Home healthcare, an essential ingredient of post-acute care, can help people recover from injury or illness faster, which ultimately can prevent relapses that leads to an emergency room visit or hospital readmissions. Increasingly, home devices are being used to monitor the health status and vital signs of patients; at the same time, there also has been an explosion of mobile apps that can work with such devices, smartphones, and/or tablets to aid consumers in managing their own health. Both of these developments hold promise for improving post-acute and chronic care.
Unfortunately, the guidance from the U.S. Food and Drug Administration on mobile apps and the report from the National Research Council on flaws in home health devices--both released last week--failed to address one of the main problems in health IT for home use: a general lack of connectedness between home and provider information systems. To really apply the new technologies in ways that will prevent readmissions, doctors must be online with their patients and their caregivers, and must receive relevant data from both in a way that's easy to use.
Today's approach to remote monitoring has not progressed far beyond that of a decade ago: patients in a disease management program for, say, congestive heart failure, still receive telephonic support from nurse case managers. In some cases, the nurses might be able to monitor the patients' weight online via digital scales, and patients might be able to answer questions about their symptoms and diet through a web-connected device.
Despite evidence of home monitoring's efficacy, payers that cover it are few and far between; so, unless there's a financial reason for hospitals to pay for home monitoring, as there is with heart failure, it may not be done at all. For example, a 2008 article in Managed Care Magazine notes that most insurers don't cover blood pressure monitoring at home, even though it's been shown to be more accurate than in-office measurements. As for connecting digital blood pressure cuffs directly to an electronic health record in a physician's office, we're talking about the impossible dream. Even if health plans paid for the technology, physicians would not be reimbursed for keeping tabs on patients at home.
Home care nurses are actually more likely to use an electronic health record than physicians, partly because of Medicare documentation requirements. But physicians usually don't hear from these caregivers unless a patient has a serious problem, or needs to have their medication adjusted.
Connecting home care records online with ambulatory-care EHRs is still the exception, but at least one prominent healthcare organization has made progress. A few years ago, the Cleveland Clinic interfaced its discharge planning software with its home care application--both of which happened to come from Allscripts. By 2010, Cleveland Clinic had also found a way to send the home care data into its Epic enterprise EHR so that physicians caring for patients could view it.
With bundling and accountable care organizations looming on the horizon, I wish I could say that other healthcare systems are following Cleveland Clinic's example. But frankly, I haven't run into much of it, outside of St. Vincent Health System in Indianapolis and Partners HealthCare in Boston. This is a big hole in enterprise health information exchanges, and one that will have to be filled sooner rather than later. - Ken