Mobile at bedside
Point-of-care software can make residents’ care plans available to caregivers anytime and anywhere.
Given the high incidence of urinary incontinence among long-term care residents with dementia, today's standard of care is for nurses and other skilled nursing facility staff to conduct periodic checks with these patients to make sure they are dry.
“But let's be honest, no one wants to wake up an 87-year-old woman by sticking their hand in her briefs to see if she's wet,” says long-term care industry veteran Doug Fullaway, president at FourteenPlus, LLC. “So it doesn't get done.”
Such logic is difficult to argue against.
Enter a new technology to illustrate just how far things have come. In this instance, it's called BriefWise, developed by the Portland, OR, technology start-up WaveSensor. It uses mobile technology to provide a non-invasive and simple way for caregivers to check if a patient is dry.
“[It] allows a caregiver to walk into the room and hold their phone over a patient and it tells you if they're wet or dry,” Fullaway says. “So now you know whether or not you need to bother them.”
A case study conducted at a skilled nursing facility with the technology found that it results in more timely brief changes, improved caregiver satisfaction and a significant reduction in hours spent changing residents.
“It's just one example of how a mobile sensor can help solve a problem human beings haven't been able to,” Fullaway explains.
The company joins SCA Tena, Simavita, and others in smart brief monitoring. Other point-of-care technologies — such as bedside charting and automated vitals recording — are playing an important role in improving residents' quality of life and health outcomes, says Terri Weckle, senior vice president of strategic products for PointClickCare.
“As mobile devices become more mainstream, long-term care providers can leverage these types of devices to improve and streamline the care delivery process and their staff compliance and efficiency,” Weckle says.
Through point-of-care software, nurses can direct caregivers on care to be provided and caregivers can chart care as it is delivered, making it accessible anytime and anywhere as part of the resident's electronic health record, says LeRoy Boan, ASN, MSIT, a clinical subject expert with NTT DATA Long-Term Care Solutions.
However, as more point-of-care and wearable monitoring options come into play, providers also need to understand the potential limitations of these devices, including whether the data can be integrated into EHRs, a lack of standardization for data exchange and their ability to keep resident information private and secure.
Technology changing daily
Given today's ongoing focus on preventing hospital readmissions, it's not hard to see the benefits of incorporating point-of care documentation and remote patient monitoring devices to monitor resident vitals. Blood pressure, heart rate, weight, blood sugar levels and vitals are needed to manage chronic conditions such as heart disease and diabetes, says Harry Rhodes, MBA, RHIA, CHPS, CDIP, CPHIMS, FAHIMA, the director of national standards at the American Health Information Management Association.
One area of growth is wound management, with WoundRounds recently announcing a partnership with Nautilus to let those wound images and data be shared between hospitals and post-acute providers.
This “delivers a key piece of the puzzle to our hospital customers, who seek to establish critical technology links with the post-acute providers that care for their patients post-discharge,” notes Tim Kelley, CEO of Nautilus Medical.
In addition, some second-generation remote monitoring and wearable technologies even provide a framework for alerting care providers to safety concerns, early-onset symptoms or warning signs of impending health episodes, says Charlie Daniels, chief operating officer at HealthMedx.
“Most wearable and mobile devices now include GPS, which has important applications in skilled nursing, assisted living and home health settings for location and activity monitoring,” he says. “For instance, it can alert providers if a patient somehow wanders away from a memory care unit.”
Fullaway agrees, noting that these early alerts can help providers take action quickly to redirect residents away from unsafe areas — in a more humane way than locking them in a certain area. These devices also provide a means for real-time daily motor activity, sleep and other vital sign monitoring, data that can be applied to a whole range of tasks including detecting depression, sleep disorders and more.
“We've been talking about predictive and prescriptive analytics in healthcare for a long time,” says Robert Choi, chief strategy officer with LG CNS Healthcare Solutions. “If a long-term care facility uses an EHR to store information on a resident's admission date, ADL score and discharge or return to acute care date and compiles that with data from some of these wearable and sensor technologies, we're able to get some interesting insights on patterns that might lead to a hospitalization.”
Connecting mobile point-of-care devices with EHR systems also offers providers reliability in knowing that clinical measurements were taken and that the information was entered into the EHR without errors, says Keith Speights, president and CEO at Constant Care Technology. It also saves time because no one has to manually enter the information into the EHR.
“Time saving will become an even bigger factor as the acuity level of patients in long-term and post-acute facilities increases,” Speights says.
Yet adoption barriers remain before true system integration is achieved, Choi notes.
“Everyone has their own cloud and stores their data separately,” he says. “We need to get to a point where we're doing more of a rain barrel-type collection of data into a robust clinical data repository.”
Rhodes points out the operating systems for phones are different from EHRs, making it difficult to integrate data collected on a mobile device into an EHR. Speights agrees, adding that it's important for providers to know that because a device is capable of integrating with an EHR system doesn't mean that the device will integrate with their EHR system.
“There are many devices that claim EHR interoperability, but when you read the fine print, it turns out the devices don't interface with the major EHR systems that support long-term and post-acute care,” he says. Or in some cases, they may integrate with your EHR, but the device vendor might require the provider to maintain an additional server either at each facility or in the data center. That requires greater support from a provider's information technology team.
Where to go from here
Amidst all this changing technology, how can providers figure out what point-of-care options to implement at their facility? Choi and Daniels recommend every provider start by considering its organization's long-term goals for resident health management.
“Providers should be engaged in an open, ongoing dialogue with their EHR vendor around organizational strategic goals,” Daniels says. “In our consolidating market, providers need to be looking at how to integrate with home-based systems and providers — even if they don't currently serve the home health market. With remote health data exchange, the question is no longer ‘If?' but ‘When?'”
It's also imperative to connect with others in your health ecosystem, including local hospitals and healthcare systems, to get a sense for what technologies have worked well for them — and identify the potential for bundling resources.
“If you find trendsetters that are dipping their toes into the mobile health water, reach out to them,” Rhodes says. “Ask them about their long-term plan, as well as what they've learned about the interoperability of their devices with their system's EHR.”
Always keep an eye out for ways to improve the integration of technology into a healthcare delivery system, advises American HealthTech President Teresa Chase.
“Software vendors have worked hard to get data into EHRs and get EHRs to the bedside effectively, but we cannot stop there or be satisfied with that milestone,” she says. “We need to focus on the next generation of data mobility and access at the bedside, using smaller devices that do not create a barrier between the caregiver and the patient but rather contribute to good patient care.”