Wheres Waldo IEEE Advancing Technology for the Benefit
Where’s Waldo? IEEE: Advancing Technology for the Benefit of Humanity 1
U. S. CMS “Places of (Healthcare) Service” - Potential Remote Connected Care Locations Place of Service Code(s) 01 02 03 04 09 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 31 32 Place of Service Name Pharmacy ** Telehealth (facility) School Homeless Shelter Facility Prison/Correctional Facility Office (Provider office) Home Assisted Living Facility Group Home * Mobile Unit Temporary Lodging Walk-in Retail Health Clinic Place of Employment-Worksite Off Campus-Outpatient Hospital Urgent Care Facility Inpatient Hospital On Campus-Outpatient Hospital Emergency Room – Hospital Ambulatory Surgical Center Birthing Center Military Treatment Facility Skilled Nursing Facility IEEE: Advancing Technology for the Benefit of Humanity Place of Service Code(s) Place of Service Name 33 34 41 42 49 50 51 52 53 54 Custodial Care Facility Hospice Ambulance - Land Ambulance – Air or Water Independent Clinic Federally Qualified Health Center Inpatient Psychiatric Facility-Partial Hospitalization Community Mental Health Center Intermediate Care Facility/ Individuals with Intellectual Disabilities 55 56 57 58 60 61 62 65 71 72 Residential Substance Abuse Treatment Facility Psychiatric Residential Treatment Center Non-residential Substance Abuse Treatment Facility Non-residential Opioid Treatment Facility Mass Immunization Center Comprehensive Inpatient Rehabilitation Facility Comprehensive Outpatient Rehabilitation Facility End-Stage Renal Disease Treatment Facility Public Health Clinic Rural Health Clinic https: //www. cms. gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 2
U. S. CMS “Places of (Healthcare) Service” - Potential Remote Connected Care Locations Place of Service Code(s) 01 02 03 04 09 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 31 32 Place of Service Code(s) Place of Service Name Pharmacy ** Telehealth (facility) School Homeless Shelter Facility Prison/Correctional Facility Office (Provider office) Home Assisted Living Facility Group Home * Mobile Unit Temporary Lodging Walk-in Retail Health Clinic Place of Employment-Worksite Off Campus-Outpatient Hospital Urgent Care Facility Inpatient Hospital On Campus-Outpatient Hospital Emergency Room – Hospital Ambulatory Surgical Center Birthing Center Military Treatment Facility Skilled Nursing Facility Office Home Office Office Outpatient Office Hospital Outpatient Skilled Nursing 33 34 41 42 49 50 51 52 53 54 55 56 57 58 60 61 62 65 71 72 Place of Service Name Custodial Care Facility Hospice Ambulance - Land Ambulance – Air or Water Independent Clinic Federally Qualified Health Center Inpatient Psychiatric Facility-Partial Hospitalization Community Mental Health Center Intermediate Care Facility/ Individuals with Intellectual Disabilities Residential Substance Abuse Treatment Facility Psychiatric Residential Treatment Center Non-residential Substance Abuse Treatment Facility Non-residential Opioid Treatment Facility Mass Immunization Center Comprehensive Inpatient Rehabilitation Facility Comprehensive Outpatient Rehabilitation Facility End-Stage Renal Disease Treatment Facility Public Health Clinic Rural Health Clinic Nursing Outpatient Nursing Office Nursing Skilled Nursing Office Nursing Home Office Hospital Office Skilled Nursing Office https: //www. cms. gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set IEEE: Advancing Technology for the Benefit of Humanity 3
U. S. CMS “Places of (Healthcare) Service” - Potential Remote Connected Care Locations Code(s) 04 12 14 16 55 56 01 02 03 09 11 13 15 17 18 20 49 50 53 57 58 60 62 71 72 Place of Service Name Homeless Shelter Facility Home Group Home * Temporary Lodging Residential Substance Abuse Treatment Facility Psychiatric Residential Treatment Center Pharmacy ** Telehealth (facility) School Prison/Correctional Facility Office (Provider office) Assisted Living Facility Mobile Unit Walk-in Retail Health Clinic Place of Employment-Worksite Urgent Care Facility Independent Clinic Federally Qualified Health Center Community Mental Health Center Non-residential Substance Abuse Treatment Facility Non-residential Opioid Treatment Facility Mass Immunization Center Comprehensive Outpatient Rehabilitation Facility Public Health Clinic Rural Health Clinic Category Home Home Office Office Office Office Office Code Place of Service Name Category 32 Nursing Facility Nursing 33 Custodial Care Facility Nursing 41 Ambulance - Land Nursing 42 Ambulance – Air or Water Nursing 51 Inpatient Psychiatric Facility Nursing 54 Nursing 34 Intermediate Care Facility/ Individuals with Intellectual Disabilities Hospice 31 Skilled Nursing Facility Skilled Nursing 52 Psychiatric Facility-Partial Hospitalization Skilled Nursing 65 End-Stage Renal Disease Treatment Facility Skilled Nursing 19 Off Campus-Outpatient Hospital Outpatient 22 On Campus-Outpatient Hospital Outpatient 24 Ambulatory Surgical Center Outpatient 25 Birthing Center Outpatient 26 Military Treatment Facility Outpatient 61 Comprehensive Inpatient Rehabilitation Facility Hospital 21 Inpatient Hospital 23 Emergency Room – Hospital Nursing https: //www. cms. gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set IEEE: Advancing Technology for the Benefit of Humanity 4
Remote Connected Care - Continuum High Hospital ICU Immediate Care Connect via Central Station, Command Center, e. ICU Med. Surg ER Acuity LT Rehab Hospital Procedure Center Clinic Skilled Nursing Home Hospice Assisted Living Outpatient Office LTAC Nursing Home Post-Acute Care Transport to Care Connect via Surveillance Center, On Demand Consult Home Low Slower IEEE: Advancing Technology for the Benefit of Humanity Time to Care Faster
Remote Connected Care - Impact of Clinical Io. T High Hospital Med. Surg ER Acuity LT Rehab Hospital Procedure Center Clinic Office Skilled Nursing Home Hospice Assisted Living Home LTAC Nursing Home Hospice Assisted Living ICU ER LT Rehab Hospital Procedure Center Clinic Outpatient Office Skilled Nursing Home LTAC Nursing Home Post-Acute Care Home Low Slower IEEE: Advancing Technology for the Benefit of Humanity Time to Care Faster
IEEE: Advancing Technology for the Benefit of Humanity
“Remote” Monitoring - Continuum High Nurse Station Command Center Acuity Remote Monitoring Enhanced e. ICU Rehab Hospital Nursing Home Assisted Living Senior Housing Home ICU Room Home Low Slow IEEE: Advancing Technology for the Benefit of Humanity Time to Diagnose Fast
Remote Connected Care – Patient Flow and Care Locations • Currently patients are cared in a number of locations depending on acuity and length of expected stay. Outpatient Hospital Med. Surg Clinic Procedure Center ER Office LT Rehab Hospital Skilled Nursing Home Extended Family LTAC Senior Housing Hospice “Home” Home IEEE: Advancing Technology for the Benefit of Humanity ICU Post-Acute Care Nursing Home Assisted Living
Remote Connected Care – Future Patient Flow and Care Locations • With increased use of Remote Connected Care we will see: • • Home based care increasing substantially Outpatient care reduced Hospital care reduced Post-Acute care steady Outpatient Hospital Clinic Med. Surg Procedure Center ER LT Rehab Hospital Office Extended Family Skilled Nursing Home LTAC Senior Housing Hospice “Home” Home IEEE: Advancing Technology for the Benefit of Humanity ICU Post-Acute Care Nursing Home Assisted Living
Remote Connected Care – Patient Flow and Care Locations • Currently patients are cared in a number of locations depending on acuity and length of expected stay. Clinic (community, EHC, FQHC) Procedure Center Outpatient Hospital Med. Surg Acute specific Office (PCP, Specialist) Postacute Skilled Nursing Home LTAC Senior Housing recovery “Home” Home IEEE: Advancing Technology for the Benefit of Humanity ICU LT Rehab Hospital Episodic Extended Family ER Hospice Post. Acute Care Nursing Home Assisted Living
Remote Connected Care (RCC) – Future Patient Flow and Locations • With increased use of Remote Connected Care we will see: • • Home based care increasing substantially Outpatient care reduced Hospital care reduced Post-Acute care steady Outpatient Hospital Med. Surg Clinic Procedure Center ER Office Extended Family LT Rehab Hospital R C C M H Skilled Nursing Home LTAC Senior Housing Hospice “Home” Home IEEE: Advancing Technology for the Benefit of Humanity ICU Post-Acute Care Nursing Home Assisted Living
Remote Connected Care / MH – Interaction Paths • Watching… Episodic / Consulting PCP Office Specialist Office Continuous Monitoring Surveillance Center Remote ICU War-Room Central Station Room Vicinity Mobile • Watched… Skilled Nursing Home Extended Family Senior Housing Procedure Center “Home” Home IEEE: Advancing Technology for the Benefit of Humanity Med. Surg LTAC Hospice ER Nursing Home Assisted Living Surgi-Center LTAC ICU LT Rehab Hospital
Remote Connected Care Services • • • Pharmacy Radiology Laboratory Surgery Infusion Wound Care • • • IEEE: Advancing Technology for the Benefit of Humanity PT, OT, RT (Resp Therapy), Visiting Nursing PCA (Patient Care Assistant) DME logistics (wheelchairs, beds, walkers, etc. ) Mobile Health Apps “Visiting” Physician – remote consult Drone logistics AR, VR, MR, XR 14
Care Setting Monitoring via Respond by Home Remote surveillance & alert button EMT Office Remote consult & alert button EMT Nursing Facility LT PAC Remote surveillance & alert button Nurse / EMT Skilled Nursing Facility LT PAC Remote surveillance & alert button Nurse /EMT Outpatient Facility Treatment Center Remote surveillance & alert button Nurse /MD /EMT LT Rehab Hospital Hospice Local Monitoring / Nurse Call Nurse / MD / EMT AC Hospital - Remote e. ICU Continuous Monitoring / Nurse Call Nurse /MD / EMT AC Hospital - Stepdown Command Center Continuous Monitoring / Nurse Call Nurse / MD AC Hospital – Critical Care Nurse Central Continuous Monitoring / Nurse Call Nurse / MD AC Hospital - Isolation Outside Room Continuous Monitoring / Nurse Call Nurse / MD IEEE: Advancing Technology for the Benefit of Humanity Control
“Remote” Monitoring - Continuum • Patient in a licensed high-acuity care facility (hospital, etc. ) • • • e. g. Isolation Room Close to the patient room with limited or no view of the patient • e. g. Central Station / Nursing Station Patient in a licensed high-acuity care facility • • In the same hospital but outside of the Care Unit • e. g. Command Center / War-Room In a different campus or different city (e-ICU) Patient in ambulance/helicopter Patient in a licensed medium-acuity care facility (LTAC, etc. ) • Nursing staff available to assist patient Patient in a low-acuity facility (senior housing) • Unskilled staff available to patient and contact ambulance Patient in transport Patient at home • • Remotely monitored by hospital or 3 rd party independent surveillance service • Distinguish between caregiver type, who sets up… Patient reported outcome (PRO), Structured/Unstructured, Video call, IEEE: Advancing Technology for the Benefit of Humanity Acuity Decreases • • • Response Time Increases • Just outside of the patient room with a view of the patient
Care Setting Home Care Facility Low Acuity Hospital High Acuity Hospital Monitoring via Typical Staff Home Remote surveillance & alert button Non-professional Senior Housing Remote surveillance & alert button Non-professional Assisted Living Remote surveillance & alert button Nurse (1: 30) Nursing Home Remote surveillance & alert button Nurse (1: 20) Skilled Nursing Home Remote surveillance & alert button Nurse (1: 15) Hospice Remote surveillance & alert button Nurse (1: 15) Long-Term Acute Care Remote surveillance & alert button Nurse (1: 15) Short-Term Rehab Remote surveillance & alert button Nurse (1: 10) Long-Term Rehab Telemetry & nurse call MD & Nurse (1: 7) Ward Telemetry / Vitals monitoring / Nurse Call MD & Nurse (1: 7) Remote ICU (e. ICU) Networked Monitoring MD & Nurse (1: 5) ICU Command Center Networked Monitoring MD & Tech (1: 5) ICU Central Station Networked Monitoring MD & Nurse (1: 3) Outside ICU Room Network Monitoring MD & Nurse (1: 2) IEEE: Advancing Technology for the Benefit of Humanity Provider(s) Control
WELCOME Project: Io. T In-Home Remote Monitoring (Co. PD) WELCOME project website http: //www. welcome-project. eu/about-the-project. aspx IEEE: Advancing Technology for the Benefit of Humanity
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