The Future of Home Health Care Workshop Summary (2015) / Chapter Skim
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7 Innovations in Technology
7 Innovations in Technology
Pages 91-104
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From page 91... ...
Although information technology has been used in health care for a long time to bridge geographic distances and give people access to expert opinions without having to travel, ultimately, computing and information technology may actually be used to improve the quality of home health care services and enable their redesign, said Demiris. For example, Demiris noted that a Medline search for papers on the use of technology in home health care published 91
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From page 92... ...
Passive telemonitoring technologies include bed sensors that capture restlessness, sleep interruptions, or pulse and respiration during sleep. Monitoring of Patient Function and Detection of Emergencies Active technologies include devices that can detect falls and that people can wear.
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From page 93... ...
Passive automated features operate in the background and trigger warnings, alerts, and reminders or turn on lights. The Evidence Base Although both the amount and kind of evidence on home health care technologies are increasing -- from evidence from pilot studies to evidence from some longitudinal research and randomized controlled trials -- "it is still not really clear what seems to work and what doesn't work," Demiris said, especially because the findings are sometimes contradictory.
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From page 94... ...
Simple, low-cost technologies can allow health care workers to capture information more efficiently, and sometimes new technologies let them obtain new data, Demiris said. For example, traditional telehealth allows the capture of a person's blood pressure or weight, and some of the new technologies provide information about a person's lifestyle or behavior, eliminating the need to rely on self-reports.
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From page 95... ...
From the provider perspective, telehealth can range from the use of electronic health records and remote monitoring of vital signs and symptoms all the way to doing consultations and patient visits by video. Technology can be helpful to teams of caregivers -- physicians, nurses, therapists, social workers, and others, all of whom are delivering some aspect of care -- by creating vital links that facilitate communication, coordination, and improved collaboration.
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From page 96... ...
The communication component encourages good communication and relationships with discharge planners. For the system as a whole, telecommunications applications have the potential to gather and compile useful data so that health care systems can learn more about what home health care applications produce the most desired outcomes, Kaushal said.
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From page 97... ...
These best practices involved patient education as well. According to Kaushal, positive outcomes like these can lead to organizational growth in several ways: by providing a competitive advantage, by enabling expansion of service coverage to other disease entities, and by creating opportunities for new business and new partnerships.
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From page 98... ...
Nilsen noted that the workshop started from the assumption that technology could enhance health outside of hospitals and nursing homes by improving and sustaining health and increasing the quality of life; by allowing people to live at home longer; by reducing health care costs, especially the cost of unnecessary hospitalizations and rehospitalizations; and by reducing the strain on the health care workforce and on family caregivers. Further, the participants looked for ways to use technology's strengths to facilitate communication and data collection.
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From page 99... ...
Assessment of the usefulness of various technologies may require new research methods, such as "continuously evolving evaluations where technology can be evaluated on the fly," Nilsen said. Randomized clinical trials may still have a place for the evaluation of specific outcomes and the development of best practices.
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From page 100... ...
Cindy Krafft, American Physical Therapy Association, said that some of the technologies in development have great potential to support patient 2 See http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ ucm331675.htm (accessed December 8, 2014)
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From page 101... ...
Incentives Krafft noted that a tremendous opportunity exists to expand rehabilitation therapies to prevent patient decline and keep patients out of higher-cost care. Unfortunately, she said, the current payment methods discourage the widespread use of rehabilitation methods that might replace a reimbursable therapy visit.
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From page 102... ...
She said that one way to overcome that disincentive might be to base rewards on patient outcomes and counting telehealth encounters into the productivity standards rather than just the number of patient visits per day. Evaluating New Technologies Bruce Leff, Johns Hopkins University, questioned whether randomized controlled trials are really a robust method for evaluating these technologies.
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From page 103... ...
INNOVATIONS IN TECHNOLOGY 103 for additional purposes. For these reasons, the use of "pragmatic clinical trials" or greater flexibility in the research protocol may be useful and allow the inevitable evolution of technology over the period of the research (Demiris, 2011)
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