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Wireless Revolution in Home Health

Improving wireless technology empowers home health nurses to chart and educate remotely.

With texting, tweeting, Facebook PMing and Gchat increasingly replacing face-to-face or telephone conversations, it's only logical that clinicians will find a way to enhance provider-patient communications.

But don't expect 140 characters to replace a discharge planning session anytime soon. While healthcare communication capabilities are advancing every day, clinicians feel an increasing responsibility to display professionalism and maintain patient privacy.

Nowhere is the potential for technological advancement greater than in the arena of home care. As the national focus shifts to keeping patients in their own homes (and out of ED admissions), technology is increasingly enabling patients to connect with their clinicians remotely.

The trend is official now. In October, the Federal Communications Commission (FCC) allocated use of the 2360-2400 MHz bandwidth for medical use. Those bands were previously reserved for flight testing in the aerospace industry. This change should further facilitate real-time monitoring.

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According to a statement by the FCC, it "will promote the widespread use of beneficial MBAN technologies. Such deployment will reduce healthcare expenses, improve the quality of patient care and could ultimately save lives."

The agency estimated MBAN technology could save the healthcare industry $1.2 billion annually by reducing the need for hospitalizations.

Leading software developers have devices in development to meet the increased spectrum allocation and are encouraging the FCC to finalize the MBAN coordinator appointment.

Manufacturers that develop MBAN technology would have to register and coordinate use of the devices with the MBAN coordinator, who will ensure that they will not interfere with other devices. The FCC set a target date of June 2013 to have the coordinator in place.

Rural Connectivity

Illustrating the increasing wireless application in home care is Frederick Memorial Home Care in Frederick, MD.

The system has been profiled as a case study for their manufacturer, and Heidi Brown, MSN, RN, director of home health and home medical equipment, is amazed at how quickly the technology has evolved.

Since her facility made the decision to acquire a durable mobile computing system approximately 3 years ago, they've already upgraded once and are switching to a tablet format next year.

At their initial launch, Frederick Memorial was one of the first home health agencies to use wireless technology for their approximately 70 caregivers and clinicians.

"It really makes our clinicians much more independent," said Brown. "They're no longer dependent upon an Ethernet connection and don't have to go back to an office to file a report."

Brown and her team selected a wireless laptop that resembles a small suitcase. Integrated mobile broadband communication capabilities are built into the computer, negating the need for a dedicated connectivity device.

While Frederick Memorial serves the suburbs of Baltimore and Washington, DC, patients residing just five miles away from the hospital are considered residents of "farm country," said Brown.

"Just as you'd lose a cell connection, it's easy to lose Internet connection in the hills and mountains," she explained.

"For this reason, as well as safety, we train staff not to transmit data while they're driving. They could hit the sync button or go through a bad spot and interrupt connectivity."

Even given that requirement, Frederick Memorial nurses can file patient reports or communicate with a multidisciplinary team while rounding in patients' homes.

The robustness of laptops was a strong selling point as well.

In home care, it's all too common for mobility to be associated with cracked computer screens, missing keys or water damage. These polymer-encased hard drives can absorb impacts and a have sealed all-weather design. Batteries are designed to have a longer life, keeping nurses focused on patient visits rather than scrambling for outlets.

Integrating with EMR

One of Brown's and her staff's favorite features of the system is the ability to communicate with colleagues via an instant messaging system. The messages are then attached to the patient's clinical chart, eliminating a step in the nurses' workflow.

"The messaging feature really cuts down on phone calls," Brown said. "Our staff finds it very positive that messages about patients become part of their chart. We no longer have to go back into a note and add something like 'I emailed the PT.' It saves a step."

While clinician-to-clinician conversations are increasingly occurring in the electronic stratosphere, patient education and family caregiver instructions are still very much a face-to-face occurrence.

That may not always be the case. In home health and hospice circles, murmurs are beginning about the possibility of using text messaging to notify family members about a loved one's decline or provide educational information.

Brown can't conceptualize the idea of using mobile devices for such sensitive patient conversations but looks forward to this year's upgrade to a tablet.

"With these, we'll have the capability to do face-to-face video educations sessions," she noted with excitement.

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Remote Monitoring

Like many other health systems, Frederick Memorial's home health patients do have a web-based method of recording their daily weight, blood pressure and other indicators with a nurse providing the necessary follow-up.

Though the 65+ generation rarely asks about mobile or smartphone apps, Brown said they're frequently online seeking health information and very receptive to the web-based remote monitoring.

"It's our intent that the patient becomes engaged and takes ownership," she said. "They have a sense that someone's looking out for them.

"Our intent is to catch problems before they would have to go to the hospital or present at the ED. It might not save the system money, but it decreases healthcare costs. We're acting more efficiently than ever to keep them out of the hospital."

Robin Hocevar is senior regional editor at ADVANCE.

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There are state and federal regulations in place for this reason. Agencies have to register with there appropriated state. Background checks are mandated and should be at the federal level to protect clients.

tatjana December 12, 2012


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