From electronic health records to sleeker, lightweight instruments to monitor patients’ vitals, technology is changing the face of home healthcare. In Middle Tennessee, home health providers are adopting high-tech advances and adapting them to improve patient care.
“Traditionally, when you made a home visit, everything would be hand-written. That meant you were bound by a paper chart,” recalled Laura Beth Brown, president of Vanderbilt Home Care Services. “What’s really neat about our situation today is that all of our staff members have laptops in the field, so they can key in all of the patient documentation. Therefore, when other disciplines make visits — for example, if the physical therapist follows the nurse — they have all of that information in real time right there at their fingertips, right there in the home.”
Such point-of-care technology, which depends on wireless access, improves efficiency, patient safety and patient care, she added, and is equipped to ensure privacy with double-guarded passwords and other precautions for HIPAA compliance. But what if a care provider visits a home where wireless technology isn’t accessible? “Every morning, every mid-day and every evening, the computers are synched with each other and with the main server,” Brown explained. “So you could synch and drive to the patient’s home and still have the up-to-the-minute information.”
Vanderbilt Home Care logs an average daily census of about 500 patients in Davidson and contiguous counties and employs about 250 caregivers with varying levels of skill. Services include skilled nursing, social services, home aid, and physical, occupational and speech therapy.
Nashville-based Alive Hospice launched its electronic records system this year for caregivers in the field. So far, about 35 physicians, nurses, chaplains and social workers have been trained and are using new laptop devices at the point of care, according to Tony Taylor, the Alive Hospice director of health information management and privacy. He said all 150 members of the organization’s home-care team will be similarly trained and equipped, followed by deployment of the system in all inpatient units.
“Your information is more readily available to all care providers at any given time. It makes us more productive with data collection and also reduces errors with regard to illegibility … and that improves patient safety,” Taylor said.
Alive Hospice uses 14-inch laptops, which can be rotated to become a tablet. The units are equipped with handwriting-recognition software and a pen to use for writing or to point and click.
Brown said if a new home health patient was discharged from Vanderbilt University Medical Center, Home Care Services has electronic access to the patient’s hospital record. “That’s a value-added service, because we can understand what went on with that patient before he or she got to us. As you can imagine, there was a day and time when we didn’t have access to that, and we had to rely on word of mouth or what the case manager or discharge planner was able to tell us. Now we have a much more comprehensive overview of our patient, which falls right in line with CMS’ (the federal Centers for Medicare and Medicaid Services) initiative around the continuum of care.” Does the patient have a history of rehospitalizations because of, for instance, high blood pressure? “That makes us even that much more astute and aware of what we’re taking care of at home, because we want to prevent another hospitalization,” Brown said.
In the arsenal of a home caregiver today are much more than dressings, catheters and a blood-pressure cuff, according to Pam Barnes, administrator of NHC Home Health in Murfreesboro and Franklin. “Every nurse has access to a pulse oximeter machine, which checks oxygen levels. So if a patient is exhibiting symptoms like confusion, they can check to see if that’s what’s going on,” she said. Home nurses are also frequently equipped to check blood glucose levels or the uterine contractions of women experiencing pregnancy complications and prescribed bed rest.Other Home Health Happenings
One of the latest technological advances allows home-care providers the ability to check whether patients on blood-thinning medications are receiving the optimal dose. Called the PT/INR (Prothrombin Time, International Normalized Ratio) test, it evaluates the blood’s clotting time. Yet the jury is still out, according to both Barnes and Brown, on the accuracy of the test; some doctors are sold, others aren’t. “Some agencies are already using them,” Barnes said, “and we’re looking into it.”
Barnes added, “For us, the biggest change that I’ve seen — and I’ve been with NHC Home Care since 1993, so I’ve seen a lot of changes — is access to Wound VACs from KCI Products, which help to heal wounds much quicker than just traditional methods. Patients get better faster.”
When it comes to adapting the latest and greatest technology to home care, caution is a frequent byword. Definitions of the word telehealth run the gamut — from the use of a telephone, to nocturnal hemodialysis accomplished via an internal jugular catheter. Brown says adoption of much of the gee-whiz technology will happen when reimbursement strategies change. “Historically, considerations around telehealth were purely based on reimbursement,” she said. “In general, decisions you made in healthcare you made based on whether you were going to get paid for it.” Yet she added, for the first time in her 16-year home health career, reimbursement “truly lines up in favor of the patient and also in favor of doing it in an efficient way so that we’re not spending a lot of excess money and not achieving good outcomes.”
In October, Brown became president of the Tennessee Nurses Association.