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Points of Care

April 30, 2008
by Kate Huvane
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As the home care industry continues to expand, technology must connect caregivers to home base

Gene gretzer

Michael Smith


The home care industry has been in existence since the 1880s. And while the field witnessed a great deal of change during its first century or so, perhaps the most significant transitions have occurred in recent memory, as technology has assumed a more predominant role in the delivery of care.

The National Association for Home Care and Hospice estimates that 7.6 million patients in the United States require some form of home care, be it for an acute illness, long-term health condition, permanent disability or terminal illness. As this number escalates and healthcare expenditures continue to skyrocket, spending is projected to double by 2013. Based on a study released in March by the Washington-based Deloitte Center for Health Solutions, methods of care delivery that can help hospitals and other facilities more effectively allocate resources are going to be relied upon much more heavily.

“We need to be paying attention to this movement because healthcare will be moving increasingly into the home,” says Bill Crounse, M.D., worldwide health director for Redmond, Wash.-based Microsoft Corporation. “We have to get smarter in terms of how we provision exactly the most appropriate level of care at the most appropriate time and place.”

One way to do that is to maximize the potential of wireless technologies in facilitating improved communications between mobile workers and those based in hospitals or other care centers and enabling care to be delivered and documented in real time.

Michael Smith, CIO at Lee Memorial Health System, a 1,600-bed, community-owned healthcare system based in Fort Myers, Fla., feels that the technology used in home care has evolved significantly in the past decade and is on pace to continue in that direction.

“The use of electronic records is much more pronounced than it was 10 years ago,” he says. “There is certainly more of a desire to have integration with other care settings such as hospitals, and there's more interest in using other features such as e-mail. There's also a desire to have mobility.”

There are, however, significant factors that stand in the way of these objectives, the first of which is the care environment itself, which can vary considerably from one home setting to the next. And even in those settings where technology is readily available, providers still encounter issues.

Trials to triumphs

The Visiting Nurse Service of New York (VNSNY) deployed Mobility XE, a mobile virtual private network solution from Seattle-based NetMotion Wireless, in order to maintain a reliable connection for its traveling workforce. “We did not want to burden our nurses with the manual process of switching between WiFi and broadband networks using our secure VPN software,” says CTO Randy Cleghorne.

Mobile XE enables clinicians to roam across different networks while ensuring data transmissions are secure, according to NetMotion CEO Bob Hunsberger. The software supports the application session persistence, which helps maintain a connection if there are gaps in wireless coverage. When this occurs, says Hunsberger, the mobility server communicates to the main application server that the device is still ‘connected,’ which prevents the device or application from locking up.

“One of the reasons why we went with NetMotion was that they can maintain persistence for the application,” says Cleghorne. Once clinicians enter data, it is automatically saved on the application, which then establishes a communication session in order to send the data to the back end system for processing. NetMotion, she says, facilitates the successful data transmission by creating a secure VPN tunnel through which transmissions occur.


Debby ramundo, r.n.

Debby Ramundo, R.N.


Having a reliable network “has been very good for the agency. Now the clinician is able to communicate the status of a patient more often,” she says. “Rather than once in the morning or once in the evening, they can do it at the culmination of the visit,” which is a crucial component in improving patient care because it allows clinicians and therapists to view the most updated information.

Additionally, when a new patient requires service, mobile clinicians can receive alerts from VNSNY via cell phone to retrieve the record on their device. Instead of having to stop and take handwritten notes, they can proceed to the patient's home and administer care that can immediately be documented, Cleghorne says.

Mobile care workers at Swedish Medical Center in Seattle have also benefitted significantly from utilizing wireless technology in the field.

According to Debby Ramundo, R.N., senior project manager of home care, clinicians at Swedish used to work on a local version of their EMR that was synchronized onto their tablet PC at the beginning of the day. They proceeded to document on the tablet, but any new information they entered would be out of synch with the server until the next synchronization. With Sprint Mobile Broadband (Reston, Va.), clinicians can transfer data at each visit and view any changes that have been made to patient records. “Using wireless has allowed us to increase that real-time nature of the information,” Ramundo says.

Another option that seems to be gaining momentum is the use of point-of-care systems like those from Homecare Homebase (Dallas) and HealthWyse (Wilmington, Mass.), which support workflow management, integrate with physician portal and management reporting tools, enable OASIS coding, and allow clinicians to synchronize and share data using Pocket PC and Sprint Mobile Broadband.


Bill montgomery

Bill Montgomery


These systems, according to Bill Montgomery, national director of healthcare for Sprint Business Solutions, often incorporate GPS solutions not only to provide navigation to patients' homes and facilities, but also to track mileage, calculate mileage, and track caregiver locations and manage assignments based on location proximity. Some solutions also come equipped with an emergency alert that can be deployed in case a clinician requires immediate assistance, he says.



For those situations where a home care clinician seeks a second opinion, many facilities are distributing cell phones both to mobile workers and charge nurses who are instructed to carry the phones at all times, so that mobile workers can always reach someone and aren't stuck playing phone tag.

“We want them to know that they have support behind them,” says Ramundo. “No matter how skilled you are, there are times when not having someone else standing there to talk to or ask questions can become critical.”

Taking home care technology further

As fields like nursing face impending worker shortages, technology will need to pull even more weight.

Many of those in the home care industry — including providers, vendors and other experts — share a belief that the field is edging closer toward a telehealth-based model that utilizes Web-based tools for disease monitoring.

“There's a $30 billion market for telehealth and we've only implemented about 20 percent of it,” says Ramundo of the remote facility technology.

Another trend that could significantly impact care delivery is the increased use of video conferencing to facilitate communications between clinicians and home-based patients. “I think that in the coming years, video is going to have a pretty dramatic effect and improve the quality of the experience for these patients,” Montgomery says. The biggest obstacle it faces, he says, is reimbursement issues.

But rather than focus on the roadblocks, Ramundo stresses that it's important to see the big picture and focus on the potential that these technologies offer. She estimates that conducting visits via remote conferencing, rather than traveling back and forth, can enable clinicians to see as many as 15 patients a day versus five or six. Seeing more patients in this manner can equate to significant savings in time and costs, and even more importantly, usher the home care industry into an age where resources are used more efficiently to better serve patients.

And that, says Smith, is the bottom line. “You want to feel like you're providing the best solution so that nurses and other workers aren't worried about technology. What you really want them worried about is somebody's daughter or son or mom or dad.”


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