Randall Holley, Director of Information Technology,
Commonwealth Care of Roanoke

Long-term post-acute care providers are no different than acute care providers and ambulatory practices when it comes to the evolution from fee-for-service payment models to new value-based care. While it’s a complex pivot from traditional reimbursement to new ideas based on quality metrics, I believe that technology—applied in new but sensible ways—can help us meet the ambitious goals of cutting costs while improving quality.

As health IT evolves, more providers and patients are using new devices. Senior care is no exception. Commonwealth Care of Roanoke (CCR) operates 12 skilled nursing rehabilitation centers in Virginia. We’ve struck upon a new telemedicine workflow delivered through Vuzix Smart Glasses for wound care as one of those practical applications of new technology. We’re currently exploring other use cases for the glasses in our facilities.

As any healthcare CIO can attest, one does not just drop a new technology into a clinical workflow and walk away. There was piloting, training, thoughtful compliance consideration, and EHR integration to think about before two-way video went live with physicians at remote offices.

 From ‘interesting idea’ to implementation

How did we get from “smart glasses might be able to help wound care” to enterprise deployment? Elbow grease, mostly. We designed a pilot project in 2015 involving Vuzix and a wound care specialist consultant. Prior to that, we had considered using a popular competing glasses tool but decided against it for technical reasons, such as connectivity issues switching between wireless access points between facilities.

The pilot helped us iron out issues of using the glasses, such as training onsite and remote caregivers how to approach residents and then documenting how they reacted to it. We also worked out how we would handle compliance with privacy and consent regulations. We developed a resident consent form and processes around how to use the glasses. For example, the wound care nurse keeps the glasses powered down, in a pocket, until in the resident’s room. We also developed a video to show residents, their families, and prospective physician users how the glasses work1 and how we address privacy issues.

The pilot proved the effectiveness of connecting remote physicians with residents and nurses. It also confirmed that the residents were comfortable with the technology—something we worried about before testing. We then trained more employees on the glasses and eventually deployed a pair to each of our centers.

Integration with our PointClickCare EHR is still in progress, and the company is always looking for ways to work with its partners to improve information flow across the continuum. At the moment, our care providers manually document the proceedings into the electronic record during and after the virtual visit. However, we are looking forward to assistive technologies in the future to more fully automate documentation processes and enable pertinent tele-visit data to flow between health system EHRs.

Results, advice and why it’s worth the investment

The project has been a great success with the residents who appreciate avoiding ambulance rides—sometimes an hour each way—in order for a physician to look at wound progress. It also lowers costs and risk for the resident as well as our facilities. Sometimes, physicians can’t see the residents due to scheduling or distance considerations, although they can find time to squeeze in a virtual visit to look in on their patients. In this way, telemedicine has not only streamlined and improved care, it has increased care access for some residents.

On the business side, we’re still gathering data on an ongoing basis. This includes how the wound care project is affecting readmissions and healing time, as well as staff matters, such as retention of wound care nurses. We already know anecdotally that our CCR brand is becoming a de facto wound care center of excellence in our communities, and residents are getting sent to us because of the reputation the smart glasses have helped grow.

It’s not all perfection, however. We’re still working out billing issues with payers and providers. As with any new technology in every facility, a few practitioners aren’t as enthusiastic as the rest when it comes to using the smart glasses. In the future we look forward to closer integration with EHR systems to capture more details of the virtual visits. Vuzix also will be coming out with new models that will improve video features as well as comfort for the users.

A work in progress, but so far, so good

Overall, I would consider our implementation a success, thanks in part to our clinical champions and the privacy and security mechanisms we built into it from the start. These nurse executives saw the value to the residents and the business, and worked tirelessly to teach and promote the smart glasses inside CCR and to our remote physicians.

The resident themselves enjoy the experience, in some cases even getting to know the remote practitioner’s voice coming through the tiny glasses speaker and asking if the virtual visits with that person can continue after they are discharged to home care. They don’t see the technology as much as the care they’re receiving and the people involved. And that’s the perfect role for technology—not interfering with care, but enabling it.

Telemedicine and EHRs, together, are powerful tools to document care and bring it to places where residents are. Wearables, too, have the potential to improve care for seniors, especially those who aren’t as mobile. If we choose our implementation with the resident in mind first—improving care quality, improving their experiences, and making care more convenient—technology implementations are much more likely to succeed in this changing world of reimbursements that is forcing us to examine care workflows for opportunities to improve those areas. At least that’s what we’ve found with our smart glasses project, and we hope to find more use cases that will streamline other frequently treated health issues at CCR.

RESOURCE

  1. https://www.youtube.com/watch?v=P8O_VZHXbAo&feature=youtu.be

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