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Idea Adapted tele-health systems to serve patients with disabilities

By Kathlenn Healey | 08 Dec, 2014

Idea submitted by: Kathleen Healey

My practice involves serving profoundly disabled individuals with MS who live at home, I do make house calls with my team.

My idea includes an adapted tele-health system to serve the severely disabled including "super" screens, keyboards and enhanced voice interaction supporting care delivery. Multidisciplinary interactions (primary and speciality care, social services, speciality consultations, PT, OT) addressing many aspects of care could be provided. This "high tech" application would support our "high touch model" which includes patient and family and requires highly competent staff, committed to continuity and coordination of care.


Tara Narula Advisor Replied at 3:17 PM, 9 Dec 2014

Dear Kathleen, Thank you for your idea and thoughts. I definitely see tele-health as the future of medicine in terms of dealing with patients with chronic conditions. We are using this in our heart failure patients with much success and I completely agree that a mulitdisciplinary approach is the most useful. What do you feel are the biggest barriers at this point to implementation of these systems?

Kathlenn Healey Replied at 11:06 PM, 9 Dec 2014

Dear Tara

Because of the multidisciplinary nature of the care ....communication is probably the most challenging I work from an academic med center that does not house a home health AGENCY my team has different EMR systems that do not "connect" so much is faxed and sent on paper. Much of our communication is done by telephone and we have a patient care conference on each homebound patient weekly and include PT, social service, medicine and nursing. In between frequent calls are made between team members, email is used, although text messaging would be ideal it is not used due to confidentiality issues. These patient are extremely disabled most have suprapubic catheters, some have g tubes, and some are admitted to our service with severe pressure ulcers (stage 3 and 4) most are in power wheel chairs need hoyer lifts to transfer many have poor use of upper extremities ....our goal is to prevent common complications .

We have recently equipped the home health nurse with computer with video link secured system to the University we plan to include the patient in their own care conferences at least monthly.

Redundancy is an issue because of the documentation requirements using the Oasis system and home health regulations, disciplines continue to ask the same questions numerous time and there is still no central data assessment or form that can be use by all disciplines. (There should be an app for this focusing on function and prevention of complications.)

Documenting and billing with our current EMR Epic is extremely difficult and time consuming our system poorly integrates non traditional care functions.

Difficult to support our program financially although initial experience suggests reduction of complications reimbursement is still based on fee for service and to support the intensive care we provide at home is generally not adequately reimbursed with the current time requirement (automation may improve this situation) . Also difficult for patient to access technology even using a cell phone can be difficult with this degree of disability. Generally all of our patient have life lines (emergency call systems). Adapting technology for these patients could vastly improve their lives but again financing this technology is difficult generally all of our patient are medicare and most dual eligible medicaid.

Other barriers include variable staff entering patients homes with little continuity or education. We have partnered with home agency that has provided the same nurse, PT, OT etc and we have done additional education for the staff regarding multiple sclerosis and specific problems. Continuity of educated personal is critical for success we have found.

I would like to hear more about your heart failure patients how you use technology, how you keep your program financially viable. what is your documentation like ?

Joaquin Blaya, PhD Advisor Replied at 8:46 AM, 13 Dec 2014

It's saddening to hear that your biggest challenges come from badly designed IT systems and lack of communication between them (which could potentially reduce the redundancy issue). Unfortunately, the IT systems are just a reflection of the organizational structures in place at a national and institutional level and those are really hard and slow to change.
One change that hopefully is coming is a requirement to have all health IT systems have a standard way of communicating with each other (API in programming language). There's a breakthrough idea submitted for that

Kathlenn Healey Replied at 5:34 PM, 13 Dec 2014

Thank you Joaquin for understanding. I wish that administration would realize this... that in fact it seems like we need more time with our patients Especially for complex chronic patients with very severe disability and IT to support and enhance the process not impede it. I will be patient and wait and in the meantime "cut and paste" and do whatever we need to do to give good care in spite of these challenges.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.