Orbita Health has published a new eBook titled:  The Digital Technologies Behind the Home Health care Revolution. The book was summarized in this post. To learn more about this book, we decided to interview Nathan Treloar, President and COO of Orbita.

What do we mean by Home Health care?

The National Association for Home Care & Hospice defines home care as follows.

Home care encompasses a wide range of health and social services. These services are delivered at home to recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living. Home care is appropriate whenever a person prefers to stay at home but needs ongoing care that cannot easily or effectively be provided solely by family and friends.

We like this definition because it does not limit home care to a specific population (i.e.; seniors) or solely to delivery of medical care. Social services, for example, play a significant role in helping people with health conditions stay out of hospitals and skilled care facilities.

The definition states that “home care is appropriate whenever a person prefers to stay at home.”  Certainly, patients have a choice. Yet, in recent years, consumer choice has become less of a driving force. Today’s health care system is experiencing dramatic shifts, with financial incentives for payers and providers who keep patients in their homes.

This definition also highlights the need for “ongoing care that cannot easily or effectively be provided solely by family and friends.” Undoubtedly, family members and friends play an integral role in helping loved ones stay in their homes. When we set out to create the Orbita platform, we intentionally considered the needs of family and friend caregivers. Our solution includes powerful capabilities to include family and friends in the care management process — because engagement of these individuals can be nearly as powerful, if not more so, than engagement of patients themselves.

Why do you think that the demand for better home health care is on the rise?

The US has the world’s highest per capita health care costs – more than twice the average of other developed countries. To counter this, fee-based, “volume” reimbursement is being replaced by value-based reimbursement models focused on quality of care and outcomes. The Affordable Care Act rewards providers that reduce unnecessary care, duplicative care, and medical errors. Readmission penalties are being levied. The list goes on.

Demographics are also a driving variable. As of 2012, about half of all American adults had at least one chronic health condition; one in four suffered from two or more. Many of them are baby boomers, who are aging into Medicare at the rate of 10,000 each day. Home care for chronic conditions, and for medical problems that come with the aging process, makes sense.  What may be the biggest driver of the move to home health care, however, are the digital technologies that make it possible to provide care that’s more cost effective, more outcome effective, and more of what the healthcare consumer wants.

How can technology enhance home health care?

Better care and better outcomes happen when medical professionals have access to better and more timely insights into what’s going on with their patients, when all the parties involved – medical professionals, patients, caregivers – are in better communication, and better able to coordinate care, and when patients are more equipped, informed, and engaged in their own care.

Here are some areas where digital technology improves home health care:

• Access to information and expertise

Patients who understand their care plan are 30 percent less likely to be readmitted. When patients leave the hospital or medical office, they often have a thick packet of instructions. But how can we ensure the information stays with them, and is used? Digital versions of care instructions can be always-ready at the patient’s fingertips. Going further, home care plans can be part of a complete digital experience that guides the patient through their treatment with reminders, encouragement, education, and more, all delivered in a way that is always available, personalized, and adjusts over time as the patient’s needs change.

• Ensuring that patients take medicine and follow treatment protocols

Nearly 60 percent of the US population takes at least one prescription drug, and as many as one-half of them don’t take their medication as prescribed. Technology can empower reminders for patients and caregivers, and assist providers in monitoring medication use.

• Monitoring patients and intervening as needed

Effective healthcare requires careful, consistent monitoring of vital signs; body chemistry (e.g., glucose for diabetes); movement (e.g., to avoid bed sores); healing progress for wounds; heart, lung, and muscle strength; sleep quality and duration. While monitoring devices were, at one time, available only in hospitals, today’s technology can bring effective monitoring into homes.

• Coordinating care among caregivers and providers

Connecting patients to their providers is an important step in creating strong home health care experiences, but most patients have a team of care providers around them: their physician, nurse practitioners, visiting nurses, and home aides, as well as friends and family members. Care coordination involves “deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care.

• Patient Support, Encouragement, and Engagement

Many patients need help with the basics of self-care and daily living. In an inpatient setting, timely support and encouragement can be delivered with great regularity. Once home, patients must rely on family, friends, neighbors, visiting nurses, and home health aides for this type of care. Digital home health applications offer a communication path to keep patients involved and engaged in their own care, while empowering and informing their care providers.

What are examples of technologies that could revolutionize how home health care is delivered?

Digital home health care is being enabled by the same technology that brought us the always-on, totally connected world we live in today. What Steve Case calls the 3rd wave of the Internet is transforming how healthcare is being delivered at home through near ubiquitous connectivity as well as mobile apps and the computing power of smartphones,

Ninety-five percent of all American households have wired network access to the internet and two-thirds of Americans have broadband at home. Two-thirds of Americans now own smartphones. Smartphones have become fully-functioning computers that provide a personalized, mobile, always on/always available way to access friends, family, applications, games, and information.

The growth of ever-cheaper and smaller sensors has revolutionized home health and wellness. Smartphones are smart, in part, because they’re packed with sensors – sensors that can record step counts, location, ambient temperature, and other data relevant to patient activity and wellness. For example, step count data can help to inform how well a patient is adhering to a recovery plan for a hip or knee replacement.

“Self-care” medical devices, like blood pressure and blood glucose monitoring kits, and telemetry monitoring for heart conditions, have been around for years. Today, as they become more accurate, cheaper to build, more connected, and even disposable these devices become a part of a holistic system that connects patients with caregivers and healthcare providers.  Wearables are emerging as a key tool for home health care.

These core technologies combine to provide the foundation for all modern applications in digital home health care. Smart devices provide the data, mobile apps and smartphones the personal platform for engaging the patient, and ubiquitous network access to connect it all together. The results are applications that enable the patient, their caregivers, and their providers to better understand when health is at risk and to respond more quickly and in a more informed way to problems or potential problems as they’re spotted.

Where do you see the Digital Home Health care industry in the coming 5-years?

Over time, we will see increasing use of devices that are not strictly designed for wellness or healthcare. Motion monitoring devices have been used for years to track the movements of those at risk of falling. It’s now possible to buy home security systems for a fraction of the cost and complexity of more well-known personal emergency response systems. New voice-powered digital devices like the Amazon Echo are generating significant interest as alternative ways to engage patients whose special needs prevent them from using other digital interfaces.

These are not the only technologies required to deliver a complete digital home health care solution. Software is required to power the applications and user experiences for patients and providers. Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care.

A comprehensive solution requires the following types of software:

• Social computing: The success of social media applications like Facebook, Twitter, and others have set the digital standard for how people communicate, collaborate, and coordinate with each other in group settings. From this world comes important digital technologies and capabilities that are relevant to coordinating care, managing intervention, and engaging patients at home in their own care. Technologies like text, voice and video messaging, activity feeds, notifications and alerts, and shared calendars will bring significant value.
• Analytics (actionable insights): Digital devices and smart phone apps create data. But without the ability to quickly process and analyze it to detect important trends, anomalies, and risks, all that data is useless. Clinicians don’t need more data. They need actionable insights. But it’s not just about sending alerts. Clinicians struggle with “alert fatigue” already. These solutions require intelligent data-driven decision support tools that are aligned with established care protocols, and are flexible enough to meet the needs of individual patients.
• Content and experience management: Technologies for managing content and user experience are mature in the digital marketing world – for example, they are used to manage, monitor, measure visitors to consumer web sites and mobile applications. These same “customer engagement” technologies play an important role in digital home health and “patient engagement.” Content management capabilities, for example, apply to curating and delivering educational information, treatment instructions, and other patient-centric content. Managing and delivering this information digitally – whether as digital text, prerecorded video content, or live video teleconference – increases patient engagement and improves treatment adherence while saving costs.
• Secure cloud computing:  Cloud computing offers a high performance, extensible, highly scalable means to quickly bring solutions to market. Protecting personal health information is critically important. While moving sensitive health data between the patient at home to a cloud-based application accessible by caregivers and physician systems seems prone to peril, modern cloud technologies have advanced considerably to address these challenges. Key security requirements include strong authorization and authentication, end-to-end encryption of all digital data both “at rest” (in storage) and “in transit” (moving over the network) and HIPAA-compliance of all systems and organizations serving the solution.

What recommendations would you like to give to those willing to enter this industry?

Most companies in this space have focused on development skewed toward meeting either patient needs or clinician needs. The challenge lies in bridging the gap to strike a balance between both. Orbita excels at this – and includes family and friends as well.

Some vendors have done an excellent job in building care management workflow – but they lack the ability to integrate data from a wealth of IOT devices.  Add to this the complexity of ensuring HIPAA compliance outside traditionally “closed” systems, and things can become complex.

Most solutions either push content to patients or capture data from patients and, as such, are relatively “static.” We are unaware of a home health platform that provides an “orchestration engine” whereby the system can identify and automatically “react” when something goes wrong – whether that be notifying the patient to take some action, alerting a clinician about a problem and enabling him/her to act quickly via the system, or engaging a family member to take on specific roles.

A handful of home health solutions seem to be one-size-fits-all. These enterprise-type systems lack extensibility. Orbita chose to build its solution on a platform – enabling organizations to readily bring bits and pieces together to meet their needs, then even more readily plug into an existing infrastructure. In addition to minimizing costs and headaches for ongoing technical maintenance (upgrades, patches, etc.,) this approach is future proof. New technologies can be readily added and older ones stripped out.

Digital home health care is defined by the three core technologies of connectivity, mobile apps, and smart, sensor-enabled devices. But purpose-driven home health requires many more technologies to enable the full range of patient monitoring, education, intervention, and collaborative care required for a complete, digital home health care solution.