Technologies for improving post-acute transitions demonstrate the value of health devices and computer-based technologies for enabling care that is more coordinated, informed and less error-prone. Technologies also help engage patients and caregivers in the care process, as home-use technologies can promote personal responsibility and support early patient education and activation on how to better monitor and manage health.
Technologies that can assist in many areas – improving medication adherence, medication reconciliation, patient monitoring, communications between and among clinicians, patients, and informal caregivers, risk assessment, and others – are widely available, but generally are underutilized. Based on a study from the Veterans Health Administration, care coordination that is supported by medical devices and computer-based technologies led to fewer hospitalizations and emergency room visits, high patient satisfaction and acceptance, and reductions in the cost of care.
As a result of the positive benefits for transition of care software, look for a proliferation in patient-centered technologies over the next few years that case/care managers can implement as part of their transition of care plans.
This article highlights examples of patient-centered medical devices and computer-based technologies that are producing positive outcomes: reducing emergency department visits and avoidable hospital readmissions, improving patient and provider satisfaction, improving patient engagement and reducing healthcare costs.
Medication Adherence. The multipronged interventions for improving medication adherence include:
- Simplifying the patient’s medication regime.
- Identifying if the medication has untoward effects.
- Improving self-efficacy and activation.
- Providing cues or reminders to take medications as prescribed.
Today, medication adherence technologies are in the beginning stages. Products on the market can:
- Fill or provide patients with information and/or instructions about their medications.
- Remind patients to take medications.
- Dispense medications through automation at certain times.
- Produce reports that can be provided to clinicians and caregivers, showing the date and time when the medication was taken.
More advanced features are in development that will provide healthcare professionals information they can utilize in their care coordination activities. These include products that can measure how the patient ingests medications, enable us to better understand how medications are metabolized, and deliver programming to adjust medications automatically.
Best in Class: The leader in this technology is the Philips Medication Dispensing Service, which can organize and dispense 10-30 days worth of medication in individualized plastic cups. The device includes a reminder system, has a safeguard to prevent double dosing, an alert to notify caregivers if a medication is missed and a web-based system that allows the team to review alert and dispensing history.
Medication Reconciliation. Medication reconciliation is the process of creating an accurate list of all medications the patient is taking, comparing that list against new physician’s orders, checking for discrepancies, making clinical decisions based on the comparison, and communicating the new list with the patient, caregivers and providers. The primary goal of medication reconciliation is to avoid adverse drug events.
Currently, medication reconciliation is done manually, but there are some online tools that can begin the process. But until the industry adopts systemwide electronic medical records with a patient interface, case/care managers have to assist patients in developing their medication list as part of their educational efforts.
Remote Patient Monitoring. Remote patient monitoring (RPM) systems are used to closely watch a patient’s health in their home. Today, there are a variety of integrated or standalone RPM devices to monitor vital signs, oxygen saturation levels, weight, blood glucose levels, medication management, mental health, physical and cognitive fitness and other data that assist ongoing monitoring of patients with chronic medical or behavioral health conditions.
The information can be transmitted via phone lines through cell phones to healthcare professionals who can intervene by providing coaching or adjusting the course of treatment. Best in Class: Health Buddy is one of the many remote patient monitoring tools and has received NCQA Accreditation for 10 programs: asthma, cancer, coronary artery disease, CHF, COPD, chronic pain, depression, hypertension, diabetes and pediatric asthma.
Social Support and Communication. This area includes tools such as personal health records (PHR) that help patients track their healthcare services, access health records and manage their own health information. PHRs enable the patient to store and share information with professionals, family and others who may be involved in their care, and they foster self-management and care coordination.
Best in Class: A good example of this is the Stepping Stones Project of Whatcom County, which representatives of Qualis Health reported on at the Dorland Health Care Coordination Summit in May. The Stepping Stones Project is aimed at improving communication gaps between healthcare providers and patients to ensure safe transitions from one healthcare setting to another. It engages providers, patients and caregivers to take steps to ensure safer transitions, using tools like a shared PHR, transitions coaching and medication self-management.
Social Networking enables communities of patients, caregivers and clinicians to connect, share knowledge with, and provide support to, patients and their care providers. Social networking has the potential to improve transitions of care by increasing social connectedness, improving communication between formal and informal caregivers and providing self-management of care. Social networks use a variety of methods to facilitate communication through discussion groups, chats, messaging, email, video and file sharing. Some examples of social networking sites are PatientsLikeME and EmpowerHER.
Remote Training and Supervision Technologies. These are systems that support the training and supervision of healthcare workers and patients who are not physically connected with their educator. Training and supervision can occur synchronously in real time or asynchronously on demand. Best in Class: Rest Assured, a ResCare Company, is one leading organization that provides remote training and support to older adults seeking independence.
There is a great deal of activity in this area. Here are some resources you can use to keep up to date.
As the technologies mature and become more widespread, we invite you to keep up to date with Case In Point and find these important resources in the Case Management Resource Guide (www.cmrg.com). Both products will provide access and education about these trending topic areas.
Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN, is Editor in Chief of th Dorland Health Group. Email: allewellyn@accessintel.com
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