Healthcare at Home: The Rowan Report

CMS Administrator Seema Verma announced the agency’s new “Data Driven Patient Care Strategy” as part of the MyHealthEData initiative at the ninth annual Health Datapalooza conference in Washington, D.C. The strategy, CMS states, positions the agency to further support industry innovation in unleashing the power of data to inform patients’ healthcare decisions and transform the healthcare system by enhancing security and privacy, improving quality, increasing efficiency, and reducing costs.[Additional efforts to assist patients in accessing their records and making more informed decisions about their healthcare conditions are noted..]

In March 2018, the Trump Administration announced MyHealthEData, a government-wide initiative spearheaded by the White House Office of American Innovation, designed to help patients access and share their medical data throughout their healthcare journey while ensuring they are empowered to make decisions about when to share it, keeping their information secure and private.

As the latest effort under MyHealthEData, the Data Driven Patient Care Strategy is based on three critical cornerstones: putting patients first, making more data available and taking an “application programming interface approach” to exchanging data in a secure and private manner with CMS partners in the spirit of improving healthcare for all beneficiaries. These cornerstone principles are reflected in the data initiatives CMS announced and other federal efforts underway to improve the nation’s healthcare system through data innovation.

“We know we can’t achieve value-based care until we put the patient at the center of our healthcare system,” Administrator Verma said. “The Data Driven Patient Care Strategy will empower patients with the information they need as consumers of healthcare to enable them to make informed decisions about the care they need. Ultimately, the cornerstone of a patient-centered system is data—quality data, cost data and a patient’s own data.”

Additionally, as part of CMS’ commitment to data-driven innovation, Administrator Verma announced Medicare Advantage encounter data is now available to researchers for the first time, and annual updates are planned. Release of the Medicare Advantage encounter data will provide researchers insight into care delivered under Medicare Advantage and permit research that will improve the Medicare program.

Expanded Access to Encounter Data

CMS is expanding data available to researchers starting with 2015 Medicare Advantage (MA) encounter data, which provides detailed information about services to beneficiaries enrolled in a Medicare Advantage managed care plan in calendar year 2015. Researchers already have access to Medicare claims data for the fee-for-service program, and this release of MA data will provide a fuller picture of care provided to Medicare beneficiaries.

CMS also plans to release data from Medicaid and the Children’s Health Insurance Program next year, realizing such data has the potential to facilitate research that will help drive innovation and competition in the healthcare system and, ultimately, help doctors and patients make the best decisions about care.

“Data has the potential to help produce better, more targeted treatments for patients, improving their quality of life while at the same time reducing costs,” Administrator Verma said.

For more information or to request encounter data, please visit the CMS Research Data Assistance Center website at www.resdac.org.

More CMS Efforts to Unleash the Power of Data

This announcements follows and builds on several ongoing initiatives launched earlier this year to put patients’ health information into their own hands and make healthcare data more useful to consumers:

Blue Button 2.0: As part of MyHealthEData, CMS in March 2018 launched Blue Button 2.0, which allows Medicare beneficiaries to take charge of their own claims data by providing it to them in a universal, secure digital format. Blue Button 2.0 is a developer-friendly, standards-based API enabling beneficiaries to connect their claims data to the applications, services and research programs they choose.

Promoting Interoperability: CMS, in the proposed hospital payment rule, announced plans to overhaul the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, which are now known as the Promoting Interoperability programs. CMS has proposed to focus the program requirements on EHR interoperability and providing patients with electronic access to their health information, so data follows the patient and consumers can take ownership of and access their records in a usable format.

The Administrator’s remarks at the 2018 Health Datapalooza will be available after her speech at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-04-26-2.html

A fact sheet on the CMS Data Driven Patient Care Strategy is available at:  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-26.html

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

Please call at least 15 minutes prior to the forum start time.

Agenda

(Subject to Change)

1. Opening Remarks: Chair – Hillary Loeffler; Moderator – Jill Darling (OC)
2. Announcements & Updates
3. FY 2019 Hospice Payment Update
4. Proposed regulations text changes recognizing physician assistants (PAs) as designated hospice attending physicians
5. Hospice QRP announcements
6. HH QRP Website Recent Updates
7. Announcement of June 27 MLN call on Star Ratings
8. Updates on Hospice CAHPS
   1. For technical assistance, contact the CAHPS Hospice Survey Project Team: hospicecahpssurvey@HCQIS.org  or 1-844-472-4621
   2. To communicate with CMS staff about implementation issues: hospicesurvey@cms.hhs
9. Updates on Home Health CAHPS
   1. For technical assistance, contact the HHCAHPS Coordination Team: HHCAHPS@rti.org or call 1-(866) 354-0985
   2. To communicate with CMS staff about implementation issues: homehealthcahps@cms.hhs.gov
10. Hospice Claims Processing Update
11. Home Health Claims Processing Update
12. Open Q&A

Mailbox: HomeHealth_Hospice_DMEODF-L@cms.hhs.gov

Some complex technologies are best left to the IT Department, under the philosophy, “I don’t want to know how to build a car; I just want to drive one.” Blockchain is not one of those technologies. As it becomes more mainstream, blockchain will impact a healthcare provider’s operational processes, HIPAA compliance efforts, and clinical policies. There may be no need to know how it works but all healthcare providers will appreciate knowing what it can do for them.

We spoke with Lynn Carroll, Chief of Strategy and Operations for HSBlox, an Atlanta-based team of healthcare, financial technology, and digital supply chain management professionals. He describes blockchain in lay terms, focusing on what it can do, not how it works.[Details about HSBlox’s 3 broad areas of the healthcare ecosystem: as a Value–Based Reseller of population health systems; as a company that secures and transmits  patient permissioned data among patients, their caregivers, and their care team members; and as a deployer of machine learning, using Distributed Ledger Technology (Blockchain’s formal — and more descriptive — name), to distribute analytics results on a permissioned basis. Blockchain as a network model in healthcare is discussed; and background to the HSBlox company provided.]

“Our company is focused in three broad areas of the healthcare ecosystem,” he began. “We are a Value–Based Reseller of population health systems. Second, we secure and transmit patient permissioned data among patients, their caregivers, and their care team members. And third, we deploy machine learning, using Distributed Ledger Technology (Blockchain’s formal — and more descriptive — name), to distribute analytics results on a permissioned basis.”

Where these three foci intersect, you find healthcare’s need to securely transmit patient data from one care locale to another, as the patient moves through the healthcare system. Carroll believes physical, technological, and competitive obstacles to sharing patient data can be overcome with distributed ledger technology.

Two flavors

You have already heard of the version officially known as Public Blockchain. This is the Distributed Ledger that made crypto-currency possible, the primary example being BitCoin. But public Blockchain is not appropriate in healthcare, banking, or any other industry where security and privacy are at issue.

The other version, Private Blockchain, is based on permissioned rather than public ledgers. (For the basics on how distributed ledgers work, see HCTR, 4/18/18, “Blockchain 101“)

“In a common healthcare case,” Carroll explained, “we have participants in transactions that have a common business interest, are in established relationships with each other, and who seek more transparent, auditable transactions. Blockchain gives them a way to do that without extra overhead.”

Carroll drew us a step-by-step word map to explain the way a private Blockchain enables this. He calls the mechanism a “smart contract.” The agreed upon conditions of the private interactions are operationalized in self-executing Blockchain code. When a new piece of data arrives in the ledger, the smart contract “sees” the triggering information and replicates it to the appropriate ledgers in the Blockchain according to the contract’s permissions and rules.

Blockchain in healthcare

As a network model, a private Blockchain has a finite number of authorized participants. Each participant has a complete copy of the ledger and each ledger has auto-executable code. As patient information is sent, say, from a hospital to a home health agency, those new transactions are recorded according to established parameters in the smart contract. When particular trigger events are recognized by the contract, the transaction and its content are replicated to specific participating nodes.

For example, there might be ten participants in a particular concern — perhaps members located at a hospital, a post-acute provider organization, a physician group, etc. — Maybe everybody needs a copy, or maybe only three of them need it. It is all governed automatically by the smart contract. There is no danger that any patient data can be accessed by bad actors outside the Blockchain, nor is there danger that data can be leaked outside of the Blockchain. HIPAA compliance is handled by the smart contract.

When will this technology come knocking on your door? Carroll sees a current struggle to introduce Blockchain into healthcare. “Healthcare moves slowly,” he reminded us, “partly because there is so much misinformation out there. People hear that Blockchain has an issue with latency, or scalability, causing it to introduce workflow delays. But that is a problem in a public Blockchain; it does not impact the private type. Why? Replicating to 30 nodes is not as subject to latency as replicating to 3 million nodes.”

Final analogy

Admitting Blockchain in healthcare is a new and unfamiliar concept, Carroll tried to help our understanding with a couple of analogies. First, he suggested, to see the consensus building more clearly, think of the smart contract as a notary service that validates entry of the transaction into the ledger. The notary is an additional node, a peer to the nodes managed by people, that permits or denies every request to exchange data in the ledger.

If baseball is closer to your experience than notaries, look at the way the Blockchain works to avoid setting up a centralized authority. The smart contract node is like the entire crowd empowered to reach consensus on whether an umpire’s call was right or wrong.

About HSBlox

Carroll’s company, HSBlox, furnishes the healthcare industry with a range of services. After it was acquired by Broadridge Financial, the new parent invested in the enterprise by bringing in experts in healthcare, machine learning, and Blockchain. Today it is bringing this expertise to bear by building what it calls solution-centric Blockchain to help with bundled payments, revenue cycle management, referral management, and other areas where privacy and efficiency are primary concerns. The company has spent the last 16 months building enterprise scale solutions for specific healthcare problems, with open APIs, and is now bringing them to market.
hsblox.com

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

Over the past year, the Ohio Council for Home Care and Hospice has been advocating for the state Department of Medicaid to make changes to its Electronic Visit Verification system. This month, OCHCH announced that those efforts have produced some results. A report summarized four areas, including ECC’s impact on HIPAA; and EVV implementation and rule delay. Rowan mentions that OCHCH’s Executive Director Joe Russell’s entire message to  OCHCH members is reproduced elsewhere in this HCTR issue; and  Joe Russell’s summary of his conversation with Rowan  is also reproduced in this piece, in which he provides clear advice and encouragement to members’ building strong relationships with the state’s Medicaid officers. EVV-related summits held in Ohio by OCHCH members in 2017 are discussed and positive outcomes noted.]

 Joe Russell

We have posted the entire, unedited message to OCHCH members elsewhere in this week’s issue. To deepen our understanding, we spoke with Joe Russell, Executive Director. A former lobbyist, Russell summarized our lengthy conversation with one piece of advice to his counterparts in other states:

“Get to know the people in your state’s Medicaid office, starting with the ones designing your EVV plan. Engage early. Engage often. Make friends with the state people. Make sure they know you want to work collaboratively to achieve the best outcome for patients, providers, and their budget.”

He added that he was appointed OCHCH Executive Director less than a year ago, after the planning process was already well along. “I don’t like to be reacting after the fact and asking for changes,” he told us. “I prefer to be helpful to the process from the beginning.”

Along with his advice to colleagues, Russell recounted the policy message he had given Ohio Medicaid providers. We all have to work collaboratively with officers in the Ohio Department of Medicaid, even if we are not completely in agreement with what they are doing. Our fear is, if their plan does not work out well, we would be blamed for sabotaging it because they know we are not happy with what they are proposing.”

To avoid the appearance of sabotage, he added, “We told ODM that we had some major concerns but wanted to make it work. Since then, our relationship has been good. They have listened to our proposals, even though they have not proposed changes of their own after hearing our concerns.”

One of the positive things that came out of these discussions was a series of “EVV Summits,” which are attended by OCHCH members and ODM officials. The first summit was held last December and, in Russell’s words, was a big success. “Our members saw what ODM wanted and they saw what our members wanted. We brought up five points and, though their team did most of the speaking, they walked through each point and let the audience ask questions.”

At the second summit, ODM director Barbara Sears attended. “What an eye-opener that was for her!” Russell said. “Those conversations have led to more and more support from ODM staff. Today, they meet monthly with our EVV stakeholder group.” The whole premise of the summits, Russell added, is based on “if this doesn’t work, it’s not going to be because home health providers were not ready or did not have enough support to get ready.”

The former lobbyist was quick to add the political dimension. “EVV is a federal mandate to be carried out by each state,” he explained. “We didn’t want to derail the intent of the rule because that would only have resulted in ODM being penalized. And we would still have to implement EVV.”

Specific provider issues with Ohio plan

Russell outlined for us the components of the Ohio EVV plan his members would like to see changed.

1. Tying EVV to billing. This mandate has already been discarded after OCHCH members convinced ODM regulators that it can take a caregiver up to four minutes to access the system and register her arrival at a home after knocking on the door, and her departure after completing her tasks. Requiring billing hours to match EVV in and out times turned out to be completely unworkable. “Take those 8 minutes per visit and multiply them by hundreds of visits per week and an agency is suddenly losing substantial revenue,” Russell said. The state’s solution was to require EVV data to correspond to billed units, not to precisely match clock time.

   This, Russell emphasized, solved one problem while creating another. “ODM is paying all claims today but letting providers know if a claim would not have been paid because of an EVV discrepancy. This is great, educational for our members, but when they switched from matching clock time to matching units, that programming change disabled their ability to know — and to tell a provider — why a claim would have been denied. They only report now that it would have been denied, not why, making the service useless.

2. Vendor choice. The plan calls for Sandata to act as data aggregator, receiving EVV data from other vendors and compiling it so that state systems receive data in only one format. The problem is that ODM must approve every vendor wanting to do business with Ohio providers. “The specifications imposed on EVV vendors are quite technical,” Russell told us. “So much so that it is not clear exactly what they are looking for. Some vendors have been approved and others are still wading through the 90-day process. And they will not tell us how that process is progressing.”

   Russell elaborated on this issue. “Now, the 21st Century CURES Act allocates money to states for implementation and training on EVV requirements. The amount of money a state can receive, however, appears to be tied to the number of providers electing to use the preferred vendor, the one acting as data aggregator. Is the state doing things to encourage more people to use that system? We do not know for sure.”

3. Cost. The way the state contract is written, Sandata’s basic EVV system is underwritten by state funds and free to providers. However, the basic system does not include Sandata’s scheduling or billing add-ons. Those must be purchased from Sandata. Many providers are reasoning, “if I have to spend money to get a full-featured system, I might as well consider all my options.” Other vendors receiving ODM approval so far include Alora Health, McKesson (Change Health), MaximCare Mobile (for Maxim branch staff), Celltrak, ContinuLink, Rhinobill, Ampersand International, and Maxim. Some of these are standalone EVV systems, others are embedded into EMR software and only available to users of that EMR.
4. The GPS issue. Ohio requires GPS to confirm EVV even though the federal law does not. “There are three problems,” Russell began. “Most of our people are using telephony for EVV and, of course, there is no GPS on a patient’s landline telephone. Second, the disabled community is giving us pushback about ‘the world knowing where I am.’ They are fearful, feeling vulnerable, about their GPS location being shared via a computer system they do not trust. Lastly, our members are reporting occasional, wildly inaccurate GPS data, such as a person in Columbus being told he is checking in from Cleveland — that kind of inaccuracy.”
5. The devices. To offset device and data plan costs that are typically born by providers in other programs, ODM elected to deploy stripped-down mobile devices kept in each patient’s home. CEO Tom Underwood told us the devices are being widely used by caregivers in Ohio. He added that they have the potential to add significant value to care deliver, far beyond the six data elements required by the CURES Act. One examples would be capturing health status changes, relaying that status to a case manager, and potentially avoiding an ER visit or hospitalization.

   Still, Russell reminded us, they are essentially cell phones and subject to all the maladies every cell phone suffers from: not being charged, getting lost or broken, or simply not working at times. “Anything that can happen to any other mobile device has been happening to these Mobile Visit Verification devices,” Russell concluded.

Joe Russell had a lot more to say when we ran out of time for this interview. He does, however, make the offer that his peers at other state associations are welcome to contact him. He will be happy to prepare them to work collaboratively with their own state Medicaid officers.

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

In a public statement announcing the planned acquisition, Consortium members said they partnered with the objective of investing in and building businesses that can help modernize, enhance and transform home healthcare in America. “Curo brings a highly capable management team and a tech-enabled, centralized model for hospice care that presents the opportunity for Humana and its Consortium partners to be a leader in managing the continuum of home health, palliative care and hospice in an integrated fashion, creating a positive and differentiated experience for patients and their families – as well as their care providers. This integrated model will leverage data and analytics to measure and advance evidence-based clinical outcomes for patients and seamlessly coordinate the transition from home care, to in-home palliative care, and thoughtfully into hospice, as chronically ill patients’ disease burdens progress.”

The Curo transaction, which is anticipated to close during the summer of 2018, is subject to customary state and federal regulatory approvals as well as other customary closing conditions.

One more in a chain of acquisitions

The Curo transaction is not conditioned upon the closing of the Consortium’s separate acquisition of Kindred at Home and is expected to occur after the closing of Kindred at Home. Upon the closing of these transactions, the Consortium intends to merge Curo with the hospice business of Kindred at Home to create the country’s largest hospice operator. Meanwhile, Humana continues to have talks with Walmart about being acquired by the retail giant.

Acquisition management team

Fried Frank acted as counsel to Humana Inc. with a team including Brian T. Mangino, corporate partner Stewart A. Kagan; executive compensation & ERISA partner Adam Kaminsky; intellectual property and technology partner Amir R. Ghavi; litigation partner Peter L. Simmons; tax partner Alan S. Kaden; corporate special counsel Jose R. Morales; corporate real estate special counsel Jessica H. Mayes; litigation special counsel Justin J. Santolli; corporate associates Kendra Clark, Stacey Harlow, Adam S. Natan, and Adam J. Ross; environmental associate Mary Beth Phipps; executive compensation & ERISA associates Maggie A. Kornreich and Jaclyn I. Waters; intellectual property and technology associate Marli Sussman; and tax associate Shane C. Hoffmann.

Simpson Thacher Represents Evercore as Financial Advisor in Humana with a team including Caroline Gottschalk and Erika Tang.

Debevoise & Plimpton LLP is advising TPG Capital and Welsh, Carson, Anderson & Stowe with a team including Andrew Bab, Jennifer L. Chu, Daniel M. Abuhoff, Gary M. Friedman, Henry Lebowitz and Jeffrey E. Ross; counsel Erich O. Grosz, Stuart Hammer, Jacob W. Stahl, Charles E. Wachsstock and Erica S. Weisgerber; and associates Bill Barlow, Elizabeth Eleanor Burke, Elizabeth Costello, Zain A. Kazmi, Samuel D. Krawiecz, Matthew J. Petrozziello, Ryan T. Rafferty, Milan Udawatta, and Meredith Wren.

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

According to the Orlando Sentinel, Humana has acquired a large, independent family practice in Orlando, at a time when the insurance giant is itself in talks to be acquired by Walmart. The for-profit insurance company announced on April 10 that it has acquired Family Physicians Group, one of the largest providers to Medicare, Medicare Advantage, and Medicaid beneficiaries in Central Florida, with 22 clinics in in Lake, Orange, Osceola and Seminole counties. [Rowan provides many details on other significant acquisitions by large entities in the post-acute realm. Humana’s business activity focuses  on its strategy of helping physicians and clinicians to “evolve from treating health episodically to managing health holistically.” The expected end result, according to a Humana spokeperson, will be enabling physicians to achieve improved health outcomes for patients, reduce medical expenses, and “transform healthcare nationally.”]

HCTR previously reported that Humana also acquired Kindred, the nation’s largest home healthcare provider. Kindred operates home health, hospice and community care businesses, in addition to long-term acute-care hospitals, inpatient rehabilitation facilities and a contract rehabilitation services business.

The Sentinel story reports that Humana indicated this acquisition advances its strategy of helping physicians and clinicians evolve from treating health episodically to managing health holistically. “Physicians play a critical role in achieving improved health outcomes for patients, reducing medical expenses and transforming healthcare nationally,” a Humana spokesperson said. Both parties assert that the practice will continue to operate as a payer-agnostic physician group serving multiple health plans.

FPG has over 22,000 Medicare Advantage patients, including nearly 4,000 Humana members and over 21,000 patients in Medicaid, Medicare fee-for-service and commercial plans. Financial terms of the Humana, FPG transaction, completed on April 10, were not disclosed. Humana said the acquisition is not expected to have a material impact on its 2018 financial guidance.

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

McDonald, co-founder and head of ecosystem development for R3, was one of the first to uncover the promise of distributed ledger technology for financial services. Prior to R3, he spent fourteen years at Standard Chartered Bank as a managing director in their financial markets group where he held positions such as global head of electronic FX trading and head of FX for the Americas.

“Blockchain technology is positioned to deliver a new level of security, transparency and efficiencies to the healthcare industry, with HSBlox leading the pack,” said McDonald. “I am delighted to join the Advisory Board and help drive these much-needed improvements throughout the healthcare ecosystem while continuing our collaborative work on R3’s Corda™.”

Dr. Burchard has served in many capacities in healthcare and brings a proven track record in the fields of wellness, preventive medicine, medical management, and organizational growth and development. He served as president of AWAC (subsequently inVentiv Medical Management), a national consulting firm specializing in medical management, case management, disease management, wellness and claims cost containment. During his tenure at AWAC, employer clients saved hundreds of millions of dollars in medical costs through advanced claims surveillance and analysis, fraud and abuse detection, and other cost-saving techniques. Dr. Burchard continues to practice medicine at MD360®, the urgent care division of Greenville Health System in South Carolina.

“The incredible potential of leveraging both machine learning and blockchain will help achieve industry goals of increased care quality, improved population health and lower healthcare costs,” said Dr. Burchard. “HSBlox’s technology automates tasks for healthcare stakeholders, reducing the risk of manual data sharing and potential delays in patient care. Instead, providers and staff can focus on higher value tasks that lead to better patient care delivery. As a medical advisor for HSBlox, I will have the opportunity to be a part of this long-awaited shift in healthcare – and I couldn’t be more thrilled!”

“We are extremely pleased to welcome Mr. McDonald and Dr. Burchard to HSBlox,” said CEO Rahul Sharma. “Their combined knowledge and experience in developing distributed ledger technology and leading medical organizations will assist our team with solution stakeholder feedback and go-to-market connections. Their contributions will aid HSBlox as we expand our market presence as a premier solutions provider in the value-based and population health space, applying blockchain and machine-learning approaches to industry challenges.”

AboutR3

R3 is an enterprise software firm working with a network of over 200 banks, financial institutions, regulators, trade associations, professional services firms and technology companies to develop on Corda, its blockchain platform designed specifically for businesses. R3’s global team of over 160 professionals in nine countries is supported by over 2,000 technology, financial, and legal experts drawn from its global ecosystem.

About HSBlox

HSBlox brings patient-centric solutions to the healthcare ecosystem, combining machine learning and blockchain (distributed ledger technology) to address the healthcare industry’s demand for secure, real-time information sharing and interventions. To support value-based care programs, HSBlox deploys smart contracts to automate multi-party transactions, such as bundled payments, claims management and patient referrals. The proven technology enhances the provider, payer and patient experience throughout the care continuum, driving better outcomes for each healthcare stakeholder. For more information, visit www.hsblox.com

Editor’s note: For a beginner’s explanation of Blockchain, see “Blockchain 101” in this week’s issue.

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com

She goes through this routine anywhere from three to nine times a day. [Means to make healthcare at home nurses’ routines more efficient are indicated by two words: mobile printers. The many advantages for nurses and patients are indicated, chief among them is making needed materials (such as up-to-date patient teaching sheets and medication lists) readily available at the same-day visit. The time-saving advantages are noted.  Nurses’ ready adapting to mobile printer use is described.]

You are the owner of her home healthcare agency. Recruitment and retention of clinical staff — in other words, staff satisfaction — is the headache that keeps you awake nights. The last thing you want to do is ask her to carry one more device. But you have heard about the efficiencies that can be gained if your mobile computers could print right in the patient’s home. Do you do it?

“ABSOLUTELY,” proclaims Jean Gonynor, MS, MBA, RN, NE-BS, CHCA, administrator of Nightingale Home Healthcare in Phoenix. “We equipped all of our field nurses and therapists with a one-pound Brother mobile printer and they couldn’t be happier.”

The list of advantages Gonynor described to us in a recent interview is lengthy. Immediately, the stack of documents disappeared from the back seat. “You never know what medication and exercise teaching sheets you might need before you meet the patient,” she explained. “So you have to weigh the pros and cons of bringing everything into the home just in case versus running back out to the car to get what you need after the assessment. Now, they just bring the little printer and four or five blank sheets of paper.”

Brother PocketJet

Med Lists

Printing patient medication lists on the spot is the biggest time saver, she added. “On that first visit, and often during subsequent visits, you don’t have an up-to-date med list. You might have one from the hospital but they don’t know what else is in the home. You might have one from a doctor not affiliated with the hospital who doesn’t have access to the hospital’s EMR. And you might find a collection of benign or risky herbal supplements in the cupboard. With a mobile printer, you can update your software and print a complete, accurate teaching sheet.”

According to Ms. Gonynor, the Jean Gonynor (administrator of Nightingale Home Healthcare (Phoenix), they  are small and compact, which makes them easy to carry. “That’s critical,” she said, “because our clinicians already have so much in the tool kits they travel with, including a wound supply kit, a blood pressure cuff, scale, gate belt and tape measu0re.”

The printers also use thermal printing technology, which means they do not need ink. “This is important here,” Gonynor continued. “We are in the desert, which means the ink would be likely to dry out, constantly causing problems.” She added that Nightingale’s IT department found it to be easy to get new employees up and running with the mobile printer.

Regarding patient care quality, she said, “A computer-generated, printed medication list will be clearer to read than a handwritten one, which helps prevent medication errors. And having the ability to edit a care plan in real time and then print it for the rest of the care team is huge for care coordination. It can be a challenge to keep the correct, most up-to-date care plan in everyone’s hands, especially in the case of long-term patients with several different caregivers.

“Think about it,” she continued. “It can take 20 minutes to enter all of a patient’s meds into their computer. If the clinicians then have to write it out on paper to leave in the home, they’re doubling their time spent on the same task. The ability to save 20 minutes per visit throughout the day adds up to having time to see an extra patient. The added advantage is that the less time the clinicians have to spend on administrative tasks, the more time they have to focus on what they are there for – providing patient care.

EMR Compatibility

Nightingale’s EMR software, CareVoyant, was not previously set up to print to a mobile, thermal, Bluetooth printer but the vendor stepped up and accommodated Nightingale’s requirements without hesitation. “They saw it as a challenge and, though they were initially unsure about making a software adjustment for one customer,” Gonynor said, “they were soon convinced that it is likely the practice of using mobile printers will catch on and other customers will be asking for the interface.”

To learn more about Brother Mobile Solutions’ next-generation mobile printing solutions: brothermobilesolutions.com

©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only.editor@homecaretechreport.com