Telehealth in the Home Setting Lessons Learned Presented

Telehealth in the Home Setting: Lessons Learned Presented by: HCR Home Care November 2, 2017 HCRhealth. com

Who We Are HCR Home Care is a Medicare-Certified home health care agency in 22 counties across upstate New York, established in 1978. North Country Expansion: HCRhealth. com 2012, 2014

HCR in the Adirondacks • In 2017, over 4, 000 patients will be admitted to our North Country agency • 75% of patients are admitted directly from a hospital • Most patients score high-risk for readmission using evidence-based tool • Our top medical diagnosis is COPD, followed by CHF HCRhealth. com

Our Telehealth Journey Ø In 2009, HCR secured a small grant from DOH to fund telemonitors Ø Small scale start up: 10 units Ø Expanded to nearly 200 units in use Ø “Standard of Care” for high-risk patients Ø Changed vendors to gain better reporting and integration with EMR Ø Began analyzing by Diagnosis … these are our lessons learned…. HCRhealth. com

Know Your Patient Population What goal are we trying to achieve? Ask this question first! Determine the patient population you are targeting: • High-risk/unstable/acute medical conditions • Chronic patients with a focus on improving patient engagement, health literacy, and disease self-management • Data will help you focus on the population that will yield the best results • Vendor selection, features, and the monitoring model should be influenced by the patient population that is your focus HCRhealth. com

Not Every Patient Will Benefit Won’t most high-risk patients benefit from telemonitoring? Analyze results by diagnosis: HCRhealth. com

Not Every Patient is Appropriate • Patient/caregiver must demonstrate appropriate cognition and understanding to use appropriately – Low income/low education/low literacy isn’t necessarily a barrier – Must have language options for non-English speaking patients • Telephone access/cell service/Wi-Fi are necessary for telemonitors • Homes with infestation or unsanitary conditions are not appropriate HCRhealth. com

The Model Makes a Difference Who will monitor the incoming data and information from the patient? The field nurse? Nurse supervisor? Centralized monitoring station? • Dedicated Nurse(s) in a centralized monitoring station: • • • Specialist nurses with expertise in disease management and triage; trained to manage the dashboard, escalate issues, collaborate with physicians Provide management of problems in real time View as co-case manager of the patient; work on solutions before escalating to a home visit Manage changes in medical orders and plan of care Need to be able to monitor (7) days a week including holidays Field RNs do not have time to effectively monitor their patients HCRhealth. com

The Nurse Makes a Difference Won’t we save money by using LPNs to monitor the incoming data? Don’t try to save $$ by placing the wrong nurse in the monitoring role: • • • Use a RN who can assess patient, triage, and revise the plan of care; LPNs cannot do this by licensure Strong acute care/cardiac skills; home care experience Good critical thinking skills Ability to multitask is crucial Must be able to work efficiently Strong customer service/communication skills; developing a relationship with patients and their physicians is a factor in success HCRhealth. com

There are Hidden Costs We got “free” telemonitors through a grant! YIPPEE? • Anticipate the many costs associated with a well-designed program: • Administrative costs for policy/procedure development, educational materials, staff education, etc. • Staff resources: visits have to be made to install units ‐ Will the visit nurse install? Consider extra time needed ‐ Will you schedule a non-billable visit and have non-clinical staff install? ‐ Consider direct ship to patient; consider shipping costs • • Have staff available to follow up and make visit when needed Salary/benefit cost needed for RN centralized monitoring HCRhealth. com

There are Hidden Costs • Understand costs associated with the inventory • • • You need accessories: phone cords, extension cords, carpet coasters, storage/transport containers, replacement peripherals, cleaning supplies • • • Units cost you whether in use or not…. do not let them sit on a shelf! Have a plan/person to manage inventory: deploy, recover, refurbish, re-deploy in minimal time Inventory is easily lost and needs to be replaced on a regular basis Space and personnel will be needed for isolating, cleaning, sanitizing, quality control Refurbishing fees, lost units and shipping/handling costs show up in monthly bills Understand the costs of monitoring: staff costs (including weekends/holidays), space needs, desktop computers, dual screens Getting monitors is not a “program” – Consider costs to support your data analytics needs and quality improvement process and plan HCRhealth. com

It’s Only a Tool in the Toolbox If we invest in Telehealth, won’t it fix our readmission problem? Telemonitoring can be beneficial to specific patients/populations, but is only one of the options we employ to help reduce readmissions: • Predictive analytics home calls program ‐ Advanced analytic platform intended to identify likelihood of return to hospital ‐ Automatic phone calls with disease-specific/symptom-specific interview “prompts” - 5 times per week (works well with patients not needing daily monitoring of Vital Signs) ‐ Lower cost and better suited for COPD patients • High risk visit protocol ‐ Front loaded visits in the first couple of weeks ‐ Smart-scheduling visits among disciplines to increase clinical contacts • Afterhours triage and on-call rapid response HCRhealth. com

Communicate with Stakeholders Won’t everyone be impressed we have Telehealth? Communicate early and often with others to get buy-in and avoid failure: • Staff • • • Patients • • Obtain staff input on program design; teach staff how to communicate with MD Ongoing education/in-services to share data, success stories Foster patient involvement in own care vs. enabling or making patient dependent on units Physicians • • Use of telehealth will increase need for contact with Physician – educate offices in advance on goals and benefits of program; you need the MD Order! Discuss how/when will physician want to receive information Discuss VS parameters and possible standing protocols to manage changes in condition Physician portal and/or fax patient reports and trending prior to office visit HCRhealth. com

Trend Report for MD HCRhealth. com

Trend Report for MD HCRhealth. com

Symptom Report for MD HCRhealth. com

Telehealth: It’s Not This…. . HCRhealth. com

The Value is in the Dashboard Hourly email notifications provided when care escalations require your attention Client Partner Telehealth Champion <<Client Name>>. cardiocom. com application. HCRhealth. com

Patient Screen HCRhealth. com

Care Coordination 4/24/14: Reviewed weight and symptom trends. Communicated proper use and protocol of PRN diuretic with patient. Patient scheduled for follow-up in HF Clinic tomorrow 4/25/14. Provider Visit Scheduled HCRhealth. com

Summary A telehealth program can be a targeted solution to help manage patients, however, assessing your organizational readiness, prior to an investment, is essential. HCRhealth. com

Contact Information Elizabeth Zicari, RN BSN CENP ezicari@hcrhealth. com Kari Charette-Furnia, RN BSN kfurnia@hcrhealth. com Kris Smith, RN COS-C ksmith@hcrhealth. com HCRhealth. com