There’s No Place Like Home

Sept. 1, 2007

How will hospitals care for the massive influx of patients as boomers age? Home care technology may be the answer.

Technologies such as the personal health record (PHR) have the potential to transform how care is delivered in the home. Potential beneficiaries of the surge of interest in PHRs and electronic health records (EHR) include patients with chronic and disabling conditions, the frail elderly, volunteer caregivers and parents of severely ill children. Also standing to gain are healthcare professionals such as home health aides, therapists, and nurses and physicians who work in palliative care and hospice.

How will hospitals care for the massive influx of patients as boomers age? Home care technology may be the answer.

Technologies such as the personal health record (PHR) have the potential to transform how care is delivered in the home. Potential beneficiaries of the surge of interest in PHRs and electronic health records (EHR) include patients with chronic and disabling conditions, the frail elderly, volunteer caregivers and parents of severely ill children. Also standing to gain are healthcare professionals such as home health aides, therapists, and nurses and physicians who work in palliative care and hospice.

 To date, most PHR sponsorship has come from hospitals and health systems, health plans, employers and pharmaceutical companies. The latter have an opportunity to use PHRs to influence compliance, while health plans, such as Highmark Blue Cross and Blue Shield, have already begun to integrate claims and administrative data into PHRs, including dates of service, diagnoses and treatments and medications. Meanwhile, employers such as Verizon and Wal-Mart see PHRs as a value-add for employees and a strategy to contain healthcare costs.

 PHRs allow home care professionals to obtain the most comprehensive and up-to-date ” read” on a homebound patient. These professionals could introduce therapies and treatments based on tracked information on immunizations, medications, allergies, diagnoses and procedures, and then arrange for communication of patient-specific alerts. Through PHR technology, home care professionals can close the loop and facilitate better communication between and among homebound patients and every member of the healthcare team.

Technology Comes Home

 Healthcare consumers, patients and caregivers who once depended on desk and laptop computers to access online PHRs can now retrieve personal health information directly from cell phones. The use of portable, low-cost, familiar technologies, such as cell phones, will help make PHRs a reality for millions of technology-phobic Americans, as well as healthcare consumers and providers throughout the world.

 According to a USA Today 5-part series, as eldercare shifts from the nursing home to the home and ” other less restrictive forms of care, such as assisted living and supervised day care,” highly educated and independent baby boomers will increasingly assume the role of champion, advisor and healthcare decision-maker for aging parents, siblings and friends.

 But patients and family members aren’t the only people who will benefit from PHRs. Healthcare professionals realize that PHRs help to empower patients and improve the physician-patient relationship. Moreover, healthcare professionals can use PHRs to draw formerly homebound patients out of the home. A pediatrician for more than 30 years, Boston-based Eugenia Marcus, M.D., has worked closely with an EHR company since 1996 to develop the first pediatric templates for EHRs. When Marcus added PHRs to her practice in 2006, she noted that patients and family members who had been tethered to home or burdened by paper medical records were freed to travel for the first time in years.

 Home health aides, physicians, therapists and nurses can also use PHRs to obtain quick reviews and updates of how a patient has progressed since the last home visit. Once a patient provides a caregiver with access to the PHR, the caregiver can update treatment protocols, lab test results, newly prescribed medications and potential drug-drug or drug-food interactions. Doing so will generate helpful automatic alerts and reminders, as well as easy-to-understand instructions for the patient and caregivers to follow.

To the Future, and Beyond

 The PHR has clearly earned the attention of employers, health plans, pharmaceutical companies, hospitals and health systems, medical groups and private physician practices who are eager to perfect a technology that enables patients to better manage their healthcare, and communicate and collaborate more effectively with their providers.

 In the near-term, PHRs will benefit from enhanced clinical decision support tools that alert patients and providers to gaps in care (e.g., missed vaccinations or colon cancer tests) through e-mail, cell phone and text messaging reminders. Analysis of employers’ claims data also may generate alerts for patients who miss important procedures.

 Home health-focused PHRs will benefit from expanded sources of electronic data that are capable of populating the record. While data from select sources such as physician records, payers, pharmacies and home monitoring devices are currently available, by-and-large, the electronic data feeds are inconsistent and not designed to populate a consumer-centric record. Instead, they create multiple records tied only to the data source. This puts the onus on the consumer to aggregate data from multiple sources (most of which are paper-based) and manually enter this information. In the years ahead, data standards to support a truly interoperable healthcare infrastructure will become the norm and not the exception to support widespread adoption.

 Home health patients also will benefit from developments in PHR portability. Patients can typically choose to access their PHRs online, from desktop and laptop computers, and from portable USB devices. Other technologies in varied stages of development and adoption include mobile phones, smart cards and even implantable devices holding personal health information. The success of such technologies will depend on their ease of use, convenience and price, as well as patient preferences for managing personal health information.

 Boundless Opportunities

 There are boundless opportunities to help a broad variety of patients through PHR technologies. Here are just a few of them:

 Nancy is a 78-year-old widow who lives in Florida. After developing a serious neurological condition, she signed a consent form giving her baby boomer daughter, Kathy, access to her PHR. Although Kathy resides in Indiana, she uses the PHR to track her mother’ s medications, treatments, and signs and symptoms. Through the PHR, Nancy’ s many providers, including a cardiologist, neurologist and orthopedist, gain a big-picture view of Nancy’ s health. This, in turn, allows them to do a better job with care coordination.

 Rachael is a 32-year-old mother whose 7-year-old son, Josh has muscular dystrophy. She depends on the PHR for quality patient education information for Josh, her husband and her two other preschool children. Because each family has an individualized PHR, Rachel no longer has to track and remember appointments, tests, medications and development data for five people. Able to manage health information in a single online location, Rachel can invest more time in caring for Josh, enjoying her family and stealing a few moments of peace for herself.

 Kevin, a 45-year-old attorney, was recently diagnosed with pancreatic cancer. As soon as Kevin’ s oncologist diagnosed the condition, the front page or ” personal health dashboard” of Kevin’ s PHR started to feature relevant education materials on the disease, including information on treatment, prevention and self-care. Kevin’ s wife and two grown children, who also have access to the PHR, are in a better position to help him fight the disease and make more informed medical decisions.

 Ryan is a 60-year-old insurance executive with COPD. Each morning he’ s able to upload information to his PHR from an array of medical devices that measure blood pressure, cholesterol, heart rate, blood sugar and body weight. By doing so, he receives ongoing reminders of the importance of taking control of his own health. Based on the numbers generated, he can make decisions about his care. So can the healthcare professionals who also receive Ryan’ s data. Instead of performing a series of separate measurements and tests, both Ryan and members of his healthcare team obtain a comprehensive portrait of his health status.

 Nancy, Rachel, Kevin and Ryan have something in common: They’ ve all assumed the emerging role as ” chauffeur” of health information. Involved and committed to their own good health and recovery, they boldly ” take the wheel” of their high-speed PHRs. In doing so, they help ensure that the right information gets to the right professional, friend or relative at the right time. Among those in this designated circle of healthcare communications are friends, relatives, colleagues and neighbors, as well as home care workers, school nurses, pediatricians, therapists, pharmacists, nutritionists, nurse practitioners at retail clinics, physician specialists and social workers.

 Scenarios such as these will become increasingly common in the years ahead as the population ages and as more people develop chronic diseases. The number of children who live with chronic diseases, such as diabetes, has quadrupled in the past three decades, according to a study in the June 27, 2007 issue of the Journal of the American Medical Association. Growing numbers of patients with these diseases— COPD, diabetes, heart disease, asthma and Alzheimer’ s— will intensify the pressure to develop more cost-effective home care alternatives.

Wendy Angst is general manager of CapMed,
a division of Bio-Imaging Technologies Inc.
She can be reached at wangst@ capmed.com.
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