“Provide care at home, create the ability to rotate patients out of the hospital to make room for monitoring more critical cases”
The need for continuity of care remains during a pandemic and the need to provide this care is essential. As stated in 6 above, the COVID-19 pandemic experience is showing significant impacts of isolation from care and the failure to deliver ongoing care. Deaths due to CHF increased substantially during COVID-19 and most of this has been attributed to a breakdown in the continuity of care. Providing virtual care in the home is a proven solution.
The most common applications include: post-procedure recovery, chronic disease management and remote patient monitoring. Most healthcare providers are already considering these telemedicine applications as part of a day-to-day care strategy and as a method to reduce the cost/risk of readmissions. It is also a method of establishing longer term, “sticky” relationships with patients and their caregivers/family. This is especially critical in the management of chronic diseases (e.g. hypertension, CHF, COPD, diabetes and behavioral health). Additionally, care for COVID-19 patients diverted to the home must be addressed (See Critical Issue #3 ).
A variety of remote patient management (RPM) and chronic disease management (CDM) telemedicine services and solutions are available and many of these services are currently reimbursed at federal and state levels. (see the Pandemic Action Plan Policy and Regulatory Summary) Many of these platforms can be integrated into the EMR.
In addition to RPM for chronic disease, “Hospital at Home” (HaH) capabilities are available to move more acute patients to the home. This reduces exposure to infection, reduces cost and makes more beds available in the hospital. Tools and technology are similar to RPM but aimed at more acute patients[17] [18].
To be successful, organizations must address technical issues, care support, monitoring, and address issues of isolation and quarantine/patient safety. A critical part of moving patients to the home is transition management. Whether diverting a COVID-19 patient to the home or transitioning a patient from the hospital to home, there must be a clear, managed, effective transition that ensures successful continuity of care. This will be more critical for patients with greater needs while convalescing in their homes. A formal assessment and discharge-to-home process or service and ongoing continuous communication with the patient and caregiver are essential. Most current telemedicine solutions offer all or most of these capabilities.
Using the telemedicine capabilities of remote patient management (RPM) and chronic disease management (CDM) services, continuous contact systems and “Hospital at Home” (HaH) services to enable safe, early rotation of patients out of the home can ensure support for patients as they heal.
Ideas:
- Automate post-procedure instructions and reminders.
- Transition support systems to assure smooth transition and prevent gaps in care.
- Implement at-home telemedicine solutions (RPM, CDM).
- Put RPM and CDM measurements, coding, and billing in place.
- Use a contact management (CRM) system to prevent gaps in care and maintain contact with patients. Manage from discharge-to-heal.
- Create constant comment support for caregivers in the home.
- Consider the healthcare needs as well as the social requirements of patients.
- May include support group engagement (telemedicine can enable)
- Provide remote communication for family and friends outside the home leveraging the capabilities of the telemedicine solutions in the home
- Engage hospital-at-home providers in your area or initiate a program potentially with partners. Allow them to leverage the telemedicine solutions in the home.
- Train providers in the capabilities of these home care and telemedicine services to allow them to make informed decisions for when to send a patient home.