Sometimes things really do come full circle, especially in healthcare. There’s perhaps no better example than hospital-at-home, which, because of the technology component, has become a hot topic.
Traveling to the patient’s home to provide care, however, is certainly not a new trend. “We traditionally provided care at home; that’s what visits looked like,” said Stephanie Lahr, MD, former CIO and CMIO at Monument Health. “We moved into hospitals as a way to consolidate and better leverage resources.”
Technology, she believes, can play a critical role in putting it all together. “There are a lot of caveats around which patients, which homes, and what we need to do to help them be successful,” noted Lahr, a hospitalist by training. “But it allows us to provide those benefits with centralized staffing if we’re able to put devices in the home that allow us to understand what’s happening with the patient.”
During a panel discussion at the CHIME22 Fall Forum, Lahr and co-panelists Jim Feen (Chief Digital & Information Officer at Southcoast Health) and Audrius Polikaitis (CIO and AVP of Health IT at University of Illinois Hospital and Health Sciences System) shared their thoughts on how hospital-at-home models can change the game, what they’ve learned so far, and the challenges that exist.
It’s a concept that offers tremendous potential, according to the American Hospital Association, which claims hospital-at-home “has been shown to reduce costs, improve outcomes, and enhance the patient experience.” Steve House (Managing Director, Baker Tilly), who moderated the session, cited patient satisfaction scores of more than 80 percent in some cases. Beyond cost reduction, it can help decrease ED crowing and waste, and facilitate better care distribution.
Getting this type of program off the ground, of course, isn’t easy, said House, who outlined the approval measures and conditions of participation in CMS’ “Hospital Without Walls” initiative.
Beyond that, there are several other components that must be addressed, from connectivity to staffing. “We need to figure out how the devices work, how they integrate, and the ease of connectivity,” noted Lahr. “Providing care from a centralized studio beaming out into people’s homes is going to require different tools, a different education, and different skills. Fortunately, the technology is there for us to do all these things. We just have to build it the right way.”
The integration piece is one of the most critical, according to Feen. While hospital-based clinicians are able to log into the EMR and document, it’s much more challenging for those in patient homes, particularly given the connectivity challenges. “Up to 20 percent of our population doesn’t have broadband or a smartphone, which makes it tough.”
At Southcoast Health, the hope is to use hospital-at-home to complement a patient’s care plan, and ensure they’re always receiving the appropriate care. “We’re leveraging remote monitoring to take better care of patients — and also to prevent them from occupying a bed that’s needed for a more medically complex patient.”
Similarly, UI Health has struggled with bed placement, with the ER constantly running at 98 to 99 percent capacity. “There’s no room. It’s like a game of Tetris that you can’t win,” he noted. The high volumes are also forcing the organization to delay cutting-edge initiatives due to the lack of beds. “We need to expand the in-patient capacity.”
And while some, including UI Health, are entertaining the option of using hotels to house patients, that comes with “its own set of interesting challenges,” he noted.
Finally, there’s a growing concern that hospital-at-home models could further expand the digital divide by excluding those who can’t afford technology. “It’s definitely a concern,” said Lahr, noting that pilots tend to feature “the idea scenario,” and often aren’t tailored toward most populations. “How we solve that is going to get tricky. But what we can do is recognize that and be cognizant as we explore more technologies.”