The Ankota Healthcare Delivery Management Blog

Blackberry & Home Care Businesses

I usually leave this type of information to the Home Care Software Geek to report on, but some news is just too good not to pass along right away.

You can now get Blackberry Enterprise Server Express for free.

So what? Well, let me first say that we are not taking a position on one mobile device vs another. We at Ankota like to profess that we are device agnostic, choosing instead to make even our most advanced technology available via web browsers and common mobile devices that our customers have readily available. Frankly, we don’t want to force new infrastructure or hardware requirements on our customers. That just wouldn’t be efficient...and those of you who know Ankota know that we are efficiency zealots.

A more pragmatic description of our position is that we are in favor of anything that helps mobilize technology for our customers and does so securely, productively, and affordably. Blackberries have proven to be excellent mobile devices for many of our customers. Our customers include Home Health, DME, Private Duty, Infusion, Respiratory Therapy and other companies that we say make up the “Homecare Ecosystem.” In the past, the cost of purchasing mobile devices like this (& their service plans) has been a deterrent to many. As devices and plans continue to get cheaper, more and more of our customers will buy them. This announcement helps make it cheaper and easier for our customers to manage their mobile staff and their Blackberries.

Blackberry Enterprise Server Express synchronizes wirelessly with Microsoft Exchange, calendars, contacts, and provides remote file access & access to your intranet. It will run on your existing mail server whether you run that yourself or have that managed for you by another company.

Of course, schedules, calendars, POC forms, and even optimized route plans created in Ankota HDM can be pushed to Blackberry devices in real time. You can still utilize Ankota's telephony interface as you would with any other mobile phone.

Click on this image to view key features:

Ankota provides software to improve the delivery of care outside of the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

 

Who Should "Do" Telehealth? Home Care? Hospitals? or Families?

The conversation on telehealth has shifted quickly...  Just one year ago the question was "does Telehealth deliver value?"  Over a very short period of time and backed by many studies showing positive results, the question of the value of telehealth seems to have been answered with a resounding yes... Now the question is "Who should 'do' telehealth?" What I mean by who should 'do' it, is the following:

1. Who should make the case to an individual patient/client about the value of telehealth for their situation?
2. Who should buy and own the Telehealth unit?
3. Who should perform the monitoring and follow up?

It would seem that home care agencies would be very well equiped to do telehealth, but there are other contenders - most notably hospitals/doctors and families.

One of my favorite bloggers, Tim Rowan from HCTR (Home Care Technology Report  at www.homecaretechreport.com) wants homecare to do telehealth.  He has been evangelizing telehealth as a primary focus in his writing for over a year.  But more recently, Tim has been cautioning and lamenting that market forces (specifically telehealth device manufacturers) aren't bothering to target home care.  They're having more success with hospitals and families.  See specifically this weeks feature article entitled "With or Without Home Care Agency Involvement, Remote Patient Monitoring Moves Into Consumers' Consciousness" at this link.

We've been trying to do our part to educate the home care market on telehealth as well and I'd direct your attention to Will Hicklen's article "Telehealth, Home Monitoring and Home Care Business" and my follow up "Telehealth, Home Monitoring and Home Care Business - Part II".

The core issue here comes down not to who will "do" telehealth, but rather who will pay for it.  For an interesting take on this, I'd highly encourage you to look at the post "Healthcare Reform without Permission - A Recipe" inspired by a presentation by Dr. Randall S. Moore who is president of American Telecare - a maker of telehealth devices.  Dr. Moore compells us to focus on the value (savings) delivered by Telehealth and to collaborate with the effected players to find the money (e.g., if care for a CHF patient will cost $15K less per year with Telehealth than without, then the insurance company would be silly not to pay for the telehealth).

So presuming that you want your home health or private duty agency to do telehealth, what should you do about it?  Here are a couple of thoughts:

• If you're in home health, you can go to the hospitals, doctors and insurance companies and make the case that you can do it better and cheaper.
• If you're in private care, you might grow your business significantly by helping families get started with telehealth early (this way, as care needs increase you'll be the obvious choice to fill the gap)
• In either case, waiting for CMS to come forth with "we'll pay you if you do this" isn't going to put you in a leadership position

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

Telehealth, Home Monitoring and Home Care Business

In a related piece, the Veterans Administration Proves Home Telehealth Works for Everyone—Payors, Providers, and Patients. From Tim Rowan’s Home Care Technology Report (11/17/09): Titled "Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Conditions," a report detailing results of a four and a half year study should be required reading for every home care agency owner, every clinician and especially every state and federal lobbyist. It declares without bias and without vendor influence that use of home telehealth systems had the following measurable effects for 17,025 patients over nearly five years:

1. Reduced bed days of care by 25%
2. Reduced number of hospital admissions by 19%
3. Added $1,600 per annum cost to per patient average of $13,121 for home-based care
4. Avoided $77,745 annual nursing home costs with this $14,721 investment

The paper’s onerous title notwithstanding, the lessons from the VA’s success are clear. A proactive program of home-based care and monitoring that allows the patient to spend more time at home results in

Fewer hospitalizations

Less time per visit in the hospital

Lower overall healthcare delivery costs

 

Ankota is not a telehealth company (we develop Healthcare Delivery Management or HDM technology that helps home care businesses better coordinate and utilize staff while cutting operating costs). However, telehealth and home monitoring technologies have been proven to be valuable tools in managing care at home. This VA report is the most comprehensive ever published on the topic, and provides compelling data that will certainly help advance adoption.

Without question, these technologies will be an important part of the home care ecosystem, which includes providers in Home Health Care, Private Duty Home Care, Respiratory Therapy, Home Infusion, DME and other companies that provide staff, equipment and supplies to support patients in the home.

From a simple economic perspective, these technologies offer the opportunity to scale various home care services with less overhead and infrastructure costs such as staff and travel time. In an industry that desperately needs to increase staff utilization and efficiencies, and fuel growth, this is a welcome development.

A few things to consider: As Home Health, Private Duty, and Respiratory Therapy companies—Ankota’s customers—add telehealth and home monitoring services, they should expect that this will also require some new management discipline and add complexity to their businesses. Consider that providers will have to coordinate delivery, implementation, service, and recovery or disposal of equipment in addition to providing or provisioning monitoring services. This brings a component of physical distribution that must be managed, much like a DME company faces today. Staff, delivery and fuel expenses can be optimized through HDM technology like Ankota’s. Consider also that, as these devices proliferate, so will the need to "monitor the monitors." New skills will be needed and new processes managed. Expect command and control interfaces to emerge that allow providers to aggregate disparate monitoring technologies, manage responses, and assign staff for follow up based on established best practices.

Telehealth and home monitoring technologies have been proven effective and present new business opportunities for providers. The benefits to patients and healthcare delivery models will be considerable, but will also require a disciplined approach to process management. Look for tools to help do this job more efficiently.

Related Links

Click here for Tim Rowan’s Home Care Technology Report

BeClose (Vienna, VA) Remote home monitoring, elegant simplicity for family members to monitor home activity. There is a good report on this on the Aging In Place Technology Watch website

Honeywell Hommed One of the better established telehealth companies

GE-Intel related article: http://futureofaging.aahsa.org/2009/04/intel-ge-team-to-develop-telehealth-technology/

Cariocom download a white paper titled "Ten Steps to Building a Successful Telehealth Program"

How will Home Care Change with Life Expectancies over 100?

Scientists in Denmark recently published a report in The Lancet indicating that half of babies born today in the developed world will live past 100 years of age.  There was a good deal of coverage of the report and you can choose your favorite news source below for more complete coverage.

   

 

 

I find this research to be extremely thought provoking.  Here are the top questions that come to mind for me:

• How long will people be able to work if they live 100 years?  My understanding is that the retirement at age 65 was established at a time when average US live expectancy was 72.
• Does a longer life mean a longer healthy and productive life?  Will a 90 year old person in 100 years have a comparable life to a 65 year old person today from the perspective of mobility, vision, etc.?
• How will healthcare be paid for? We've all seen projections about how Medicare will run out of money in the not too distant future.  What will this mean?
• Will we be able to cure Alheimer's by then? So far the cure to Alzheimer's has been elusive, but this projection would seem to raise the urgency to find a cure
• Will this trend continue? Will the babies born in 100 years live to age 125?

If nothing else, this should convince us that we need to keep the innovation coming in the delivery of care.  Maybe it will stimulate our imaginations and accelerate our progress.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

 

How Can Disruptive Innovation Transform Health Care: 10 Minute Video

One of my favorite authors and professors is Clayton Christensen from the Harvard Business School.  He has written numerous books about disruptive innovation - the kind of innovations that often go on to replace the way something is done.  More recently he wrote The Innovator's Prescription, which was named as Ankota's Book of the Year for 2009.  Here, thanks to BigThink.com is a 10 minutes video of Dr. Christensen explaining these key concepts.  Home Care and Private Duty Care organizations should realize our opportunity to be a major part of the most needed innovation in healthcare today.  Enjoy the video.

 

Some leading candidates for Ankota's book of the year in 2010 are The Checklist Manifesto, by Atul Gawande, and Healthcare Won't Transform Itself, by George Halverson.  Check out our blog posts on these books by clicking their links.

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

Relationship and Results Oriented Health Care is a Win/Win

One thing that we've really enjoyed as we've launched and grown Ankota is that home care people are willing to share their needs, their best practices, their frustrations and their ideas on how to make care better.  We're also proud of our reputation for listening and innovating in response to what we learn. 

One of the home care and private duty care "luminaries" who I like to talk to every few months is Ginny Kenyon, who runs Kenyon HomeCare Consulting.  Our discussions always start around a certain topic such as breaking down the silos to improve transitional care, or how to better connect agencies and family members, and Ginny always provides crisp input from her experience and the agencies she supports.  But the part of our calls that I like the most is when Ginny tells a story that she's really passionate about.  Today she shared a story from her experience as a respiratory nurse, which I'll paraphrase below"

Back when nursing was more personalized and the goal was to do whatever you could to yield the best possible outcome, I was working as a respiratory nurse with some of the toughest patients you can imagine [many of whom suffered from end stage COPD].  There was a treatment plan and course of care that I had to deliver, but what I would always do is to find out what was important to the patient.  I'd very simply ask them "How can I help you?" and "What would you dream to be able to do that's not possible for you?"  The result was a patient-centered vision and goal, which often proved very powerful.

One of my patients [who we'll call Bob] told me that he dreamed to get back into his wood shop so he could build flower boxes and planters.  Once he shared this, we were on a mission, and we were able to work together over the course of a few months to get back into that wood shop.  Integrating the required treatment elements was easy as part of attaining the goal.  And a few short months later, Bob rewarded me with some planter boxes he had built for me.  The boxes were wonderful, but the improvement of Bob's life plus my own personal satisfaction as a caregiver was priceless.

Ginny shared that one of her friends and colleagues, Ruth Hansten, has built a care delivery methodology around these best practices, which she calls Relationship and Results Oriented Health Care* (RROHC), which is pronounced like "rock".  I have a link below to Ruth's site where you can learn more.  Ginny also shared that there will be some forthcoming webinars about RROHC that you won't want to miss.  We'll follow up with more from Ginny and Ruth in upcoming posts.

*RROHC is a registered trademark

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

LEVEL OF FRAILTY PREDICTS SURGICAL OUTCOMES IN OLDER PATIENTS

Researchers at Johns Hopkins have shown that frailty of patients has a direct impact on how well they will do in surgery.  Moreover, they've developed a simple 10 minute test to measure the frailty level.  Our main focus here at the Ankota Healthcare Delivery Management blog is to share information about improving the quality of care outside the hospital, and another sub-focus is entrepreneurship as we see more and more agencies coming up with new and creative services to improve care.  So perhaps, this research offers Home Care and Private Duty Care Agencies with an opportunity...  What if your agency learned how to administer the frailty test and was able to provide objective evidence to your clients and their family members based on research from Johns Hopkins?  Also, what if you could update your care plans to focus on improving the frailty factors that may preclude a client from undergoing a surgery that can help them?  These seem like compelling benefits to offer your clients...  The full story from Johns Hopkins Medicine is included below:

LEVEL OF FRAILTY PREDICTS SURGICAL OUTCOMES IN OLDER PATIENTS, JOHNS HOPKINS RESEARCHERS FIND

May 12, 2010- A simple, 10-minute "frailty" test administered to older patients before they undergo surgery can predict with great certainty their risk for complications, how long they will stay in the hospital and - most strikingly - whether they are likely to end up in a nursing home afterward, new research from Johns Hopkins suggests.

"There's been this hunger to have some sort of scientific way to predict surgical outcomes in older people," says Martin A. Makary, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine and the study's leader. "We think we have a way now to accurately measure risk instead of eyeballing somebody or guessing."

The key is a means of measuring frailty using a five-point scale, developed at Johns Hopkins, Makary says. It includes loss of 10 pounds or more within the previous year, weakness as measured by a handheld dynamometer, exhaustion, low physical activity and slowed walking.

On the scale, one point is given for each problem. Scores of 4 or 5 mean that patients are considered frail; 2 or 3 mean they are considered intermediately frail. The test for frailty is simple to perform, taking just 10 minutes to complete.

In a study reported online and in the June issue of the Journal of the American College of Surgeons, Makary and his team applied the frailty test to 594 patients over age 65 who had elective surgery between July 2005 and July 2006. Results showed that patients who were frail were 2.5 times as likely as those who were not to suffer a postoperative complication, 1.5 times as likely to spend more time in the hospital and 20 times as likely to be discharged to a nursing home or assisted living facility after previously living at home.

Previous research has also linked frailty to poor outcomes even in patients not undergoing surgery and has associated frailty with mortality, morbidity, falls and increased hospitalization.

Surgeons have long known that some patients over age 65 do quite well after major surgery even though they appear feeble at the outset, while others who seem to be healthier before an operation emerge diminished. Predictive formulas based on cardiac health and medical history failed to stack up well against the new frailty score, the researchers found.

Makary says frailty is a relatively new clinical concept and is best defined as someone's physical reserve and ability to withstand stress to the body. Many patients considered medically healthy can be frail.

Approximately half of all operations in the United States are performed in patients over 65.

"Some surgeries are absolutely required no matter the risks and other surgeries are elective," Makary says. "A good frailty test can help patients and surgeons make more informed decisions."

At a minimum, providers who use the frailty score will be alerted to special needs and risks of older patients, he says. But having the information up front, he says, may enable providers to decrease the risk of complications in frail patients through closer monitoring and attention to hydration, nutrition and mobilization.

The research also found that using the frailty score strengthened the predictive ability of other commonly used risk assessment models for surgical patients.

Other Johns Hopkins researchers involved in the study include Dorry L. Segev, M.D., Ph.D.; Peter J. Pronovost, M.D., Ph.D; Dora Syin, M.D.; Karen Bandeen-Roche, Ph.D.; Purvi Patel, M.D., M.P.H.; Ryan Takenaga, M.D.; Lara Devgan, M.D., M.P.H.; Christine G. Holzmueller, B.L.A.; and Jing Tian, M.S. Former Johns Hopkins faculty member Linda P. Fried, M.D., M.P.H., also contributed to the research.

For more information:
http://www.hopkinsmedicine.org/surgery/faculty/Makary
http://www.hopkinsmedicine.org/Rehab/Services/Prevention_Frailty.html

Ankota provides software to improve the delivery of care outside the hospital.  Today Ankota services home health, private duty care, DME Delivery, RT, Physical Therapy and Home Infusion organizations, and is interested in helping to efficiently manage other forms of care.  To learn more, please visit www.ankota.com or contact Ankota.

Woohoo! Home Healthcare In A Crisis!

Or: The double edged sword of health care reform

Or: What should YOU-the Home Care Provider (HHC, PD, DME, RT, Infusion ...)-do RIGHT NOW to improve your business.

There are a number of companies, like Ankota, that make their business in various healthcare markets. For many, healthcare reform presents both opportunity and risk.  I recently did an interview on this topic with Elain Pofeldt of the Atlantic Monthly, which you can read here:  http://bit.ly/cNFomN

To be sure, the constant escalation of health insurance premiums affects Ankota like any other business. It consumes financial resources that could otherwise be directed to product development, hiring and fueling the company's growth. Recent legislation adds to that uncertainty, but we were in an uncertain market before, as well.

So why are we so excited? Because our customers' businesses are in crisis. "Seriously?" you say. I don't mean to celebrate any misfortune, but consider what this means for a company like yours as well as Ankota.

Markets in crisis tend to exhibit certain behaviors. Businesses in crisis tend to innovate. They find new and more productive ways to manage their business. They are less likely to stick to old, inefficient ways. Or they die. They find ways to cut spending and reduce operating expenses.  They leverage technology to improve efficiencies, to utilize staff better, and to get rid of old, tedious (and often paper-based) methods. In short, they look to do more with less. And markets in crisis are motivated to act immediately.

Companies making decisions to spend money in this type of environment do it for one reason: to become more profitable. Often times, they do it just to survive. They hold would be vendors to a very high standard, saying,

"Don't waste my time: Show me exactly how you are going to save me money, help me bill faster, or increase my revenues."

They want immediate, quantifiable results and they want to pay for enabling technology as they use it (like current subscription based models). They won't spend a lot of money today to see nebulous returns a year or two down the road.

The exciting news for Ankota and other Health IT companies is that companies in the home care ecosystem are under extreme pressure to improve productivity immediately. A business in crisis is motivated to act. Winning technologies will help them cut operating costs by better planning and delivering home health care. The providers who adapt and innovate will ultimately thrive.   

The exciting news for those that provide home health care (Certified or Private Duty) and related services (such as RT and Infusion), and those companies that deliver home medical equipment (HME/DME), pharmaceuticals and supplies, is that there are a number of ways you can immediately improve your business:

• Get rid of paper-based processes such as scheduling and reporting. Use technology to plan schedules and routes for your mobile staff and vehicles more efficiently.
• Coordinate Care Plans with the staff and resources needed for execution. Good intentions are not enough. Efficient follow through and execution are critical.
• Keep track of work performed in real time via technology such as "telephony" that anyone with a cell phone can use. This is inexpensive and requires no additional investment in equipment. Whatever telephony solution you choose, make sure that it is integrated with the care plan and schedules.
• Measure your performance. Much of the technology mentioned above will begin to help collect the data such as time and cost information that you need to measure performance. This will lay the foundation for continuous improvement.

Healthcare Won't Reform Itself, writes Kaiser Chief

George Halvorson, the CEO of Kaiser Permanente, continues to emerge as one of my heroes.  Since Kaiser is a managed care company, they win by providing the best care at the lowest cost.  If they don't provide the best care, they loose customers.  If they don't provide the lowest cost, they loose earnings.  For this reason, George always offers a fact-based perspective on where the improvements lie in our system of health.  His book Healthcare Will Not Reform Itself might be in the running for Ankota's book of the year.  For information about last year's book of the year, The Innovator's Prescription, by Clayton Christensen, click here.

A few of the provocative quotes and facts from Halvorson's Healthcare Will Not Reform Itself, are listed below:

• "Health care in America is badly organized, highly inconsistent, internally dysfunctional, sometimes brilliant, almost always compassionate, close to data-free, amazingly unaccountable in key areas, too often wasteful, too often dangerous and extremely expensive" (from the book's introduction)
• US Healthcare costs $2.7 Trillion
• 1% of the patients consume 30% of the dollars
• 5% of the patients consume 50% of the dollars
• The healthiest 50% consume only 10% of the dollars
• 75% of the money is spent on Chronic Diseases
• 80% of this is spent by patients with 5 or more chronic diseases
• Care coordination deficits are a primary driver
• "We can have a huge impact on care costs and care quality by making care better coordinated for about five percent of our total population. That is entirely doable if we choose to do it"

Ankota is the pioneering company in the field of healthcare delivery management.  Ankota provides software to improve the efficiency, coordination and efficacy of care delivery outside the hospital.  To learn more, go to www.ankota.com or contact us.

Aging in Place Technology Trends for 2010

Here in the Home Care Technology world, we keep our eye on a very closely related set of technologies designed for Aging in Place, and nobody tracks this better than our friend Laurie Orlov.  You can follow Laurie's blog here.  Also, we'd like to thank Laurie for spending an hour learning more about Ankota Healthcare Delivery Management a few weeks ago.

Laurie wrote a strong summary of the biggest trends that she say in the Aging in Place technology world and summed them up in this article entitled 2009 Spawned Ten Aging in Place Trends to Watch in 2010.

Among the top trends that we particularly want to keep an eye on are the following:

• Location-aware tech enables more info, greater safety
• Mobile health app possibilities grow
• Virtual doctors' visits and other health innovations
• Broadband access and Internet use among seniors grows
• Caregiver portals and tools blossom

With Ankota's vision to improve care coordination, we expect that home care management software will directly interact with aging in place technologies and that scheduling for home health will be enhanced to interact with home monitoring systems.