Healthcare at Home: The Rowan Report

by Tim Rowan, editor

“A great marriage,” is the way Allscripts’ Director of Solution Management Marie Finnegan describes the newly formed joint venture between her company and Netsmart. (See “Allscripts Reinvests in Home Care” in this week’s issue.) We spoke with Ms. Finnegan and Area VP Jason Banks this week to learn how company insiders feel about the biggest change since Allscripts acquired Misys nearly eight years ago. [Details are provided about these 2 senior executives’ experiences getting involved with the joint ventures’ operations and providing solutions to what will be exclusively post-acute healthcare at home patients and clinicians.]

HCTR: Let’s start with the name. What will the offspring of this great marriage be called?

First, they clarified that the offspring of this marriage will be named after one of its parents. The new Netsmart will continue to be headquartered in Overland Park, Kansas but the entire Allscripts Homecare team will remain intact and continue to work from their current locations in Chicago and Raleigh.

Jason: We have already been working together since August of 2014, when we integrated some of our solutions into Netsmart applications to enhance clinical workflow and enable view access to some of the health records located within our respective EMR platforms. With our focus on Medicare and Medicaid and Private Duty home care and their emphasis on behavioral health, our goal is to have a streamlined user experience across the continuum of care for clinicians.

Marie: I say this is a great fit because they concentrate in the post-acute space, as we do, but with different solutions. Netsmart has an Electronic Medical Record that services the behavioral health space. They also offer Revenue Cycle Management, hosting, and IT outsourcing. Jason and I have been working together to move our products toward what he calls “frictionless” for the client. We had been working with several other solutions providers, including making plans to partner with somebody who can host our Homecare application and somebody who can add RCM to it. Now we are landing in a place where all of that can be done with Netsmart.

Jason: And it’s not just a technical synergy. Some of the services they provide, such as child and family healthcare, behavioral care and the like, bleed over into home care, so they have already been moving in our direction. At the same time, some of our Homecare clients have been expanding their service lines into these areas. In order to serve them we have been wanting to move in that direction.

Marie:  We have been seeing some clients branching into both spaces. Netsmart has core competency in one area and we have it in another; so that’s why I call it a great marriage. We will maintain our focus on Medicare agencies; I don’t want anyone to think we are diverting from that mission. What we are doing is expanding into another skill set.

Jason:  I am also impressed at how knowledgeable [current Netsmart and new joint venture CEO] Michael Valentine is about our side of the healthcare industry. He has been studying home care for a long time.

HCTR: What is your message to customers?

Jason:  Our executive team has already reached out to our largest clients. We also have a team actively engaged in reaching out to every client, with the message that this joint venture is creating the largest tech company focused on human services and post-acute care. It will mean increased investment in resources to take both platforms to a higher level. We will also be telling them that nothing will change with regard to whom they are working with today: sales teams, support teams, and management teams will not be changing.

Marie:  I’ve been telling my contacts, “Nothing for you changes. You are going to contact us the same way you do now. Leadership and management teams for home care are all still going to be there.”

©2016 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 

Heart failure, diabetes, respiratory problems, canoeing, bicycling, golf. What else belongs on the list of adjectives that describes today’s seniors? Multiple co-morbidities? Shopping? Dialysis? Hiking?

Last year, I was chided by the founding president of the American Telemedicine Association for assuming that remote monitoring is only for the elderly and that “chronic condition” automatically means “homebound.” In an interview that eventually became the HCTR piece “Keeping Seniors Independent, It All Makes Cents,” Dr. Jay Sanders, one of the gentlest people in healthcare, strongly advised me to get in touch with today’s seniors.

He told me, “This is not the elder population of 50 years ago,” citing examples of engaged and connected persons of AARP age living active lives and working seamlessly with technologies. He stressed, “A new senior market is demanding attention from providers of all stripes to heed its desire to age in place in their own homes. Active, healthy seniors populate [today’s] telehealth marketing literature, not homebound people with multiple chronic conditions.”

A new web page from home telehealth research firm Information For Tomorrow identifies a range of new telecommunications-ready tools and health services to accommodate this new breed of seniors that is voicing a new set of needs. They may need some help but, unlike their parents, they want to live independent, active lives, and not necessarily always at home. [Details about Stay-n Touch PERS, one of the new telehealth products and services noted on the new web page, is discussed in this article.]

This is a new generation of mobile home care clients, clearly expressing new needs and new demands. There are a number of these new tools outlined on IFT’s new web page. One of the more unconventional is the Stay-nTouch personal emergency response system from SafePresence out of Lincoln, Nebraska [IFT outline here].

According to company literature, instead of automatically signaling for help after a fall or other emergency, the Stay-nTouch PERS is designed to “accommodate users.” Users set up the discretely designed device, which looks like a clock radio, to indicate who should be notified in an emergency situation and what type of situation should be consider an emergency. Noting that call buttons are sometimes pressed mistakenly, product designers inserted a customizable “grace period,” after which the device asks the user if the designated emergency caregivers should be contacted. The senior living alone is spared the worry that adult children, already on edge about Mom still stubbornly living alone, might grow more concerned than necessary due to frequent alerts. Outcome: no unnecessary call is made, and users know that their independence and dignity will be maintained.

Audrey Kinsella, MA, MS, is HCTR’s telemedicine reporter. She has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. Audrey can be reached at audreyk3@charter.net or 828-348-5308.

©2016 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

Failing one out of every five customers is bad business. Yet that is the 30-day readmission rate for patients treated in U.S. hospitals for acute myocardial infarction, pneumonia, and congestive heart failure.¹ There is no question that patient outcomes are partly the result of the quality of care received in hospitals. However, once at home, the ultimate outcome depends on the patient’s actions as his or her own caregiver. Effectively addressing that reality – patients as their own caregivers – can reduce readmissions.

When Parkview Medical Center and Incendant Inc. developed a program of personalized and automated post-discharge patient guidance, their readmission rates for AMI, Pneumonia, COPD and CHF dropped 35%, 21%, 13% and 12% respectively. [This article provides details on Parkview Medical Center (Pueblo, CO) nurses’ usual but ineffective means of monitoring the progress of their discharged patients [ineffective in preventing readmissions, that is], and steps taken engaging the patient training services of Incendant Inc. (Pueblo, CO) to effectively help discharged patient learn self management skills and routines.]

Background
When most people cannot locate their major body organs, it should be little wonder that many fail as their own caregivers.² In the US, health literacy is so poor that only about 1 in 10 people have the skills necessary to manage their health.³ One emergency department study showed 78% of patients left the facility confused about their condition, treatment, or steps to recovery.⁴

Meanwhile there is little incentive for physicians to take time to effectively educate their patients. Payment structures and organizational necessities put pressure on doctors to see the next patient rather than help the last patient understand their condition. In fact, in the US only 65% of patients report “staff always explained about medicines” and even fewer – 52% – reported they understood their care when leaving the hospital.¹

Solution
During hospitalization patients are sick or injured, medicated, and uncomfortable. Yet this is when facilities try to educate. In reality, after discharge patients are very interested in recovery, making it prime time for support and instruction. And while hospitals archaically continue to hand out paper discharge instructions, people send and receive over 196 billion emails and view 4 billion YouTube videos per day!^5,6

Patients – even boomers – actually prefer email over phone calls.⁷ And videos are a superior solution for educating people.⁸

Until July, 2014 every nurse at Parkview Medical Center was tasked with calling “their” patients post discharge. While somewhat effective, only about 30% of calls reached patients and even just five, seven-minute phone calls kept nurses from their bedside care of other patients. To increase the effectiveness of post discharge contact, a group of three nurses was designated as the Transition Care Center. To increase their efficiency, the TCC nurses were given Incendant software and videos to better educate patients. With three nurses and Incendant, the TCC was able to increase post-discharge contact from 30% to 81% (15,000 patients/year) while reducing readmissions for AMI from 14.3% to 10%, Pneumonia from 15.5% to 12.5%, COPD from 13.3% to 11.6%, CHF from 13.6% to 12% and all readmission from 11.6% to 9%.

Incendant Technology & Videos
With enough money any facility could reach and educate every patient post discharge. But Parkview’s choice of Incendant made post discharge care both effective and efficient. Incendant software made it easy to send patients emails or SMS with over 200 disease, medication and procedure specific videos.

Incendant software monitors and reports the patient’s attention to the material. The reports focused the TCC nurses’ efforts on patients more likely to have bad outcomes. With the Incendant technology, groups of patients can easily be enrolled to automatically receive a series of video/emails (care paths) or individuals can be sent video/emails or SMS to answer specific questions. The videos are professionally produced with actors, animations, and images. The content is evidence based and vetted by medical experts and educators to put the right information at the right literacy level in front of each patient. Emails, SMS, and video make every interaction simpler for clinicians and better understood by patients.

Parkview’s Transition Care Center
While Parkview’s previous attempt to have unit nurses contact their patients the day after discharge was noteworthy, the logistical realities were a nightmare. Nurses were busy addressing the needs of their new patients. Patients were often difficult to reach by phone or unwilling/able to talk with the nurses when called. Messages were often left, but when patients returned calls they would be unable to connect with the correct person. Trying to train every nurse in every unit (>900) in good post discharge care and customer service added additional complications.

By designating a small group of nurses as the TCC nurses, Parkview was better able to contact and educate more patients. The small group of TCC nurses was easier to train regarding four critical post discharge factors:

• medication reconciliation/purpose
• primary care physician follow ups
• disease specific education and management
• community resources

These factors have consistently been shown to affect outcomes such as readmissions.⁹ With Incendant, the TCC nurses were able to more effectively and efficiently address questions about medications and disease management. Additionally, the phone calls, emails and SMS from the TCC, connected patients to a hospital resource ready and willing to answer their questions while accessing their visit history.<strong.conclusion< strong=””>
The readmission problem is multi-factorial. However, all patients discharged home ultimately must understand their condition and treatments to avoid negative outcomes like readmissions. A small, designated team is superior for post discharge care because they are more easily trained and focused on discharged patients. Using software to deliver videos via email and SMS is more effective and efficient for contacting and educating discharged patient. At Parkview Medical Center a designated transition care team, using Incendant software and videos, has proven that the combination improves patient understanding and self-care resulting in significant reductions in readmissions.

Sources

¹ http://www.medicare.gov/hospitalcompare
² http://news.bbc.co.uk/2/hi/health/8092930.stm
³ Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. 1993. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey (NALS). Washington, DC: National Center for Education Statistics, U.S. Department of Education.
⁴ Engel, K., Heisler, M., et al. “Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand?” 2009. Annals of Emergency Medicine. Vol. 53: 454-461.
⁵ http://www.radicati.com/wp/wp-content/uploads/2013/04/Email-Statistics-Report-2013-2017-Executive-Summary.pdf
⁶ http://expandedramblings.com/index.php/youtube-statistics/
⁷ http://www.healthitoutcomes.com/doc/baby-boomers-ready-for-health-it-0001
⁸ Study of School Use of Television and Video, Corporation of Public Broadcasting, Washington D.C., 1996-1998
⁹ http://www.academyhealth.org/files/publications/ReducingHospitalReadmissions.pdf

One could not throw a rock at this year’s HIMSS meeting without hitting someone in the middle of a conversation about interoperability. (more…)