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Hospital-at-Home Programs: The New Frontier for Treating Chronic Conditions

Home Blog Hospital-at-Home Programs: The New Frontier for Treating Chronic Conditions

Hospital-at-Home Programs: The New Frontier for Treating Chronic Conditions

With hospitals strained to their breaking points with COVID patients and people across the country wondering whether it was wise to go to the emergency room, many systems turned to hospital-at-home programs as part of the solution.

Remote monitoring and telehealth tools effectively extended the triage process for COVID patients into the patients’ own homes, easing the burden on hospitals and helping make sure only the patients who were most sick came in to get care.

Now, the growing hospital-at-home model is showing promise for addressing another critical health problem, one that is the single biggest driver of U.S. healthcare costs and mortality: chronic conditions.

According to the Centers for Disease Control and Prevention, 90% of healthcare spending is on patients with chronic and mental health conditions. Moreover, chronic diseases such as cardiovascular disease, diabetes, and chronic obstructive pulmonary disease are responsible for more than seven out of 10 deaths in the United States and are the leading cause of disability.

Despite widespread awareness of this problem, the healthcare system has struggled to find an effective approach to chronic conditions in part because healthcare accounts for only 10 to 20% of populations’ health outcomes.

Social determinants of health — the environmental conditions in which people live and work — play a much bigger role in causing and reinforcing chronic conditions.

By combining telehealth with a care-at-home program, hospital systems can begin to develop an awareness of and data on patients’ environmental circumstances.

“Normally it’s hard to uncover data on social determinants of health. But we think that telehealth will make collecting this data a little bit easier,” explained Peter McLain, Caregility’s Chief Strategy Officer and SVP of Business Development.

Vision for the future of care for chronic conditions

In the near future, care for those with chronic disease will rely not only on social determinants data but also patient data points that go well beyond the standard measurements of blood pressure, weight, and blood oxygen levels to include other relevant physiological data — all of these gathered from hospital at home products.

Meanwhile, telehealth home care will provide the connective platform to leverage that data through the patient’s entire care journey.

Using these health records and the information gathered during the initial consultation, providers will be able to create a personalized care plan for the patient, automatically generate customized workflows, and schedule video check-ins that correspond to the care plan.

Meanwhile, with the patient at home, remote telehealth devices or hospital-at-home equipment will be able to collect new patient data and automatically transmit it through the platform.

A combined hospital-at-home and telehealth program will allow providers to conduct video appointments via the telehealth platform and then use those appointments to gather information about the patient’s social and environmental circumstances, such as the patient’s transportation options, proximity to grocery stores selling healthy food, and the safety of the local neighborhood.

The patients would also get an easy-to-understand overview of their health via a patient dashboard. If the patient for any reason was beginning to deteriorate, that would set off an alarm or notification, and the provider could initiate a video call with the patient to investigate further and get the patient back on track.

In short: a robust telehealth hospital-at-home program would facilitate preventive care that nips problems in the bud.

Telehealth home health care for chronic conditions would be efficient and effective

Another advantage of care-at-home models is that providers could check on more patients via video per day than they would be able to see if traveling to different nursing homes and assisted-living facilities.

In addition, a platform that incorporates social determinants of health data would enable providers to more effectively guide patients toward better health. Specifically, the social determinants data would reveal factors that were impeding patient compliance with the care plan.

For example, if the patient wasn’t following a recommendation to eat a plant-based diet, environmental data might reveal that the patient lived in a so-called food desert, where access to healthy food is limited. To address this problem, the care team could identify a program or service that delivers healthy food to the patient’s home.

Or, if the patient lacked transportation to a pharmacy, the care team could arrange for low-expense mail-order prescriptions.

In other words, the care model would enable a holistic approach to care that eliminates barriers to good health and even reverses chronic diseases.

Learn more about how we’re building the future of care for chronic diseases

If you’re interested in learning more about this new hospital-at-home model, please contact us.

As McLain explained, “The paradigm of care for chronic conditions has shifted to a telehealth model, and this new frontier is wide open for innovation.”

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Ease of Use: What Does It Mean, Really?

Every telehealth vendor will claim their telehealth solution is easy to use — but how many have truly designed their platform for both patients and providers? And how many telehealth vendors have recognized the myriad constraints of different clinical environments, including during the pandemic, and chosen designs that address these challenges?

We recently created an eBook that provides a deep dive on ease of use in telehealth, including concrete examples of how a well-designed user experience in telehealth technology can address clinical challenges.

Below we share a few of the eBook’s critical concepts and insights:

The pandemic introduced three principal constraints in using telehealth technology

During the pandemic, hospitals and providers have faced three principal challenges in implementing and scaling up telehealth technologies:

  1. Constraints facing clinicians
  2. Constraints facing patients
  3. Constraints inherent in clinical facilities themselves

To achieve true ease of use, telehealth solutions must address all of the above categories.

For example, an effective telehealth solution must address the challenge that clinicians have to continually monitor patients with COVID-19.

Similarly, a telehealth solution must consider that patients with COVID-19 often have very limited energy (or are completely incapacitated) and thus need a very simple telehealth interface that, when necessary, can function without the patient having to do anything.

In addition, given that patients with COVID-19 are often isolated from family and friends, it’s critical to patients’ morale that they have an easy means of communicating and connecting with loved ones.

Ease of use is also critical in responding to a facilities challenge that has arisen during the pandemic: specifically, many hospitals have had to repurpose existing spaces, such as gift shops and conference rooms, into patient rooms.

A telehealth technology that requires a time-consuming installation would not be ideal when trying to quickly set up these converted spaces.

What user-friendly telehealth looks like from the perspective of patients

Given the fatigue many patients experience, the interface on telehealth technology must be intuitive and clear.

For example:

In this example of an easy-to-use mobile telehealth interface, there is one large red button for help, and one large green button to reach family and friends.

With just that one button, the interface automatically routes the call to the correct pre-programmed party. There’s no need for the exhausted patient to remember phone numbers, punch in numbers, or go through several screens.

Another design choice that contributes to ease of use for telehealth technology is not requiring a patient’s family to download a specialized app to interact with the patient. Instead, the patient’s family can receive a video call from the patient simply by clicking a link in a text.

Practical examples of telehealth that is easy to use for providers

Just as user-friendly telehealth technology must anticipate a patient’s constraints, so must it address a provider’s needs.

For example, providers sometimes need to communicate with a patient who is too weak to pick up a video call request from a provider. That’s why a feature like auto-answer at the patient’s bedside is key.

Or consider a provider who needs to remotely monitor a patient at night when the lights in the patient’s room are dimmed or off. A telehealth solution that shows the provider only a darkened room wouldn’t be of much use. But a camera with night-vision will enable the provider to watch the patient, while enabling the patient to properly rest in the dark.

Overcoming facility challenges

With so many hospitals having to repurpose spaces as hospital rooms, imagine if a telehealth technology required drilling through drywall to mount specialized cameras and monitors. That would not be an easy-to-use system.

Instead, ease-of-use means that the telehealth technology is device agnostic. It can work on smartphones and tablets, or simple carts with small cameras and screens can be rolled into a room.

The telehealth technology should also be reliable but able to reduce its wi-fi use when feasible to preserve bandwidth for other critical network-connected devices.

Ease of use in telehealth saves time

When a telehealth solution takes into account all of these real-world issues and others, its ease of use facilitates quick care, and fast, efficient care in a hospital setting can often be the difference between life and death.

If you’re interested in reading more about how telehealth design choices facilitate ease of use and promote effective care, you can download our eBook What Ease of Use Really Means in Telehealth.

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Understanding Telehealth Security Risks: Six Ways to Evaluate Video Solutions

Virtual observation systems are rapidly gaining traction in a variety of healthcare settings, serving as a first line of defense for at-risk patients by alerting clinical staff so they can quickly intervene. This technology also drives workflow efficiency by freeing up clinical staff — who might otherwise be assigned to sit and monitor patients in-person — to perform other tasks.

Patient bedside systems can be portable wireless units or permanent installations that consist of a video camera and two-way audio that transmits to a central monitoring station. Cameras can tilt, pan, zoom, and utilize night vision technology when lighting is dim. Each monitoring station is typically staffed by a trained virtual sitter, often a nurse tech, who watches up to 10 to 12 patients at a time. The observer can centrally observe a group of patients either within a single facility or across multiple facilities.

Virtual Patient Observation: Common Applications

Common applications for virtual observation include:

  • Rapid response
  • Fall prevention in hospitals
  • High-risk patient monitoring (harm to self, harm to/from others)
  • NICU observation
  • Telestroke management
  • Patient transfers

Not all patients are viable candidates for virtual observation. Typically, a patient’s nurse and clinical staff will determine if a patient meets the criteria for virtual observation by considering a variety of factors and asking questions such as: Is the patient re-directable? Does the patient have low impulsivity? Is the patient able to hear and comprehend verbal direction?

If the answer to any of the above questions is “no,” the patient may instead benefit from having a physical sitter in the room.

8 Things to Look for in a Virtual Observation Solution

If you’re considering implementing virtual patient observation technology within your organization, you’ll want to make sure that the solutions you’re considering have the capabilities you’re looking for. Make sure to ask potential vendors about these features:

  1. Does the system have one-way or two-way audio and/or video capability? In some situations, you may want to talk to a patient without using two-way video. Or you may want only one-way video capability (for example, if you want to observe the patient, but don’t need them to be able to see the remote observer).
  2. Does the camera have pan, tilt, and zoom capability?
  3. Is there an alerting/notification system to bring someone to the bedside quickly, if needed?
  4. Does the camera have night vision capabilities so that you can clearly observe patients when the room is dark?
  5. Does the system offer language translation? Which languages? This doesn’t work for two-way communication but can be helpful for simple instructions like telling the patient to stay in bed while a nurse is alerted.
  6. What types of reporting and analytics does it provide to help you demonstrate ROI back to your organization?
  7. Can the software be delivered with a cart or a wall system? Can the hardware be installed from the ceiling or the wall, or wherever you need it to be, based on your room configuration? If you already have certain technology, such as camera capability, in the room can the software integrate easily into your existing telehealth system? Or, will you need to use a different device for each application?
  8. Is the technology scalable? What additional costs might there be if you want to scale the solution across multiple facilities? What are the applicable licensing fees?

How to Tell if Your Organization Can Benefit from Virtual Patient Observation

The decision to use virtual observation technology must be made by carefully evaluating the needs of your patients, staff, and organization. How do you see the technology being implemented within your organization or facility? Do you have existing technology that might be integrated with new virtual observation software?

Here are some additional questions to consider if you are evaluating a virtual patient observation solution for your organization or facility:

  1. What is our current daily/monthly/annual spend on physical sitters?
  2. What are our current fall rates per patient day?
  3. Are there other use cases that we might be able to leverage with the technology?
  4. Are there issues with inappropriate transfers from outside locations?
  5. What is our ICU bounce-back rate?
  6. What is our post-acute hospital readmission rate?

From night-vision features to language translation services, there are key capabilities to be mindful of as you lay out your virtual care and observation strategy.

Download our white paper Considering Virtual Observation for Your Healthcare Organization, for more detail on key factors to consider when identifying the right virtual observation solution for your healthcare organization.

Learn More

Virtual Observation: Practical Application and 8 Things to Look for in a Solution

Virtual observation systems are rapidly gaining traction in a variety of healthcare settings, serving as a first line of defense for at-risk patients by alerting clinical staff so they can quickly intervene. This technology also drives workflow efficiency by freeing up clinical staff — who might otherwise be assigned to sit and monitor patients in-person — to perform other tasks.

Patient bedside systems can be portable wireless units or permanent installations that consist of a video camera and two-way audio that transmits to a central monitoring station. Cameras can tilt, pan, zoom, and utilize night vision technology when lighting is dim. Each monitoring station is typically staffed by a trained virtual sitter, often a nurse tech, who watches up to 10 to 12 patients at a time. The observer can centrally observe a group of patients either within a single facility or across multiple facilities.

Virtual Patient Observation: Common Applications

Common applications for virtual observation include:

  • Rapid response
  • Fall prevention in hospitals
  • High-risk patient monitoring (harm to self, harm to/from others)
  • NICU observation
  • Telestroke management
  • Patient transfers

Not all patients are viable candidates for virtual observation. Typically, a patient’s nurse and clinical staff will determine if a patient meets the criteria for virtual observation by considering a variety of factors and asking questions such as: Is the patient re-directable? Does the patient have low impulsivity? Is the patient able to hear and comprehend verbal direction?

If the answer to any of the above questions is “no,” the patient may instead benefit from having a physical sitter in the room.

8 Things to Look for in a Virtual Observation Solution

If you’re considering implementing virtual patient observation technology within your organization, you’ll want to make sure that the solutions you’re considering have the capabilities you’re looking for. Make sure to ask potential vendors about these features:

  1. Does the system have one-way or two-way audio and/or video capability? In some situations, you may want to talk to a patient without using two-way video. Or you may want only one-way video capability (for example, if you want to observe the patient, but don’t need them to be able to see the remote observer).
  2. Does the camera have pan, tilt, and zoom capability?
  3. Is there an alerting/notification system to bring someone to the bedside quickly, if needed?
  4. Does the camera have night vision capabilities so that you can clearly observe patients when the room is dark?
  5. Does the system offer language translation? Which languages? This doesn’t work for two-way communication but can be helpful for simple instructions like telling the patient to stay in bed while a nurse is alerted.
  6. What types of reporting and analytics does it provide to help you demonstrate ROI back to your organization?
  7. Can the software be delivered with a cart or a wall system? Can the hardware be installed from the ceiling or the wall, or wherever you need it to be, based on your room configuration? If you already have certain technology, such as camera capability, in the room can the software integrate easily into your existing telehealth system? Or, will you need to use a different device for each application?
  8. Is the technology scalable? What additional costs might there be if you want to scale the solution across multiple facilities? What are the applicable licensing fees?

How to Tell if Your Organization Can Benefit from Virtual Patient Observation

The decision to use virtual observation technology must be made by carefully evaluating the needs of your patients, staff, and organization. How do you see the technology being implemented within your organization or facility? Do you have existing technology that might be integrated with new virtual observation software?

Here are some additional questions to consider if you are evaluating a virtual patient observation solution for your organization or facility:

  1. What is our current daily/monthly/annual spend on physical sitters?
  2. What are our current fall rates per patient day?
  3. Are there other use cases that we might be able to leverage with the technology?
  4. Are there issues with inappropriate transfers from outside locations?
  5. What is our ICU bounce-back rate?
  6. What is our post-acute hospital readmission rate?

From night-vision features to language translation services, there are key capabilities to be mindful of as you lay out your virtual care and observation strategy.

Download our white paper Considering Virtual Observation for Your Healthcare Organization, for more detail on key factors to consider when identifying the right virtual observation solution for your healthcare organization.

Learn More

Virtual Sitters: How Hospitals are Protecting Patients While Keeping Costs Down

Today, hospitals and healthcare systems need to innovate in order to do more with less by providing exceptional patient care without overstretching their resources. One way that hospitals have improved patient care and reduced costs is through virtual patient observation, or virtual sitters.

Patient sitters traditionally provided in-room support to patients at risk of falling, injury, self-harm, or other behavioral issues. But, providing a physical sitter in each room can amount to a hefty unbudgeted expense for healthcare organizations.

Thanks largely to recent advancements in telehealth, virtual patient observation has emerged as a cost-effective alternative to the use of live patient sitters. These camera-based e-sitters help hospitals overcome financial hurdles while improving patient safety. The real-time remote monitoring solutions enable clinical staff to simultaneously support higher numbers of at-risk patients via two-way video and audio feeds.

Virtual sitting can reduce hospital costs and improve patient safety. Here’s how.

Financial Benefits of Virtual Patient Observation

The use non-clinical staff to provide bedside patient monitoring — also known as “specialling” — is a common practice in hospitals. Patient sitters provide in-room support to patients at risk of injury while freeing up nurses to focus on clinical duties.

The drawback is that these services are not reimbursed. Even though non-clinical staff typically receive lower wages than clinical staff, the cost can add up quickly. One 900-bed hospital, for example, saw an annual unbudgeted expense of $3 million for patient sitters.

Virtual patient observation can be used in a variety of settings but is key to helping hospitals avoid costs from fall injuries. Every year hundreds of thousands of patients fall in hospitals, with one-third resulting in serious injury. The Joint Commission estimates that, on average, a fall with injury costs $14,000, but depending on the severity of the injury, unreimbursed costs for treating a single hospital-related fall injury can be up to $30,000.

How Virtual Patient Observation Protects Patients

Virtual observation technology can be used for physical observation of high-risk patients. This could include patients on telemetry, those who require frequent suctioning, or patients who frequently bounce back to the ICU. It can also be used to remotely monitor blood pressure or other equipment in the room.

But there are many other applications of virtual patient monitoring that can also add value to patient safety protocols, including:

Lower fall risk: If a patient who is a fall risk attempts to leave his or her bed, the virtual observer can address the patient over a speaker, advising him or her to stay in bed, and then can alert clinical staff to assist the patient.

Lower suicide risk: If the patient poses a risk to him- or herself, the virtual observer can act as a second set of eyes (often in addition to a physical sitter in the room) to keep that patient safe.

Reduced risky or dangerous behavior: Virtual patient observation can be a deterrent for negative or dangerous interactions with others. This can include dissuading visitors from brining a patient something that might put them at risk (e.g., outside medications or illicit drugs), or functioning as a second set of eyes if a patient has the potential to become aggressive or violent.

Continuous monitoring while waiting for care: As patients wait to be transferred — to a higher or lower level of care, from the ED to a critical care bed, or to an outside organization —virtual sitting can help provide continuous monitoring.

Faster care when physicians are not physically available: Virtual sitting can also be helpful when providers aren’t physically available. In this situation, a rapid response team with mobile carts can utilize camera capability for visual assessment.

NICU observation: Virtual sitting can also be beneficial for the littlest patients. A remote clinician can provide continuous monitoring of newborns and infants in the NICU through one central location.

Virtual patient monitoring has the capability to improve patient safety while enabling hospitals to more efficiently allocate resources —all without sacrificing the essential human-to-human element of patient care.

To find out more about how virtual sitting resources work, which patients are candidates, and what to look for in a solution, download our white paper, Considering Virtual Observation for Your Healthcare Organization.

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