A discussion of published research on the strengths and weaknesses of using telehealth in home health settings - from the Telehealth Failures & Secrets To Success Conference: vsee.com/telehealth-failures-conference

1. WHAT STARTS HERE CHANGES THE WORLD
Unintended Consequences of
Telehealth in Home Health
Kavita Radhakrishnan, RN PhD MSEE
The University of Texas Austin

2. WHAT STARTS HERE CHANGES THE WORLD
Top Healthcare Consumers

3. WHAT STARTS HERE CHANGES THE WORLD
Home Health – Growing Healthcare Sector
• Home health clinicians provide care for about
11 million patients across the US
Discharge from
Post-Acute Facility
Goal of home health =
Patient Self-care
Home Health Agency
Patient’s Home

4. WHAT STARTS HERE CHANGES THE WORLD
Telehealth as a Decision Aid
• Early detection of health crisis
• Informed Care prioritization,
treatment and management
• Patient empowerment –
“Contextually relevant information”
to connect the dots between data &
behaviors
• Expected Beneficial effects
– ⬇ Nursing Visits
– ⬇ Hospitalization
– ⬆ Quality of life

5. WHAT STARTS HERE CHANGES THE WORLD
Studies’ Geographical Location

6. WHAT STARTS HERE CHANGES THE WORLD
Unintended Consequences

7. WHAT STARTS HERE CHANGES THE WORLD
⬆ Home Health Nursing Visits
93%
94%
95%
96%
97%
98%
99%
100%
Weight SBP DBP HR O2 sat Overall
Alerts related to
Cardiac KME
Other Alerts
< 3%

8. WHAT STARTS HERE CHANGES THE WORLD
Long Feedback Loop / Circle of Communication
ATTRIBUTION: ©2004-2013 Koninklijke Philips
Electronics N.V. All rights reserved.
http://www.telehealth.va.gov/ccht/
Fax
Visiting
Nurse
Telehealth
NursePatient’s Home Clinic Office

9. WHAT STARTS HERE CHANGES THE WORLD
Fractured Data Ownership
Lack of data ownership
No Longitudinal analysis
Clinician fear of liability
Patient
Generated
Reviewed at
Home health
agency
Stored by
telehealth
service
provider
Action at
Physician
Office

10. WHAT STARTS HERE CHANGES THE WORLD
Negligible ROI
• “No Bang for the buck”
Reimbursement for telehealth
service too low to be an incentive
• Sunk initial investment
– Low resources for updates or
maintenance
• 30-day re-hospitalization fines
may be an incentive but the
sickest may be left out
10

11. WHAT STARTS HERE CHANGES THE WORLD
Patient Empowerment or Over-dependence?
• False sense of security
• Home health model
– Telehealth is removed at end of service
– Need additional days to wean patients off telehealth

12. WHAT STARTS HERE CHANGES THE WORLD
Potential Solutions
(Besides ROI!!)

13. WHAT STARTS HERE CHANGES THE WORLD
One Size does not fit all
• Risk-based classification informed by
patient context in addition to
biometrics
– Health Literacy
– Co-morbidities
– Training & Education
– Family support
– Daily life routine
– Mobility impairment
– Cognitive impairment
• Intelligent adaptive alert system
tailored to patient characteristics and
contextual information

14. WHAT STARTS HERE CHANGES THE WORLD
Effective Inter-professional Communication
• Lack of Telehealth growth is a symptom
of the larger healthcare system malaise
• Clear goals and expectations for
individual patients
• Inter-disciplinary collaborative planning
on telehealth communication protocols
• Inter-operability to integrate telehealth
data with EHRs

15. WHAT STARTS HERE CHANGES THE WORLD
Patient Empowerment
• Add layer of responsibility
• Patient-centric
• Shift focus of telehealth from
collection of biometric data to
informing or motivating behavior
change
• Behavioral science techniques and
personalized goal-setting should
guide telehealth protocols that are
designed to motivate behavior
change

16. WHAT STARTS HERE CHANGES THE WORLD
Q & A