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Technology in Home Care Visiting Nurse Association of Central New York, Inc. Indi Shelby, President/CEO. Vital Statistics. Established in 1890 Voluntary, Non-Profit, New York State Corporation Serves Onondaga County, New York Certified Home Health Agency Census 900

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Technology in Home Care

Visiting Nurse Association of Central New York, Inc.

Indi Shelby, President/CEO


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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


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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


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Special Programs

  • Heart Smart

  • Skin and Wound Resource Team

  • Diabetes Education

  • Pediatrics

  • Maternal Child

  • Home Infusion Therapy

  • Rehabilitation Services

  • Tele-home Care Monitoring Program


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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.


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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.


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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.


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Selecting a System

  • Video versus non-video

  • Leasing versus purchasing

  • Choosing peripheral equipment

  • How many units needed to start the program


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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.


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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).


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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


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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.


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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.


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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.


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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.


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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.


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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.


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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.


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Community Education

  • Physicians’ offices

  • Hospital emergency departments

  • Care Coordinators/Discharge Planners

  • Assisted Living Programs

  • Continuing Care Communities

  • Board of Directors


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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.


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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.


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Future Plans

  • Program expansion.

  • Maximizing reports and statistics.


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