Technology in Home Care Visiting Nurse Association of Central New York, Inc. Indi Shelby, President/CEO

1. Technology in Home Care Visiting Nurse Association of Central New York, Inc. Indi Shelby, President/CEO

2. Vital Statistics • Established in 1890 • Voluntary, Non-Profit, New York State Corporation • Serves Onondaga County, New York • Certified Home Health Agency • Census 900 • Long Term Home Health Care Program • Long Term Care HIV AID Program • Electronic Point of Care Medical Records since 2000

3. Vital Statistics continued Disciplines include: Skilled Nursing Clinical Nurse Specialist Licensed Practical Nurse Physical Therapy Occupational Therapy Social Work Certified Wound Care Specialist Nutrition Speech Language Pathology Home Health Aide

4. Special Programs • Heart Smart • Skin and Wound Resource Team • Diabetes Education • Pediatrics • Maternal Child • Home Infusion Therapy • Rehabilitation Services • Tele-home Care Monitoring Program

5. Critical Factors • Fewer Case Managers due to nursing shortage. • Increasing case loads per Case Manager. • High Acute Care Hospitalization (ACH) rate. • High rates of emergent care. • Large number of visits per episode with low outcomes. • Increased use of technology throughout the organization.

6. Expectations and Objectives • Improved patient outcomes. • Reduced ACH rate. • Reduced emergent care rate. • Home visits based on clinical need rather than a pre-determined visit frequency. • Ability to increase in census without increasing staff. • Ability for clinicians to manage higher case loads. • Improved effectiveness of patient education due to immediate feedback. • Fewer visits per episode.

7. Getting Started • Researched literature on the benefits of tele-monitoring and the process for starting a program. • Consulted with other organizations who had initiated tele-monitoring programs • Researched available technology • Scheduled demonstrations with vendors • Honeywell HomMed • ATI • Applied for and received funding under the New York State Department of Health Tele-Health Demonstration Project.

8. Selecting a System • Video versus non-video • Leasing versus purchasing • Choosing peripheral equipment • How many units needed to start the program

9. Program Implementation • Primary focus: Congestive Heart Failure (CHF) disease management • Target: Medicare clients • Development of program policies, procedures and standards. • “Champion” nurses were selected and involved in program implementation. • Tele-monitoring was identified as the Standard of Practice in the care of all CHF patients.

10. Program Implementation • Educated clinical staff in program expectations and procedures. • Developed a Patient Screening Tool to identify appropriate program participants. • Developed procedures to catalogue, store, maintain and dispense tele-monitoring equipment. • Selected site for location of the Central Monitoring Station. • Selected Telehealth Program Coordinator – a registered nurse to manage the Central Monitoring Station).

11. Important Considerations Selection of Tele-health Program Coordinator • Registered Nurse • Expertise in cardiac care • Extensive case management experience • Good rapport with clinical staff • Excellent communication skills • Excellent critical thinking skills • Part time: 15-60 monitors • Full time: 60-120 monitors

12. Important Considerations Weekday versus Weekend Monitoring • Multiple manager responsibilities on weekend in addition to tele-monitoring responsibilities. • Patient compliance with weekend testing. • Access to physicians.

13. Location of Central Monitoring Station Separate, but accessible • Fewer interruptions • More accurate allocation of staff time to the program. • Conducive to teaching and case conferencing.

14. Nurse or Technician for Installation / Removal of Units • Initially used a “champion” nurse increase staff “buy-in” to the program. • Two Case Managers and two Admission Nurses involved in program kick-off. • Additional staff nurses were added as the program grew. • Eventually hired an experienced Home Health Aide as the Tele-health Program Technician.

15. Maintenance of Equipment Cleaning and tracking of monitors • Record all equipment serial numbers. • Maintain a log of equipment assigned to nurse/patient. • Upon return, all equipment is placed in a red bag, double bagged as a precaution. • Equipment is cleansed with aseptic wipes and a bleach solution if necessary. • Prompt turn around time for repairs with extra monitors available.

16. Care Coordination • Opportunity for patient education • Immediate feedback allows the patient to make the connection between behavior and exacerbation or improvement of symptoms. • Communication with physicians • Parameters: agency or patient specific. • Reports: fax trends as appropriate or requested prior to appointments.

17. Care Coordination continued • Communication with clinical Case Managers • Provides overall support for primary clinician. • Provides Case Manager with information vital for patient care • Assists Case Manager in scheduling of visits clinically indicated.

18. Clinical Staff Support • Reduces number of visits by one per week. • Prevents unnecessary visits and targets visits when needed. • Provides the most appropriate and cost efficient follow-up. • Assists the Case Manager in the coordination of care.

19. Community Education • Physicians’ offices • Hospital emergency departments • Care Coordinators/Discharge Planners • Assisted Living Programs • Continuing Care Communities • Board of Directors

20. Where are we Today? • 90 out of a possible 100 monitors are installed and in use in patient homes. • Dedicated full time Tele-health Program • Coordinator, Telehealth Nurse Manager, part-time Tele-health Program Technician, designated Medical Supply Clerk. • Clinicians recognize the benefit of the program. • Positive patient satisfaction surveys.

21. Where are we Today? • Physicians see the benefit of tele-monitoring and are beginning to incorporate the program as part of the treatment plan. • Reduced Acute Care Hospitalization Rate. • Reduced emergent care rate. • Improved patient care outcomes. • Fewer visits per episode.

22. Future Plans • Program expansion. • Maximizing reports and statistics.