Jitterbug has finally provided an answer to the problem of wanting to stay in touch with elder folks, by developing a feature rich phone that is easy and less confusing to use. My 85 year old mother is a great candidate. Check it out if your loved one would like to use a phone that accommodates sight, hearing and other impairments common to elders who want to use a cell phone. Check it out at jitterbug.com
Do you like to watch the evening news? I do. However, I grow very tired of drug commercials for all sorts of things like allergies, constipation, stomach upset, and Cialis. I bet I have seen that happy couple in two matching bathtubs a hundred times during this last TV craze of Olympics and political conventions. UGH! Like most, though, I figure if the ads didn’t work, the drug companies wouldn’t run them. A recent study says otherwise.
Although direct-to-consumer advertising by pharmaceutical companies has increased significantly since the FDA loosened its restrictions on the practice in 1997, the campaigns have had little effect on sales, according to the British Medical Journal.
Well, enter Phreesia. Phreesia is a privately held company focused on patient check-in. The company provides physician offices with a free wireless touch screen and swipe card enabled device that looks a lot like an etch-a-sketch (see above). Phreesia automates the patient check-in process by collecting personal health information from the patient (giving the patient something better to do that read old golf magazines?). The product is designed to interface with physicians’ existing and future technology and is compatible with electronic medical records (EMRs)- so they say.
Now, guess who’s paying for these “free” devices? Your neighborhood drug company, finding an “educational” way to push content, customized to the patient’s diagnosis and self-reported symptoms, via the device. It is clever. I am just hoping I don’t have to watch more ads about Activa after registering for a visit.
“As every senior executive worth his salt will appreciate, to be competitive and to sustain his competitiveness, one must steadily evaluate himself, the organization, its products and services, and the customer’s response” (Chorafas, 2002). Accurate predictions about the future of the homecare technology industry have serious implications for software vendors.
If the graphic below appears cluttered, it properly reflects the point that the homecare industry is being impacted by many new technologies. Coupled with these changes is a 2008 reduction in home health reimbursement of 2.7% per year starting in 2008 with an additional 2.7% decrease each over the next four years (Center for Medicare Services, August 2007). New efficiencies will be necessary for home health to cope with these nation-wide cuts. For home health, MIS technology is important, but it must also be affordable. Alternatives to expensive client server applications are emerging. The most promising solutions include web based technology offered along with hosting and services (SaaS).
Gartner states “by 2011, 25% of new business software will be delivered as SaaS” (Lheureux, 2006) and “software as a service will grow seven times faster than on-premise software deployments during the next three years” (Lheureux, 2006, p. 2).
Such a stunning change in the homecare IT market would impose serious new requirements including:
· A switch from initial licensing fee (ILF) and recurring license fee (RLF) revenue model to a subscription and services revenue model
· A total system re-write to support web based user access
· Maintenance of a dual support system for current customers
· A significant new capital investment for vendors
· A significant culture change for vendors as well as customers
· A change in what is sold and managed by traditional vendors
If the above challenges are accepted by the market, new customer/vendor relationships will emerge:
· By partnering for commercially available software infrastructure services (implementation, support, system administration, storage), vendors could elect to devote intense, singular focus on developing value added functionality to customers.
· Because of the subscription revenue model, vendors could experience more predictable revenues, reducing revenue spikes attributed to large software deals. This advantage would be particularly attractive to investors.
· Because of singular focus on development, vendors could expedite release schedules and get features to market quicker than competitors.
· Replacement sales for SaaS vendors might increase, as no current major homecare technology vendor offers a SaaS solution.
The above opportunities for innovative change are technology based and are therefore, not without problems. Keeping information safe in a web environment will continue to be a major healthcare provider concern. Homecare providers are entirely dependent upon a mobile workforce, thus an unlimited set of Internet access points is required for a large organization. However, the typical homecare agency is a good fit for a secure web enabled solution. Characteristics of homecare organizations can be matched to those described by Firstbrook (2007) as well suited to a SaaS technology option. Homecare organizations typically have:
· A large remote workforce
· Numerous small and geographically distributed offices
· I.T. staffing constraints
· High turnover and attrition among the clinical staff users
· Low capital resources
· Frequent changes in rules and regulations that affect the software functionality
Center for Medicare Services. (August 2007). Summary of final home health refinements compared to current home health PPS payment system. Retrieved Jan 1, 2008, from http://www.cms.hhs.gov
Chorafas, D. N. (2002). Enterprise Architecture and New Generation Information Systems. London: St. Lucie Press.
Firstbrook, P. (2007). Pros and Cons of SaaS Secure Web Gateway Solutions: Gartner, Inc.o. Document Number)
Kyte, A., & Clark, L. (2006). Hype Cycle for Software as a Service, 2006 (No. G00141122): Gartner, Inc.o. Document Number)
Lheureux, B. (2006). Predicts 2007: Software as a Service Provides a Viable Delivery Model. (I. Gartner Research o. Document Number)
Sangwan, R. (2006). Global Software Development Handbook. New York: CRC Press.
Automated point of care (POC) documentation closes the loop between the office management systems and the clinical documentation requirements for homecare. Point of care helps bring an agency’s standards into the field and enhances best practice. However, the real power of POC, in my opinion, is yet to be tapped.
Data mining- the automated searching of patterns of information using specific criteria- is now coming into its own for homecare. While it’s mainly an advantage to home health, with the coming standardization of hospice quality data collection, it will not take very long for benchmarking firms to get tools up and running for hospice as well. Home health data mining is based upon the OASIS instrument. Substantial reliability has been demonstrated for the OASIS data set items (Madigan, 2002). It’s about time for the time consuming exercise of performing the OASIS to result in something positive!
Most research on clinical data in homecare has been manual and tedious. Now, data mining tools are available and the effort can be outsourced. OASIS has been around long enough that patterns of information can be compared real time to assessment data, so that predictions of outcomes result. When an agency can identify high risk patients in the start, then beat the odds, preventing re-hospitalization or emergency visits, the statistical evidence is a very powerful marketing tool. Take advantage of proactive data tools and find the gold in them thar hills!
That said, data miners will be digging for fool’s gold if they don’t use additional POC tools to standardize the other aspects of documentation- specifically variance reporting necessary to judge the impact of care (Versel, 2003). Documentation of patient responses to care should be simple and reliable. Otherwise the clinical data warehouse will be full of data, but won’t be worth much. Recall the old saw “healthcare is drowning in data and dying of thirst”. Or, what you thought was a gold mine, turns out to be a data landfill.
For variance charting against care plans, I go for the ultra simple model: met, not met, or not applicable. A numerical value can be assigned to each of these outcomes so that a number of meaningful conclusions can be drawn by patient or by group improvements. Check out Melina Huffman’s (2005) book on how to design a homecare outcomes program. Most modern point of care systems can meet the functional requirements of her recommendations.
References
Huffman, M. (2005). Implementing Outcome-Based Home Care. Sudbury, MA: Jones and Bartlett.
Madigan, E. A. (2002). The scientific dimensions of OASIS for home care outcome measurement. . Home Healthcare Nurse, 20(9), 579-583.
Versel, N. (2003). A beautiful mine. Modern Physician, 7(7), 26.
Imagine the potential of such a dashboard for homecare. What if we could see a patient’s status ? what if each patient was tracked like a UPS package? And, what if you could know where providers were at any given time?
1. A real time screen display of the admission process, linear in nature, showing how far along the admission work has progressed..has the first visit been completed?, has the OASIS been submitted? Has the POC been approved by the clinical manager? Have the admission documents found their way (signed) and back into the patient’s record?
2. I imagine two lines, one above the other, one for business services, billing status, orders status, authorizations status.
3. What if a GPS system could identify the nearest provider to a new admit’s residence? And, you could make new assignments accordingly?
Seems to me it would be awesome to have a per patient dashboard, with a summary level display for team and branch, etc. There could be a counterpart provider dashboard, showing a virtual view of scheduling and routes. Imagine the possibilities…
Reference:
Rosow, E., Adam, J., Coulombe,K., Race, K., Anderson, R. (2003). Virtual Instrumentation and Real-Time Executive Dashboards. Nursing Administration, 27(1), 58-76.
