthcare provider channels must change to reduce cost, improve quality, increase positive patient outcomes and mitigate provider risk. In order to build these benefits into the healthcare system, the location of care must be considered. It may be that we should turn back to our historical origins and consider that healthcare may be better positioned in the home.

There are several critical factors necessary to provide effective healthcare in the home. These include the use of emerging technologies for the coordination and delivery of quality healthcare, including the use of real-time electronic medical records, and specialty programs and processes designed utilizing technology and patient- and physician-specific protocols as a way of increasing the quality of the patient experience and reducing risk factors.

Emerging Technology and EMRs

The proliferation of healthcare technology, both medical equipment and computer software, has contributed to the increase in medical care that can be provided in the noninstitutional or home environment. Prior to these advances, providers in the home environment lacked coordinated communication across the medical community. To accurately diagnose, treat and document patient care in a collaborative system was difficult even in best-case scenarios. Effective coordination related to a patient’s care plan is a critical driver for high-quality, cost-effective care and the best possible patient outcomes.

Since 2000, Great Lakes Caring Hospice and Home Health’s next-generation clinical care delivery system has driven a coordinated model. Key to this system is a central information technology platform comprising multiple interdependent technologies. The primary technologies employed in the system include:

• Mobile point-of-care devices—These provide the primary data entry point for patient condition and medical treatment in the home during patient encounters. 

• Wireless communication technology—This system transmits real-time patient data directly to a central medical record repository with all information as part of the patient’s electronic medical record. All information is transferred while the clinician (in this case the nurse) is in the patient’s home.

• Web-based medical record software—The Web-based medical records system operates in real time, providing home care clinicians with immediate information necessary to monitor and manage patient care.

• Sophisticated Voice over Internet Protocol (VOIP)—This telecommunications management software reroutes calls from any local office to a central patient care center for 24-hour coverage without changing patient behaviors.

When properly implemented, these four technologies allow for the best possible patient care experience at any time of day using the most up-to-date and accurate patient information.

Disease-Specific Equipment: Telehealth

Among the most contributory advanced devices for the provision of healthcare in the home is telehealth equipment.

Great Lakes Caring uses the Honeywell HomMed telehealth monitoring system. The HomMed system is a combination of advanced communication technology and health monitoring equipment kept in the residence to collect vital information and clinical data regarding the patient’s condition on a daily basis. This data is transmitted via a standard telephone connection or other wireless/digital telecommunication network to GLC’s central office, where a specially trained clinician monitors and reviews the data being updated.

If the data shows unexpected readings, the clinician may send a nurse to assist the patient or contact them with instructions to remonitor, or the clinician may contact the patient’s physician or emergency personnel directly, depending on the severity of the issue. GLC recommends use of the HomMed system for patients who have been discharged from care facilities or diagnosed with chronic or comorbid conditions, such as congestive heart failure, COPD or fall risk.

Results of Telehealth Pilots

In 2011, in preparation for the looming payment reductions and associated penalties for patient readmission within 30 days of discharge from the hospital, GLC initiated seven specific hospital-based pilot programs focused on hospital readmissions—specifically for COPD and CHF.

The hospitals in the program encouraged their CHF and COPD patients to select GLC as their home health provider. Upon admission to GLC, each CHF and COPD patient was assessed, and telehealth units were installed in their homes. The patients were educated on the units and instructed to monitor with the equipment each day.

Vital signs—heart rate, blood pressure, SpO₂, ECG (leads 1 and 2) and weight—were recorded, and the patients answered a series of “yes/no” questions specific to their CHF or COPD condition. Results were transmitted back to the GLC Telehealth Division and evaluated by telehealth specialty nurses. Any metrics outside the parameter ranges set for the patient resulted in an “alert,” and the patient was called and the alert reason reviewed. All alerts and nurse interactions were documented in the EMR.

When necessary, the telehealth nurse facilitated dispatch of the patient’s case management nurse. The ability to review both subjective and objective empirical data immediately at time of patient discomfort allowed for the proper intervention. In the majority of cases, a visit to the emergency room or resulting rehospitalization was avoided.

For the seven participating hospitals, the prepilot baseline rehospitalization rate for CHF and COPD patients was approximately 45%. In the first 18 months of the pilot program, 344 patients were admitted to GLC from the seven hospitals. Of these, 175 were identified as having CHF or COPD and monitored; of those only 12 patients were rehospitalized, representing a rehospitalization rate of 7%. Assuming baseline hospitalization rates at an average cost of $8,500, the total cost of care for these patients would have been $671,500. The cost of rehospitalizations for the pilot program was $102,000, representing a total savings of 85%.

Additionally, any potential hospital-acquired infections were avoided. It is important to note that the results of the study were not a driven by an increase in the utilization of home health, but rather by the selection of a home health provider with a dedicated rehospitalization program utilizing advanced technologies.

Of those agencies utilizing telehealth, more than 88% indicated it had an impact on improving the overall quality of services provided. At the same time, more than 71% indicated an improvement in overall patient satisfaction with telehealth. Patient satisfaction is increased as long as telemedicine does not entirely replace the traditional, face-to-face visits patients have with their doctors and as long as privacy safeguards are maintained.

The inclusion of specialty programs is pivotal in delivering high-quality, low-cost healthcare in the home. By establishing carefully driven protocols designed to include highly effective care modalities, the healthcare provider provides a customized, quality-driven care plan. 

Take-Home Points

• Reducing cost and improving quality may necessitate bringing some elements of healthcare back to patients’ homes.

• Multiple technologies facilitate this, including mobile point-of-care devices and wireless communication technology.

• A telehealth trial in Michigan cut rehospitalization rates from 45% to 7% and reduced associated spending by 85%.

William Deary is CEO of Great Lakes Caring Hospice and Home Health.

Adam Nielsen is vice president of corporate strategy and business development for Great Lakes Caring Hospice and Home Health.