unintended consequences of telehealth in home health - kavita radhakrishnan, univ of tx, austin -...
TRANSCRIPT
WHAT STARTS HERE CHANGES THE WORLD
Unintended Consequences of Telehealth in Home Health
Kavita Radhakrishnan, RN PhD MSEEThe University of Texas Austin
WHAT STARTS HERE CHANGES THE WORLD
Top Healthcare Consumers
WHAT STARTS HERE CHANGES THE WORLD
Home Health – Growing Healthcare Sector
• Home health clinicians provide care for about 11 million patients across the US
Discharge from Post-Acute Facility
Goal of home health = Patient Self-care
Home Health Agency
Patient’s Home
WHAT STARTS HERE CHANGES THE WORLD
Telehealth as a Decision Aid
• Early detection of health crisis• Informed Care prioritization,
treatment and management• Patient empowerment
–“Contextually relevant information” to connect the dots between data & behaviors
• Expected Beneficial effects – ⬇ Nursing Visits– ⬇ Hospitalization– ⬆ Quality of life
WHAT STARTS HERE CHANGES THE WORLD
Studies’ Geographical Location
WHAT STARTS HERE CHANGES THE WORLD
Unintended Consequences
WHAT STARTS HERE CHANGES THE WORLD
⬆ Home Health Nursing Visits
Weight SBP DBP HR O2 sat Overall0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Alerts related to Cardiac KME
Other Alerts
< 3%
WHAT STARTS HERE CHANGES THE WORLD
Long Feedback Loop / Circle of Communication
ATTRIBUTION: ©2004-2013 Koninklijke Philips Electronics N.V. All rights reserved.
http://www.telehealth.va.gov/ccht/
Fax
Visiting Nurse
Telehealth NursePatient’s Home Clinic Office
WHAT STARTS HERE CHANGES THE WORLD
Fractured Data Ownership
Lack of data ownershipNo Longitudinal analysisClinician fear of liability
Patient Generated
Reviewed at Home health
agency
Stored by telehealth service provider
Action at Physician
Office
WHAT STARTS HERE CHANGES THE WORLD
Negligible ROI
• “No Bang for the buck” Reimbursement for telehealth service too low to be an incentive
• Sunk initial investment– Low resources for updates or
maintenance• 30-day re-hospitalization fines
may be an incentive but the sickest may be left out
10
WHAT STARTS HERE CHANGES THE WORLD
Patient Empowerment or Over-dependence?• False sense of security• Home health model – Telehealth is removed at end of service– Need additional days to wean patients off telehealth
WHAT STARTS HERE CHANGES THE WORLD
Potential Solutions(Besides ROI!!)
WHAT STARTS HERE CHANGES THE WORLD
One Size does not fit all
• Risk-based classification informed by patient context in addition to biometrics– Health Literacy– Co-morbidities – Training & Education– Family support– Daily life routine– Mobility impairment– Cognitive impairment
• Intelligent adaptive alert system tailored to patient characteristics and contextual information
WHAT STARTS HERE CHANGES THE WORLD
Effective Inter-professional Communication
• Lack of Telehealth growth is a symptom of the larger healthcare system malaise
• Clear goals and expectations for individual patients
• Inter-disciplinary collaborative planning on telehealth communication protocols
• Inter-operability to integrate telehealth data with EHRs
WHAT STARTS HERE CHANGES THE WORLD
Patient Empowerment• Add layer of responsibility• Patient-centric• Shift focus of telehealth from
collection of biometric data to informing or motivating behavior change
• Behavioral science techniques and personalized goal-setting should guide telehealth protocols that are designed to motivate behavior change
WHAT STARTS HERE CHANGES THE WORLD
Q & A