Healthcare at Home: The Rowan Report

By Tim Rowan, Editor and Publisher of Home Care Technology Reportt

Brightree today announced results from a first-of-its-kind survey in post-acute care, revealing a significant gap between what referring providers and health systems want, and what home health and hospice providers are delivering, when it comes to interoperability.[Both home health and hospice service providers were interviewed for this survey, with electronic referrals and interoperability of health services delivered in post-acute care operations also a high priority among post-acute care providers.

[The survey is the first to interview both home health and hospice providers (675 respondents) and their referral sources (440 respondents). It found that electronic referrals are high on the priority list; and interoperability of health services delivered in post-acute care operations is a high priority among post-acute care providers. Agencies’ capabilities to accept electronic referrals is key; in fact,
60% of referring providers said they would switch to a new post-acute care provider if that organization were able to accept electronic referrals. In addition, all are looking for an EMR that will suit the post-acute service care needs.]

Affects of reliance on manual labor rather than using electronic interoperability of patient data in post-acute care service delivery are costly for the industry. It’s noted in the survey’s findings that “almost two-thirds of home health and hospice organizations require several full-time equivalents (FTEs) each month tracking down data and documents they feel could be obtained with better integration in place.” Hence, “Many post-acute care providers are considering interoperability a business necessity.” All are looking for an EMR that will suit the post-acute service care needs.

Pointers are provided about Brightree’s Home Health and Hospice EMR, now part of MatrixCare’s post-acute software suite, See: https://www.brightree.com/home-health-software/emr/

Company details are provided about MatrixCare and about Brightree.

On July 11, 2019 WellSky, a health and community care technology company, opened its new world headquarters in Overland Park, Kansas. The company welcomed its partners, local employees, and community members for a festive grand opening day, and the announcement of Midland Care Connection, an integrated health care services provider, as the inaugural recipient of a $50,000 donation from the WellSky Foundation.

At the grand opening, the WellSky Foundation shared its vision for a world where people in need can receive whole-person care. Financially supporting community organizations like Midland Care helps bring that vision to life. The WellSky Foundation is a nonprofit dedicated to improving quality of life for vulnerable populations by removing social barriers to better health outcomes — focusing on the top four socioeconomic factors with the greatest impact on a person’s long-term well-being: housing, food insecurity, transportation, and isolation.

WellSky is a technology company advancing human wellness worldwide. Our software and professional services address the continuum of health and social care — helping businesses, organizations, and communities solve challenges, improve collaboration for growth, and achieve better outcomes through predictive insights that WellSky solutions can provide. A portfolio company of TPG Capital, WellSky serves more than 10,000 client sites around the world — including hospital systems, blood banks and labs, home health and hospice franchises, government agencies, and human services organizations.
WellSky.com

©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article is a reprint from a vendor press release. homecaretechreport.com. editor@homecaretechreport.com

by Karen Frank, PT and CEO of Greenlight Mobility and Back Home Safely

Many older adults want to remain in the home they love. According to a recent AARP study, 76 percent of people want to stay home as they age. While adults age, though, they often find themselves at a loss to accomplish tasks that once were simple. Climbing a flight of stairs can suddenly become a challenge. Dimly lit corridors, poorly designed bathrooms, and steep door thresholds turn into hazards that were not there before. [This article provides numerous ways the healthcare at home agencies can help create a safer home for elders by addressing typically problematic issues in bathrooms, stairs, and home entrances.]

None of this is news to adult children of aging parents or to home health and home care professionals.

Nevertheless, much can be done to respect the wishes of an aging loved one so they can remain in the comfort of their own home…

* Karen Frank is a licensed physical therapist and the CEO of , a home safety and accessibility franchise with units available along the East Coast and in other parts of the U.S. Prior to launching GreenLight Mobility, she developed Back Home Safely with her husband Gregg, a licensed occupational therapist. Back Home Safely has helped thousands of seniors and people with disabilities across New Jersey remain safe at home through customized safety and accessibility modifications. With Back Home Safely as their business model, they created GreenLight Mobility to address the needs of individuals with physical challenges throughout other parts of the country.
greenlightmobility.com or backhomesafely.com

©2019 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

by Tom Maxwell is co-founder and co-CEO of Maxwell Healthcare Associates, a home health and hospice consulting firm

Six out of 10 users (59%) believe EMRs need a complete overhaul, according to a 2018 Stanford Medicine survey.
A JAIMA study from the same year shows much of care providers’ EMR dissatisfaction begins and is heightened during implementation.
It doesn’t stop with providers though. The initial disruptions to daily operations that often accompany an EMR implementation negatively affects patients. Patients sense the confusion and dissatisfaction and become disgruntled as well.

Mitigate the frustration that comes with implementation and enhance post implementation buy-in by implementing your EMR correctly. Here’s how.[Maxwell pinpoints 7 thoughtful pointers for new EMR providers, as follows:
1. Choose the right EMR. This involves doing your research, which involves talking with the EMRs’ sales teams and going beyond their vantage point by talking to your industry peers and so learning about the EMR’s strengths, but most importantly its limitations. And, remember to talk with more than just leadership. Interview those who use the technology in their day-to-day roles. At the same time, understand your own needs. Choose an EMR that allows for growing room and scalability. As Maxwell notes from his own experience, We often see that agencies find an EMR that addresses their current service lines but doesn’t have the functionality to grow with them. Maybe you just offer home health now, but is it in your five-year plan to incorporate hospice? Understand not only where you are but where you want to go so your EMR can grow with you.

2.Choose innovation. We’re all aware that our industry is under the microscope. We are all doing everything in our power to deliver the best care, efficiently. We can make exponential strides by employing technological innovation that goes beyond the man power and brain power we’ve been deploying. Your EMR needs to make you better, faster and stronger.
You’re looking for a new EMR for a reason, don’t try to make it your old one. We so often see organizations investing the time and money in a new EMR, but then undermine it by trying to make it exactly like their old one. It’s a comfort thing. They want what’s familiar. Embrace your new technology and work with it–not against it.
3) The cheapest is usually not the best. You often get what you pay for. We all know this.
Prepare your staff for change. Your tech is only as good as the people using it. Those new fancy dashboards your new EMR provides will only generate that beautiful report if your team is putting the correct information in the right place. Get your team’s buy in and train them well.
4) Invest the time. An EMR is one of your agency’s most impactful, if not most impactful, investments. It sets the foundation for your people, processes and ancillary technologies. Getting it right is paramount to your agency’s success and your patient’s care quality. Ensure leadership, field staff and back office staff all approach implementation with this weight.
5) Get it done. Make the decision to transition, put a plan together and then transition. Don’t lag and don’t prolong the actual transition. We see so many organizations drag their feet through the change. It becomes tedious, exhausting and costly. The sooner you complete the implementation the sooner you can resume business as normal.
6) Hire expertise and resources. While members of your organization may have been through an EMR implementation before, they don’t do it every day. Hire additional resources who do this every day. They’ll be additional boots on the ground who will know the most common pitfalls and will guide your agency around them–saving you time, money and ongoing dissatisfaction.
7) Once you’ve nailed your implementation, keep your organization strong with optimizations. Your EMR will have updates and initial trained users may leave their roles. Make sure you give your EMR the checkup and recalibration it needs to keep you, your team, your patients and your organization ahead of the curve.

Tom Maxwell is co-founder and co-CEO of Maxwell Healthcare Associates, a home health and hospice consulting firm that delivers operational, technological, regulatory, clinical and financial consulting services. MHA’s core services include EMR implementations, EMR optimizations, PDGM assessments and optimizations and M&A assistance. maxwellhealthcareassociates.com

©2019 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

By Elizabeth Hogue, Esq.
Home care providers remain concerned about the enormous power wielded by regulators, including the Centers for Medicare and Medicaid Services (CMS). In some instances, providers are concerned that regulators exceed the authority granted to them by Congress and essentially write laws through regulations, guidance, interpretive guidelines, etc. The U.S. Supreme Court recently considered whether to reign in the authority of the executive branch of government exercised through agencies like CMS.
In Gundy v. United States (No. 17-6086; U.S. Supreme Court; June 20, 2019), the Court essentially said that it was open to reigning in the power of federal agencies to interpret statutes, but was not going to do it in this case. In other words, the Court said, “Not quite yet!”[Hogue provides detailed information about the Herman Gundy case, which was based on the Sex Offender Registration and Notification Act (SORNA).Details about Gundy’s convictions and appeals provide the basis for Hogue’s conclusion that, citing a Ms. Gerson, who wrote much about the Gundy case; “We are now explicitly on notice that the Court will likely abandon its longstanding tolerance of Congress delegating broadly to agencies. What’s at stake is the potential upending of the constitutional foundation of the so-called “administrative state.” Today’s reality is that agencies, not Congress, make most federal laws.
The next time a similar case is heard by the Court, there is likely to be a very different result. Watch for it!”
©2019 Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author. This article was reprinted with permission in Home Care Technology: The Rowan Report. http://homecaretechreport.com.

By Tim Rowan, Editor & Publisher of Home Care Technology Report
Whether you send invoices to patients or claims to Medicare, you will soon be judged by how healthy and happy your patients and clients are, not by how many hours you spend with them or how many visits you do. Payers from John Hancock to Anthem to Humana, whether they are MCOs or operate under names like Medicaid, TennCare, or Medi-Cal, they have options. To be more specific, there are so many of you, they have multiple, virtually unlimited options as to which post-acute care organization they will take on as a partner.

Why would a payer decide to send its premium-paying, covered customers to you instead of to your competitor across the street? On the day “patient outcomes” becomes their answer to that question, if it hasn’t already, these payers will be looking for your ability to send patient data to them and receive it from them, either directly or through an established network. The technology you must acquire is called “Interoperability.”
[

Interoperability defined.

Nick Knowlton is Brightree’s Vice President of Business Development, and also one of healthcare’s leading interoperability experts. He spoke to us about his five years on the board of the CommonWell Health Alliance and his successful efforts to bring his company aboard as one of the first post-acute members.

CommonWell is a not-for-profit trade association that was formed in 2013 by a handful of competing EMR software companies, [and whose focus was on promoting improved patient care through data exchange standards that would break down silos and facilitate communication among healthcare providers and from large hospital systems to local county nursing services.

Brightree, a wholly-owned subsidiary of ResMed (NYSE: RMD, ASX: RMD), recently announced plans to make CommonWell’s network available to users of its home health and hospice EMR systems. (See “Brightree Announces Access to CommonWell Health Alliance Network,” 5/8/19)

Bringing in post-acute EMR members is a key CommonWell development, Knowlton told us. The openness to admit other than hospital and physician software companies, he said, “represents an important opportunity in bridging the gap between out-of-hospital care providers and the broader care ecosystem.”
The case for interoperability begins and ends with patient outcomes, Knowlton believes. “Yes, the use of data exchange standards for point-to-point interfaces has evolved into the use of data exchange standards to enable a national, technology-powered network, but its purpose is patient-centered. It enables the unrestricted flow of data that makes each care locale better able to serve its patients. Without a national network to manage all the policy, governance, patient identity and other issues historically inherent to health data exchange, the technology alone cannot solve for patient-centric interoperability.”

“When a patient moves from care setting to care setting, their experience is harmed if the clinician on the receiving side does not have easy access to their complete history.” Networks such as CommonWell solve this issue.”

Interoperability, therefore, is more than a mere convenience for hospital, rehab, SNF, hospice and home health clinicians. It amounts to a smoother journey for patients moving from care setting to care setting and, on occasion, it saves lives.

©2019 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

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Former Olympic ice skating competitor Fonda Figge never expected to become a customer of her own employer. In the winter of ’16/’17, the newly hired marketing representative for Rekovo was slowing to take a freeway exit ramp outside Columbus, Ohio. Behind her, a driver who was texting rear-ended her vehicle at 75 mph.

When she woke up in the hospital, Fonda started with the usual questions, “Where am I? What happened?” A doctor leaned over and gently whispered in her ear, “Fonda, you are making sounds but you are not actually speaking words. Someday you will be OK but it is going to take a lot of work and a lot of time.”
*******************************************************

Brad Burns was an active outdoorsman, athlete and hiker. A near-fatal car wreck left him paralyzed from the neck down. He was told he would improve but never walk again. The neural pathways his brain uses to instruct leg muscles what to do had been irreparably damaged.

Not a miracle, but close
Similar stories from wounded warriors, injured construction workers, and the very aged, all confined to wheelchairs, made their way do Dr. Lise Worthen-Chaudhari, PhD, MFA, CRC, a research scientist at Ohio State University. She developed a rehabilitation technology she calls “embedded arts.” In cooperation with Alex Purtell, Dr. Worthen-Chaudhari’s innovation became a company, Rekovo, and Purtell the CEO.

Adequately describing in words Rekovo’s “embedded arts” technology is difficult but the company’s 60-second video is, as they say, worth at least a thousand words. In it, formerly paralyzed Brad Burns can be seen creating drawings with leg movements while supported by a walker. To use the Rekovo system, a clinician, typically a physical therapist, attaches sensors to the injured person’s body, typically the affected limbs. A nearby computer detects movement of the sensors and traces those movements in colorful images on its screen. After a workout session, the PT can print out the work of art the patient created with whatever movements he or she was able to manage.

The Science Behind Rekovo
Rekovo utilizes a gyroscope sensor that requires implicit process to negotiate movement and allows for dual task completion. What was happening to her, Fonda was told, was that by playing the Rekovo games and creating onscreen art with it, her brain was building new pathways around the ones that were no longer working. Patients like Fonda describe the exercises and games as fun, challenging, and rewarding. Dr. Worthen-Chaudhari describes her innovation as “rerouting neural networks around the damaged area of the brain, gradually restoring function that previously would have been impossible.” Other doctors, including the most skeptical, have reportedly been astounded at the brain’s ability to build new neural pathways.

With support from grants, investors, and the University of Ohio Wexler Medical Center, Rekovo plans to offer its system to skilled nursing facilities and home health providers.

http://rekovo.com

©2019 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

By Roger McManus MBA
Any time your agency is listed anywhere online or in print, it is referred to as a “citation.” […Things change…In years past, consumers would use the phone book [etc.] but since then with the advent of search engines, the world has changed forever].
Citations[Citations typically include what is called your NAP; Name, Address, Phone number. Beyond that, it can include your URL, hours of business, images and videos, and all manner of other information, depending on the site. A link to your URL is particularly important.]
Wherever possible – particularly on Google Service area businesses can define their trading area by zip code, city or county.
Why does it matter?
Local citations are absolutely key to the visibility of a business online. The eldest daughter who lives in Chicago with a mother who lives in Denver knows she wants to talk to someone about home care. She know what she wants, but probably does not know who she wants. Local citations help your visibility and enhance the chance you will get her phone call.
When your citations are inconsistent or inaccurate, a prospective client loses confidence in your ability to deliver. An enormous amount of potential business is lost through inaccurate and/or out of date business citations.

In order for an agency’s information (data) to always be correct, it needs to be properly maintained (kept “clean”) not only for the main listings, but for every directory and data aggregator where a business is mentioned online. The author exhorts business owners to do the following:

Clean up the agency’s data by updating the NAP information. This includes the data aggregators – Infogroup, Neustar, Localeze and Acxiom. Follow with Dun & Bradstreet, Factual, Google My Business & Bing Local. Without question, this updating task can be time consuming; and an alternative plan is offered by the author: Engage Rowan Reputation Resources for a fast and low cost “citation cleaning” assignment, at: rowanreputationresources.com/contact-us

©2019 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

by Tim Rowan, Editor & Publisher of Home Care Technology Report Former Olympic ice Former Olympic ice skating competitor Fonda Figge never expected to become a customer of her own employer. In the winter of ’16/’17, the newly hired marketing representative for Rekovo was slowing to take a freeway exit ramp outside Columbus, Ohio. Behind her, a driver who was texting rear-ended her vehicle at 75 mph.skating competitor Fonda Figge never expected to become a customer of her own employer.
Details are provided about Figge’s early disorienting days in the hospital, with comforting words from her doctor saying the someday she might be ok.

Another story of a terrible accident is then provided: Brad Burns was an active outdoorsman, athlete and hiker. A near-fatal car wreck left him paralyzed from the neck down. He was told he would improve but never walk again. The neural pathways his brain uses to instruct leg muscles what to do had been irreparably damaged.

[Details are provided about rehab technology called “embedded arts” used with other wounded or injured persons by Dr. Lise Worthen-Chaudhari, PhD, MFA, CRC, a research scientist at Ohio State University. The embedded arts technology became a company, Rekovo. While “embedded arts” technology is difficult to describe easily, Rekovo has produced an informative 60-second video in which a physical therapist attaches sensors to the injured person’s body, typically the affected limbs. A nearby computer detects movement of the sensors and traces those movements in colorful images on its screen. After a workout session, the PT can print out the work of art that the patient created with whatever movements he or she was able to manage.

The Science Behind Rekovo
Rekovo utilizes a gyroscope sensor that requires an implicit process to negotiate movement and allows for dual task completion. What was happening to her, Fonda was told, was that by playing the Rekovo games and creating onscreen art with it, her brain was building new pathways around the ones that were no longer working. Patients like Fonda describe the exercises and games as fun, challenging, and rewarding. Dr. Worthen-Chaudhari describes her innovation as “rerouting neural networks around the damaged area of the brain, gradually restoring function that previously would have been impossible.” Other doctors, including the most skeptical, have reportedly been astounded at the brain’s ability to build new neural pathways.

http://rekovo.com

©2019 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

by Darcey Trescone, RN

Home health agencies, hospices, skilled nursing facilities, rehab and long-term hospitals, and all other Post-Acute Care providers are not more than a year away from hearing this conversation over and over and over again:

“We would very much like you to refer some of your hospital’s discharged patients to our care.”

“Oh, we provide excellent care. Five stars.”

“That’s not what I meant. Are you a member of Commonwell? Do you have an Epic shared instance? Does your electronic health record have open APIs or HL7 capability?[Many other pointed questions are also posed by hypothetical future partners to which the author notes.]
‘The right answers might lead to a long-term referral relationship. The wrong answer, especially if the person asking for referrals has not been trained in the language of interoperability, could bring about permanent census disintegration. The hospital is looking for partners that can meet its data sharing needs, and they do not mean with a fax machine.

Jeremy Powell, interoperability leader and CEO of Acclivity, was spoken to by the author, as was Nick Knowlton, VP of Business Development for Brightree. Acclivity software coalesces providers, patients and payers onto a common database. Knowlton led the way toward Brightree becoming the first home health software vendor to be a Commonwell member. [More to come about Brightree, in future HCTR issues.]

Acclivity CEO Jeremy Powell told us, “Interoperability is a building block for ensuring that what you can know about a patient, that might be known elsewhere in a patient’s healthcare journey, can be known at the point of care for a patient encounter. Achieving interoperability is not a difficult lift, but the outcomes vary to date. Most systems can exchange and pass information back and forth, which is not enough. The definition of interoperability is evolving, and it is expected that the data exchanged or shared between systems helps to tell a story about the patient’s overall healthcare journey.” It the data exchanged or shared between systems helps to tell a story about the patient’s overall healthcare journey.”

Interoperability Standards
In response to the interviewer’s question, Powell continued, “Standards have been the approach by CMS, IHE, HIMSS, and other bodies focused on interoperability. X12 (for Claims/payment/encounter data – the first platform) and HL-7 (Clinical Data within EHRs – the second Platform) are standards that have been in place for a long time, but these two standards don’t talk to each other. HL-7 is the standard used to share clinical journey transactions (admission, discharge, transfer, orders, results, etc.) X12 as a standard is for financial transactions. It’s a bit like comparing airplanes and automobiles. Different rules, patterns and logistics guide each body and standard, and therefore interoperability across standards is not well developed.

The Office of the National Coordinator of Health IT will host its 3rd Interoperability Forum, August 21-22. Key leaders and stakeholders will discuss the current and future direction of interoperability and provide outstanding content. The keynote and plenary sessions are available to view live through the webinar.[Regisration details are provided in this article about the 3rd ONC Interoperability Forum.]

In addition, details are provided in the current article about this week’s Interoperability Proving Ground which features the Payer Data Exchange, which helps providers request a health history from health plans in a “Fast Healthcare Interoperability Resource” format.

About Acclivity Health Solutions

Acclivity Health Solutions provides the platform for connected care communities focused on patients with advanced illness. Using the Acclivity platform, healthcare providers are able to securely connect and collaborate with various disciplines in the care team to provide appropriate and timely services to their shared patient population while meeting the requirements of value-based care. For more information, please visit www.acclivityhealth.com.

Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice.She can be reached at darcey@tresconeconsulting.com.

©2019 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