Unintended consequences of telehealth in home health - Kavita Radhakrishnan, Univ of TX, Austin - TFSS

WHAT STARTS HERE CHANGES THE WORLD

Unintended Consequences of Telehealth in Home Health

Kavita Radhakrishnan, RN PhD MSEEThe University of Texas Austin


Top Healthcare Consumers


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


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


Studies’ Geographical Location


Unintended Consequences


⬆ 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%


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


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


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


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


Potential Solutions(Besides ROI!!)


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


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


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


Q & A