Technological Advances in Home Care

The world is getting older. A product of fluctuating birthrates and increasing life expectancy, the global–and U.S.–population is aging. According to The World Bank approximately 16 percent of the U.S. population today, nearly 52 million people, are aged 65 and older. The U.S. Census Bureau projects this senior population will increase by more than 50 percent over the next 15 years, to nearly 78 million. By 2050, seniors will make up more than 22 percent of the U.S. population. 

Elderly people are more likely to suffer from chronic diseases and to have greater and more complex healthcare needs. Older adults today have an almost 70 percent chance of needing some type of support or long term care during their lifetime. As people live longer, their healthcare needs will continue to grow, and that means healthcare costs will grow as well.

New technologies are emerging almost daily, impacting the consumer and business worlds alike. Healthcare is no exception. “Digitalization of an industry means the application of various forms of technologies to upend traditional business models,” says Fred Bazzoli, editor-in-chief of Health Data Management. “New uses for existing and emerging technologies will give consumers and providers more options for delivering care.”

Emerging Technology Impacts Home Health Agencies 

Most older adults would prefer to remain in their homes as they age—as many as 90 percent, according to a 2017 article by the American Association of Retired Persons (AARP). As more and more seniors opt to “age in place,” home health will be at the forefront of the growth in healthcare services and technology.

Attracting and retaining qualified employees, thin profit margins, and keeping up with ever-changing regulatory requirements are ongoing challenges for home health agencies (HHAs). Advances in home health technology offer opportunities for more efficient delivery of services, and the home healthcare industry particularly must integrate and utilize new technologies in order to cut costs, maximize resources, enhance productivity and remain competitive. In addition, as the world changes, consumers and businesses are becoming more technologically savvy: what was once a bonus is now considered a necessity. As tech-savvy adults continue to age, HHAs will face their patients’ ever-increasing demands for the same convenience, affordability, and safety these patients have grown accustomed to as digital age consumers. 

From electronic health records (EHRs) to artificial intelligence (AI), technological options are growing every day. But it’s not just a matter of convenient new devices and the automation of existing ones; ongoing advances in home health technology must offer better options for meeting the challenges of the growing home care market and its ever-increasing demands. New technologies will need to impact quality of care and patient outcomes, and offer a proven return on investment (ROI). 

“Digital technology will be packaged with an ROI,” Bazzoli says. “Savvy healthcare organizations are moving beyond the hype of digital technologies and focusing on measurable outcomes.” 

The IoT and the IoMT

Let’s step back and take a look at how technology is changing on a global scale. As our world becomes more technologically advanced, more and more parts of our lives are being automated and computerized. Appliances and gadgets… electronics and cell phones… each new object, device, or “thing” in our lives has been designed for efficiency and convenience. More physical devices are being linked to the internet and to each other every day, and internet connectivity has quickly moved from novelty, to convenience, to a fixture of life. This interconnection is known as the “Internet of Things” or IoT. 

The IoT encompasses the billions of “things” that are connected to the internet…collecting and sharing data…identifying themselves to each other… interacting, communicating, and “talking” with each other. From coffee makers to TVs, computers to smartphones, cars to jet engines, every device or component around the world that is linked to the internet through embedded software and electronics is part of the IoT.

The Internet of Medical Things 

A subset of the IoT consists of the millions of connected health and medical devices and applications. While the healthcare industry has been slower to incorporate new technologies than other industries, the vast majority of medical companies and healthcare providers utilize some aspect of the IoT to generate, collect, monitor, analyze, and share data. This network of medical devices, data, services and health information technology (HIT) systems is known as the “Internet of Medical Things” or IoMT.

Compared to the IoT, the IoMT is in its relative infancy, but it is estimated that the global IoMT market will surpass $158 billion by 2022. While the vast majority of IoT devices are marketed to and utilized by consumers, IoMT devices are more often created for and utilized by healthcare organizations and providers. 

The IoMT is at the heart of technological advancements for home health, helping both patients and HHAs deal with the rising costs of home care. Of the millions of IoMT devices and services out there, hundreds–maybe thousands–of them are relevant to home-based care and the home health industry. Some of these include:

    • patches and implants for medication management
    • pills with ingestible microscopic sensors to measure the effectiveness of medications
    • digital therapy machines that perform therapeutic functions (acupuncture, massage, cupping, etc) to alleviate pain
    • biofeedback systems designed to help control involuntary body functions like temperature, blood pressure, and heart rate

Let’s take a look at some of the major technological advances affecting HHAs today.

HHAs are Embracing Telehealth Technology 

According to the Mayo Clinic, “telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access healthcare services remotely.” As the U.S. population of older adults aged 65+ increases dramatically over the next 15 years, the population of adults aged 25 to 64–representing the majority of the U.S. workforce–is projected to increase by only 4 percent. This growing senior population, and the relatively shrinking workforce available to care for them, can only worsen the home health workforce shortage. Home health agencies are looking for ways to stretch their resources, and telehealth services are quickly becoming not just an option but a necessity.  

IoMT technology has significantly impacted the home health industry with telehealth devices that monitor, record, manage, and share data and keep both patients and agencies connected: to each other, to clinicians and caregivers, and to other healthcare providers. The timely sharing of data allows caregivers and providers to identify real issues and potential concerns earlier, and enables more timely and efficient intervention. 

Telemedicine

Telemedicine is a telehealth option that facilitates virtual MD “visits” through computers, tablets, or smartphones. HHA patients can connect with physicians for remote diagnosis and monitoring, without the need for face-to-face consultations in the home or office. As the home health industry continues to seek more efficient and cost-effective ways to provide care, the role of telemedicine will continue to grow.

Telehealth is more than telemedicine, however. It includes a broad array of remote health services including remote patient monitoring (RPM), safety and security technology, teleconsulting and tele-education (tailored patient education), and more.

Remote Patient Monitoring

Remote Patient Monitoring (RPM), sometimes referred to as telemonitoring, comprises a range of clinical-grade, often AI-driven, wearable devices and portable or mobile technology. RPM technology can help patients and clinicians manage various medical and health conditions such as diabetes, hypertension, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD) without requiring home, office, or laboratory visits. Blood pressure and glucose monitors… pulse oximeters and spirometers… smart scales and thermometers… even handheld ECG machines… RPM devices can generate, record, monitor, analyze, and report patient health data and connect patients with caregivers or healthcare professionals when necessary. 

According to Melanie Stover, “home healthcare agencies can harness the power of artificial intelligence to automate manual tasks of observing, recording and reporting.” Clinicians can remotely monitor vital signs, heart rate and cardiac performance, glucose and oxygen saturation levels, and sleep patterns. Relevant, real-time data is transmitted to clinicians and caregivers, allowing more timely response and intervention. Some devices, such as wearable defibrillators, are autonomously and automatically interventional.

Most RPM devices and their supporting software platforms are prescribed by an MD or used in conjunction with medical advice; they are generally FDA approved or certified by other regulatory health authorities.

IoMT Safety and Security Devices

There are a variety of “smart” devices that have been developed to keep older adults and other at-risk individuals safer in their home environments. Most of these devices utilize electronic sensors and cloud-based technologies to monitor activity and alert caregivers to potentially risky behavior. They are a growing part of the “smart” home healthcare industry and include:

    • medication dispensers that can manage and/or monitor compliance to a medication regimen 
    • wearable devices that monitor activity levels and provide reminders for medication or treatment protocols
    • wearable fall protection belts that can sense falls, deploy protective airbags, and alert caregivers
    • “smart” appliances such as refrigerators, faucets, doors, etc. that can monitor usage
    • remote communication devices that allow real-time contact between patients and caregivers
    • GPS trackers for patients at risk of wandering (i.e., Alzheimer’s and dementia patients) that can be put into shoes, wallets, or handbags, or even ironed into clothing

A Closer Look at EMR Technology

The Electronic Medical Record (EMR) has been around for decades but it continues to evolve with emerging technology, becoming more interactive, reliable, and responsive all the time. The investment in a new HHA EMR is huge, and the challenge of choosing a quality EMR can be daunting. Make sure the EMR you select incorporates the best of the new IoMT technologies.

Interoperability, Interoperability, Interoperability! 

While freestanding independent EMR systems were once a feasible option for HHAs, it is now understood that provider systems need to “talk” to each other: sharing assessment and treatment data and integrating care plans between HHAs and other post-acute care facilities and hospitals for the convenience and safety of patients and providers. Interoperability is no longer an option but a necessity. 

EMR interoperability enabled the emergence of the EHR, a total patient health record which has improved the accuracy and completeness of patient records by giving multiple providers access to the same data for review and update. EHRs and the ever-growing web of electronic data communication have in turn prompted a need for an ever-more centralized approach, giving birth to the electronic Health Information Exchange (HIE) as an organizational framework. 

Reliable CCHIT Certified® interoperability is a crucial component of any quality EMR solution. Your agency’s EMR must offer the interoperability necessary in today’s interconnected healthcare world in order to: 

  • enable faster, more accurate assessment and care planning
  • facilitate coordinated patient care
  • reduce or avoid medication errors
  • reduce redundant or unnecessary treatments and testing
  • enable faster and more accurate medical billing 
  • reduce readmissions

The seamless interoperability capability offered by the NDoc® EMR is just one of the reasons the system has been rated #1 for six years in a row.

Electronic Visit Verification (EVV)

EVV refers to the system or technology by which the services of home health and personal care providers are electronically verified. The 21st Century Cures Act (the Cures Act), which was signed into law in December of 2016, mandates that all personal care services (PCS) and home healthcare services (HHCS) must be electronically verified with respect to type of service; individual receiving the service; individual providing the service; location of service delivery; date of service; and begin and end time of the service. 

The Cures Act ties reimbursements for Medicaid services to EVV data, so it is crucial that HHAs are compliant by the required dates:

    • PCS compliance is required as of 1/1/20
    • HHCS compliance is required as of 1/1/23

EVV will be implemented and managed at the state level. States have chosen which EVV model to implement and may dictate the timing (within mandated deadlines); they also may set their own additional requirements and standards. 

Many agencies are already electronically documenting visits through their electronic medical record (EMR) system, but this does not mean they are or will be automatically compliant with the Cures Act mandate. When vetting or selecting an EMR vendor, make sure the system can reliably collect and verify all six EVV data elements required by the Cures Act and make sure it’s interoperable with your state’s Medicaid enterprise systems. Talk to the vendor and other providers who use the system about how EVV is accommodated in the EMR now, and how it will work once the mandate goes into effect–next year or in 2023.

Automated Mileage Tracking

Tracking mileage is a crucial part of the job for HHA clinicians and other field staff, but recording odometer readings and tracking mileage is a burdensome chore which can lead to estimates and inaccuracies. The process can be equally burdensome for agencies. The self-reporting of mileage can be an invitation to fraud, verification of submitted reports can be time-consuming, and inaccurate reporting is costly. 

Mileage tracking software automates mileage calculations to ensure accurate, reliable reporting and reimbursement. It saves time for clinicians and field staff, and it saves time and money for home health and hospice agencies…reducing or eliminating additional costs associated with inaccurate, estimated, or fraudulent odometer reporting.

While there are dedicated mileage and reimbursement software systems available that can be integrated with your agency’s EMR system, Thornberry Ltd. has built automated mileage tracking capabilities right into the NDoc system, without the need for third-party integration. With AccuMilesTM, mileage traveled to visits is automatically recorded, calculated, verified, and submitted directly within the NDoc home health or hospice EMR. Visit mileage is calculated automatically through visit charting, and agency policies are automatically enforced through an agency policy algorithm, which simplifies the payroll reimbursement process.

Automated mileage tracking with AccuMiles virtually eliminates the errors, estimates and inaccuracies commonly associated with odometer logging and ensures accurate, reliable mileage reporting. More accurate calculations mean more accurate reimbursement, and automated mileage tracking can reduce mileage expenses for agencies by up to 25 percent.

Telehealth 

Telehealth and remote patient monitoring are the next big IoMT developments in home-based care. Patients who can benefit the most from RPM are those suffering from chronic diseases such as CHF, COPD, hypertension, diabetes, and emphysema. Telehealth and RPM enables the remote communication between devices and people, whether it be patient-to-clinician interaction or the secure transfer of medical data. Telehealth and RPM technologies can: 

    • reduce unnecessary hospital visits and readmissions
    • reduce costs for both patients and agencies
    • reduce patient mortality
    • improve patient engagement and satisfaction
    • help patients, caregivers, and family members become more involved

RPM or “telemonitoring” can be integrated right into your HHA EMR system. With NDoc, RPM readings can flow seamlessly into the clinical record, giving field nurses and clinicians a complete history of vital signs readings.

Reimbursement initiatives are underway for both telemedicine and telehealth, which is likely to increase the use of these IoMT technologies and significantly impact the bottom line for HHAs. On April 5th of this year, the Centers for Medicare & Medicaid Services (CMS) updated its policies allowing Medicare Advantage plans to include additional telehealth benefits. 

CMS administrator Seema Verma says the new policies represent an historic step: “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.” Now that RPM is allowed on cost reports, the HHA industry is hoping that RPM reimbursement is not far behind.

Watch for Thornberry’s Telehealth white paper, coming out in a few weeks. We’ll take a look at the telehealth and RPM industry: what’s here and what is coming, and what you can expect from your EMR system. 

Risk vs Reward for HHA Technology

With new developments come new challenges, and with every new IoMT development come new cybersecurity risks and HIPAA concerns. According to Ponemon Institute’s 2016 study, 89 percent of surveyed healthcare providers had experienced a data breach within the past two years, and 79 percent had suffered two or more breaches during that period. “[Healthcare providers] are ramping up security efforts and spending,” says Bazzoli. “The Internet of Things will grow as a vector for hackers.” 

Chris Murray, president of Caitlin Morgan Insurance Services, agrees: “As technology continues to advance in the home health field, providers and their parent companies must balance potential risks against the benefits these technologies offer.”

When it comes to technology, risk vs reward is an ongoing assessment for HHAs. But as information technology continues to move to the cloud, medical and IoMT data will become ever more accessible, more reliable, more secure, and less costly. It seems clear that the quality and cost benefits associated with new technologies far outweigh the challenges.

Resources

Automated Mileage Tracking – AccuMilesTM: https://ndocsoftware.com/2019/05/automated-mileage-tracking-saves-time-money/

EMRs – Choosing a Quality HHA System: https://ndocsoftware.com/2019/07/find-best-emr-agency/

Electronic Visit Verification (EVV): https://ndocsoftware.com/2019/05/evv-federal-mandate/

EVV and the Federal Mandate:  https://www.medicaid.gov/medicaid/hcbs/guidance/electronic-visit-verification/index.html

Interoperability: https://ndocsoftware.com/2019/02/interoperability-and-connecting-to-an-hie/

Interoperability – CCHIT Certified®: https://ndocsoftware.com/why-ndoc/certified-software-can-trust/

KLAS Research: https://klasresearch.com/home

Telehealth & RPM – CMS Medicare Advantage Final Rule (4/5/19): https://www.cms.gov/newsroom/fact-sheets/contract-year-2020-medicare-advantage-and-part-d-flexibility-final-rule-cms-4185-f