The Future of Home Health Care Workshop Summary (2015) / Chapter Skim
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3 Toward Personal Health: Going Home and Beyond
3 Toward Personal Health: Going Home and Beyond
Pages 23-34
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From page 23... ...
"I've spent 30 years trying to take health care home and have mostly failed at doing so, because it hasn't scaled yet." These capabilities -- from care models to payment models and technologies -- have not become widely available to enough people. Taking Control -- At Home Misdiagnosed with a rare form of kidney cancer at age 19 years, Dishman spent the next 23 years being told he would die within 1 year (until a correct diagnosis and a subsequent successful kidney transplant in 2012)
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From page 24... ...
Thereafter, in 21 more rounds, he insisted that the chemotherapy be low dose, given over long periods of time, and delivered at home as much as possible. One difficulty that Dishman has encountered is that neither paper records nor the emerging electronic health records of today include a field for patient goals.
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From page 25... ...
One of the challenges in dealing with the aging population in China is the one-child family. "They now have an average couple trying to take care of four, sometimes eight people, if the great grandparents are alive." Despite a centuries-long cultural tradition of filial piety and ancestor worship, the Chinese government in 2013 joined some other countries in adopting a law saying that people had to take care of their aging parents' financial and spiritual needs.
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From page 26... ...
The Chinese are already building smart platforms based on activities of everyday life -- railway use, communications, shopping, and phones and other devices -- and want to build platforms to provide services of daily living, like housing, laundry, and food, plus health management and medical services, Dishman said. They are not thinking about health care in isolation, as often happens in the United States, assuming that "everything else" is somehow taken care of.
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From page 27... ...
They see the need for elder services outstripping the workforce, producing health care worker shortages and creating immigration challenges around the world. What they desire is to "shift left," that is, to get more people on the end of the health continuum with lower levels of chronic disease, lower levels of functional impairment, lower costs of health care, and a higher quality of life (see Figure 3-1)
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From page 28... ...
Dishman acknowledged that Intel is learning as it goes along and is still "struggling to figure out this distributed capacity." However, the workplace is a key node of care now and will become larger. He noted that this apIntel Strategy for Innovation: Place-shift, Skill-shift, proach flies in the face of some 230 years of hospital history, which says Time-Shift from Mainframe to Personal Health Timing & Expertise of Intervention Home Care Independent Community Clinic Healthy Living Chronic Disease Management Residential Care Quality Assisted Living of Life Skilled Nursing Acute Care Facility Specialty Clinic Community Hospital ICU Cost of Care FIGURE 3-1 Intel strategy for innovation: shifts in place, skills, and time from the mainframe model to the personal health model.
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From page 29... ...
The mainframe model is simply the wrong tool for the job for the vast majority of care, he said. Around the world, Intel social scientists have mapped out people's key nodes of health care, and although they mention their local hospital -- for the most part, in a positive way -- as their node of care, many other nodes of care exist.
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From page 30... ...
The care anywhere concept represents the shift from institutions to mobile, home-based, and community-based care, with the understanding that today home health care can include a much broader range of options and produce care whose quality is much higher than that of traditional notions of home health care, tightly circumscribed as they are by policy, staff training, reimbursement, and client expectations. Care networking includes the technology infrastructure, business models, and organizational models that allow care to be shifted from solo to team-based practice, along with the information technology systems that connect all these people and devices.
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From page 31... ...
The tablet computers that they carry will use an infrastructure that gives them access to all the information that they need, although he said that the technology industry will need to develop ways to facilitate the work flow for highly mobile clinicians. For care customization, the shift to genomics and proteomics is happening rather quickly in cancer and rare inherited disorders, Dishman said, and the computing power needed is also becoming less expensive and more
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From page 32... ...
Although the creation of a database field called "patient goals" is relatively simple, the analytics that would allow the system to adapt to these goals and suggest ways to achieve them are not. Another data management problem that technology may be able to solve is automation of at least parts of the lengthy documentation tasks that home health care workers are currently required to perform.
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From page 33... ...
All the other fundamental decisions about care models, work flows, workforce needs, and optimization of resources for results, followed by determination of sustainable business and payment models, need to come before it is determined what technology infrastructure is needed to support it. Dishman said that home health care today is "relegated to a niche," to an additional capability to be added to the mainframe model.
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From page 34... ...
In pilot tests, people focus on the wrong problems, they do not learn from past innovations, and they do not have an iterative mind set that, once they have met a baseline set of safety and security standards, says, "We don't have to get it all right in the beginning."
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