Bringing Home Health Into the Fold

The movement is on to achieve the triple aim of better health, improved outcomes and lower costs—and effective care coordination for patients at home helps achieves all three.

Home health is often a blind spot on the care spectrum, but it need not be, says Hargobind Khurana, medical director of iCare at Arizona-based Banner Health. “Our goal is to keep patients healthy and safe at home. We need to be able to assist in their care. By the time they are at the ED, we’ve lost that chance.”

Vital Connections

Seamless care transitions depend on physicians, hospitals and home health agencies having access to detailed patient information and sharing and exchanging health information electronically, says Richard D. Brennan, Jr., MA, vice president of technology policy for government affairs at the National Association for Home Care & Hospice (NAHC).

Home health agencies are not eligible for Meaningful Use (MU) incentives, which has slowed their uptake of EHR systems. However, federal agencies are encouraging voluntary adoption of EHR by post-acute care providers and the interoperable exchange of health information between home health agencies, physicians and hospitals.

Voluntary adoption “is the foundation for the interoperability of health information that is required to support better quality models of care delivery in home care,” he says.

Helping Home Health Take the Leap

Stratis Health, a Bloomington-Minn.-based nonprofit organization focused on collaboration and innovation in healthcare quality and safety, has developed a toolkit to facilitate health IT adoption. 

Deploying health IT tools is critical to realize the benefits of data exchange, says Candy Hanson, RN, program manager of Stratis, who participated in a review group for its health IT toolkit.

The toolkit, which focuses on functionality, people, policy and processes, is designed to help home health providers implement a comprehensive EHR system, overhaul existing systems or acquire individual health IT applications. It includes the following six steps:

1. Assess—Providers should plan ahead by assessing readiness through surveys, inventories and staff’s attitudes toward IT, computer skills and technical infrastructure.

2. Plan—Providers should plan ahead for health IT implementation, as many vendors do not support the planning process.

3. Select—Providers should meaningfully select an appropriate vendor in the context of their overall IT strategy. An organization can’t just take the vendor’s word that it can deliver the right system for your organization, she says. “You need to understand the real world of what they actually can do and whether or not it’s customizable,” she says.

4. Implement—Providers should address the specific application, technology and operational elements that will be implemented through sample project plans, issues logs, training plans and testing plans.

Also, expectations must be established when it comes to functionality, adds Hanson. “If you don’t set that expectation, it sets you up for failure. People always want to do more with the record. If staff understand this is what we’ve purchased, and what we get out of today, then you have expectations equal with the reality.”

5. Maintain—Providers should conduct regular maintenance activities to ensure their organization is getting the most return from its investment. Physician champions are instrumental to this process, Hanson says.

6. Optimize—Providers should seek to gain optimal value from specific functionality within the EHR and health information exchange, and learn from others’ experience.

Standards & Certification

At first, vendors did not have a business case to build home health platforms that adhere to MU requirements. However, that changed as organizations increasingly eyed interoperability as essential to population health management.

“Vendors who want to be viable in the marketplace understand the importance of investing in products that have widely-accepted standards-based data,” says Hanson.

In the past few years, transitions of care standards developed by the Office of the National Coordinator for Health IT’s Standards & Interoperability (S&I) Framework have become widely accepted.

The S&I Framework’s Community-Led Initiatives included the Longitudinal Coordination of Care Workgroup, which developed standards for interoperable transitions of care, including care plan additions to the Consolidated Clinical Document Architecture (C-CDA).

The national Health IT Policy Committee (HITPC), which makes recommendations on policy frameworks for health IT, is pushing for more meaningful exchange through a voluntary certification program for long-term and post-acute care (LTPAC) entities, which include home health.

Earlier this year, the HITPC endorsed certification criteria that supports the ability to receive, display, incorporate, create and transmit summary care records with a common dataset in accordance with the C-CDA standard and using ONC-specified transport specifications. The committee also supported the general activity of tracking transitions of care standards over time to assess their maturity for future interoperability requirements.

Also, the HITPC endorsed privacy and security criteria that mirror existing ONC-certified privacy and security requirements that govern: authentication, access control and authorization; auditable events and tamper-resistance; audit reports; amendments; automatic log-off; emergency access; end-user device encryption; integrity; and optional accounting of disclosures. The committee is expected to endorse more recommendations for voluntary certification in the future.

In June, the HITPC decided not to put forward quality measure recommendations for LTPAC entities, as it is too premature. ONC is expected to continue discussions with federal agencies and stakeholders to determine the policy and standards readiness for voluntary certification for quality measures.

In the meantime, more policy-making activity is expected to come so there are clearer rules of the road for data exchange among home health agencies and others.

A growing market

Home health is moving beyond home health agencies as health systems and providers, especially accountable care organizations, increasingly coordinate care with patients in a home setting utilizing health technologies.

Vendors are taking note. Home health technologies are projected to double to $5.8 billion by the end of 2018, according to a report from information and analytics firm HIS. This sector includes everything from motion sensors to detect home activity of the elderly to consumer medical devices like blood glucose and blood pressure monitors. The growth also includes wearable technology, such as fitness and heart-rate monitors.

“As they become more comprehensive, the gap between clinical care and home health becomes more narrow, which is necessary to provide patient-centered care,” according to Roeen Roashan, HIS analyst for consumer medical devices and digital health.

Deploying mobile care teams

Phoenix-based Banner Health is part of this trend. The nonprofit health system is moving beyond the four walls of its institutions to provide care to patients who need it most.

Banner Health identified heavy users of its healthcare services, and developed a new care team to care for these patients at home using telehealth programs and technology. This identification process involves the scouring of retrospective claims data for patients with multiple emergency department visits and complex chronic conditions, says Khurana.

The program “highlights a lot of gaps in understanding when treating patients in a traditional model,” he says. “If we are going to have an impact on these patient, we have to know in a much general sense as a person, and not just as a patient.”

The mobile care team includes a health coach, home health nurses, the primary care physician, geriatric specialists, social workers and pharmacists.

Each patient is enrolled at home, where the care team conducts assessments of the home environment for fall risks and other screenings, such as depression. Medication reconciliation also takes place, so the pharmacist gets the best available truth of what the patient is taking.

Once enrolled, the patient is equipped with home health technology, including devices that measure weight, blood pressure, temperature, heart rate, pulse and oxygen saturation. The patients, who receive free Wi-Fi, have their data securely transmitted through a tablet.

The program also uses a “smart” pill dispenser, so if a patient fails to take medications out of the box, alerts are emailed so team members and caregivers can connect with patients to remind them to take medications.

So far, preliminary results are positive, Khurana says. Patients, even geriatric, have shown comfort with using the technology and the audio-visual capabilities of the tablet.

“It’s an innovative and new process, and we’re learning what to do better, what helps patients and what doesn’t. So far, from stories we hear, it’s really been a great benefit to them. If we can meet the needs of patients so they can stay at home longer and safer, that’s the key to the program,” he says.