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Khatereh Hadi and Laura SimsImproving Communication in Home HealthcareReducing Hospital ReadmissionsLaura1Problem StatementHome healthcare patients require providers to visit them within their homes. Many of these patients require frequent visits and face difficulties with communication with their provider between visits. Failure to adhere to their medical regiment often causes these patients to be unnecessarily readmitted to the hospital. Alternate modes of communication could improve adherence of home healthcare patients to their proper health regiment.Intro Problem Statement Literature Review Existing Products Goals Proposed SolutionElderly Patients: a big proportion of home care target group According to our case study, more than 50% of patient receiving home care services are elderly people. Regarding the existing literature on the high rate of readmission for elderly people, improving quality of care in home care settings would decrease hospital readmission rate.Elderly patients discharged to the community from hospitals face a higher risk of reentering the health care system .The rate of recidivism has been documented; it ranges from 17% to 38% in different studies.

Intro Problem Statement Literature Review Existing Products Goals Proposed SolutionFethke, C. C., I. M. Smith, et al. (1986). "" Risk" factors affecting readmission of the elderly into the health care system." Medical care: 429-437.A study shows that about 59% of unplanned readmission of elderly people are avoidable, pointing out seven reason for readmission:Relapse of original conditionDevelopment of new problemCaregiver problemsComplication of illnessNeed for terminal careProblems with medicationProblems with servicesMany of these problems can be solved through a good communication with caregivers.Intro Problem Statement Literature Review Existing Products Goals Proposed SolutionLau, D. T., R. Berman, et al. (2010). "Exploring factors that influence informal caregiving in medication management for home hospice patients." Journal Of Palliative Medicine 13(9): 1085-1090.Elderly Patients: a big proportion of home care target group Communication, one of the key factors in palliative careArnold B.,2011: Communication is a key currency for delivering optimal palliative care which is possible trough: (1) developing more comprehensive clinical-patient needs assessment tools; (2) improved patient-clinician communicationBaile WF, Aaron J: Excellent communication is central to the overall practice of navigation and to palliative care. Good communication between physician and patient can help in navigating the transition to palliative care and hospice.

Intro Problem Statement Literature Review Existing Products Goals Proposed SolutionArnold, B. (2011). "Mapping hospice patients' perception and verbal communication of end-of-life needs: an exploratory mixed methods inquiry." BMC Palliative Care 10(1): 1.Baile, W. F. and J. Aaron (2005). "Patient-physician communication in oncology: past, present, and future." Current opinion in oncology 17(4): 331.

Communication is important, but the quality is more important.caregivers good interpersonal relations with patients facilitated medication management, whereas poor communication/relations among caregivers within a support network impeded the process.Intro Problem Statement Literature Review Existing Products Goals Proposed SolutionLau, D. T., R. Berman, et al. (2010). "Exploring factors that influence informal caregiving in medication management for home hospice patients." Journal Of Palliative Medicine 13(9): 1085-1090.Caregivers life experienceself-confidenceemotional statescognitive and physical abilitiesKnowledgePatients emotional stateComplex medication needs Affect communication qualityDemands careful and structuresd communication frameworkLiterature ReviewUse of videophones for seniors and hospice providersSeniors found it easy to use (71%)Willing to accept technologyHospice providers could use (85%)Intro Problem Statement Literature Review Existing Products Goals Proposed SolutionOliver D, Demiris G, Porock D. The usability of videophones for seniors and hospice providers: a brief report of two studies. Computers in Biology and Medicine 35(2005) 782-790.

Literature ReviewUse of Telemonitoring SystemsPatients can be monitored from the comfort of their homePeriodically acquire vitals (eg. blood pressure, heart rate)Increasingly common for devices to be wirelessNeed to be integrated with healthcare information systems

Intro Problem Statement Literature Review Existing Products Goals Proposed SolutionGalarraga M, Serrano L, Martinez I, et al. Telemonitoring Systems Interoperability Challenge: An Updated Review of the Applicability of ISO/IEEE 11073 Standards for Interoperability in Telemonitoring. Grant work from the Spanish Ministry of Science and Education.

Literature ReviewManhattan Research survey of physician digital adoption7% of physicians use online video conferencing to communicate with patientsUsed for follow-up questions or for geographically diverse patientsBarriers: HIPAA and lack of reimbursementIntro Problem Statement Literature Review Existing Products Goals Proposed SolutionSeven percent of U.S. physicians use video chat to communicate with patients. 17 May 2011. http://www.fiercehealthcare.com/press-releases/seven-percent-us-physicians-use-video-chat-communicate-patients-1.Existing ProductsIntro Problem Statement Literature Review Existing Products Goals Proposed SolutionTelemonitoring Bosch Health Buddy Connects patients to their care providers Providers can monitor and take actionhttp://www.bosch-telehealth.com/content/language1/html/5578_ENU_XHTML.aspx

Intro Problem Statement Literature Review Existing Products Goals Proposed SolutionExisting Products

In May 2011, after a one year launch

30% of U.S. physicians own an iPad 28% plan to purchase in the next 6 months 81% of physicians own a smartphone

Taking the Pulse U.S. v11.0. Manhattan ResearchExisting ProductsIntro Problem Statement Literature Review Existing Products Goals Proposed Solution

In Denmark, patients can visit their doctor from home using simple medical devices and a notebook computer with a Web camera.Bhanoo, Sindya N. Denmark Leads the Way in Digital Care. 11 Jan 2010. http://www.nytimes.com/2010/01/12/health/12denmark.htmlExisting ProductsIntro Problem Statement Literature Review Existing Products Goals Proposed SolutionOnline Care for Providers Service for care providers Sets up live encounters through video, audio, and chat, and sets up payment automaticallyhttp://onlinecareforproviders.com/index.php

Atlanta HospiceServices: Home healthcareHome visit: physicians, nurse practitioners, social workers5-6 days a week: nurse visit1-3 days a week: physician visit2.2-2.5 days a week: social workers

telemonitoringHospice

Atlanta HospiceTechnlogies :PT/INR machine: to read patients blood clotting tendency (coagulation)

Telemonitoring: to read blood pressure

Atlanta HospiceMed Home Unit: medical alarm systemCan record and play approximately eight 15-second audio reminder messages.Emergency bottom: connected to the 24-hour call center specialist who can communicate with the patient

Atlanta HospiceMed Lucker: medication storage and emergency kitTo pick up medicine, no more waiting.Stores and tracks a variety of emergency and first-dose medications at health care facilities

Atlanta HospiceMedPORTAL :help physicians automate their entire day across all care settings

Atlanta HospiceDocument imaging system: electronic recording mechanism, it takes a paper medical record and creates a universal electronic patient medical record that is easily managed.

Problems with existing home care system and technologiesNot all the devices are available for patients; nurses and physicians are responsible to use and apply them.Not all the households have the LAN and internet accessPeople key information in, errors are possible.Information are passively collected and they are not actively used by caregivers.Data are not integrated.Patients are willing to use the devices, by they dont want commitment.Patients are different in medical adherence.The costs are too high.Only visits are covered by Medicare, not telemonitoring and other far distance technologies.

GoalsIntro Problem Statement Literature Review Existing Products Goals Proposed SolutionImprove CommunicationImprove AdherenceDecrease CostProposed SolutionIntro Problem Statement Literature Review Existing Products Goals Proposed SolutionCost effective method of using videoconferencing for home healthcare patients Bundled data plan Secure connection platform Simple interface Transferable hardware

Care NetworkInterfaceHospiceHomePatientMedHomePT/INRPhysicianNurseSocial workerHospitalMed LuckerPharmacy