A closer look at the technology needed for new and aging in-place models of care at home


As people get older, the topic of caring for loved ones enters the conversation. Most find that this discussion escalates once the events really begin.

Ashish V Shah experienced this firsthand with his elderly father. And after his father’s death, he learned how pockets of information were not shared between care teams in a meaningful way that may have delayed the fateful event.

Shah realized that there was no easy mechanism for care teams from various providers to share information that could help age patients in place, so he set out to create one. He is now CEO of Dina, which makes an AI-powered platform for models of in-home care.

Seven out of 10 people need assisted living care in their lifetime. studies It turns out that most of the elderly Prefer to stay at home and age, rather than being transferred to an assisted living facility.

Healthcare IT news I sat down with Shah to discuss the role of health IT in aging in place.

Q: Please describe your experience with caring for your elderly parent, and what you learned about not sharing information in a meaningful way.

a. Anyone who has taken care of an elderly parent knows this can be a challenging experience. Shortly after Aetna acquired my former company Medicity, my father passed away suddenly. Unfortunately, this is something you hear a lot about in healthcare projects – there is often a personal connection.

In my case, I’m trying to solve a problem that our family experienced. My dad was a senior, and the caregivers would see him at home, in seniors centers, and outside.

After he died unexpectedly, we spent time with those people who saw a meaningful drop coming, yet this information was not shared with the official healthcare team, certainly not with his insurance company, not with his family in a way we could. Intervene to try to change the course of his care. It was an untapped resource with a critical and objective perspective.

At Medicity, we were serving 1,300 hospitals, facilitating a lot of data sharing across hospitals, primary care and labs, but nothing we were doing was going to impact the home and community. As I dig deeper, I find that my story, unfortunately, is not unique; It will be one that grows in nature.

So, out of professional and personal need, we looked for an opportunity to organize the home and community care ecosystem and make it easier for health systems, ACOs and health plans to expand their reach and visibility at home, in an effort to help people make the most of their healthy days at home. We launched Dina in 2015, and we were very focused and committed to achieving the vision.

As an industry, we have two problems to solve. The first is when you are a truly connected family caregiver. How do we make life easier for that person? The second is, how do we give less engaged family members insight into what’s going on with one of our family members?

For us at Dina, this means how we revitalize and coordinate the best home care, and how we open up the vision for how that care is delivered to people who are not normally part of this process, such as insurance companies, doctors and health systems, etc.

s. What are some of the reasons why it is important for care teams from different caregivers to share information when it comes to trying to help patients age in place?

a. Health care is difficult. But if you look at a hospital, it is the place that has the best resources for clinical care in our country, for example, staff, suppliers, equipment and technology.

Now if you’re thinking that this model is disjointed, and you’re now providing care in the home and in the community, in order to match that experience and make it a smart one, you have to have great vision and the ability to keep track of everything. How do you understand what is happening now?

After coming out of COVID, it’s also becoming clear that people want to control their own comprehensive healthcare experience, and a lot of those centers are in and around their homes. Unfortunately, when people end up in the hospital, going home is often easier said than done.

Most home and family caregivers lack the technology to share how a patient is progressing with the extended care team. In addition, there is an increasing number of people who are chronically ill and who do not need occasional care but who need to stay in touch with their providers to manage their health at home.

At the hospital, you press the ‘nurse call button’ if you are not feeling well or if something is not right. You should replicate this remotely and share information between caregivers.

Finally, all people who normally interact with a patient’s bed should be enabled to share information dynamically to coordinate care. Interest occurs because all of these resources are there. What does matching those resources mean in your home?

Not all of these care team members will be in your home at the same time. They will come at different points and in different shifts, so sharing this information becomes crucial.

Q: What types of healthcare IT can help with this situation?

a. There have been major advances in virtual care, remote patient monitoring, and patient engagement. But the kind of technology that will need the most investment now is what brings it all together, for example, the right kind of infrastructure for coordinators, whether they’re in the hospital or the insurance company, so they can monitor what’s happening outside the hospital and activate physical and virtual services.

This care may include personal care, escort care, house calls, meal deliveries, home modification or durable medical equipment. It is a very broad and segmented market. So, technology that brings it all together with the push of a button is critical.

From now on, care will be provided in three ways: in high-quality facilities; Online with telehealth capabilities; And in your living room. I think in the next five to 10 years every home will need to be configured to function as a formal care setting (eg a primary care clinic or hospital), and providers – especially those that are part of value-based contracts – have to be prepared to provide care in this place.

There is no one-size-fits-all solution for creating models of care at home. It takes alignment with the payers, hospital funding and contracting teams, and you need to understand the target patient population.

Over the past year, more people have opened their doors to health care at home, and these models are here to stay. We have seen that when home is the focal point, care is more affordable, more convenient and the experience more comfortable.

s. What role do remote patient monitoring and engagement technologies play?

a. Remote patient monitoring tools act as an early warning system and create visibility between care visits. They increase the touches or connection between the health system and the individual.

If you are a traditional healthcare provider organization or health plan, creating the infrastructure to activate, track and manage care outside the traditional four walls of a hospital is critical. We refer to this as ‘care traffic control’ to remotely monitor and engage patients and create home insights to help identify functional, behavioral, and social determinants of health needs.

While most providers do some level of tracking, monitoring, and directionality, one-way visibility is not enough. For example, text-based patient check-ins can be used to obtain real-time feedback and manage by exception, helping people stay home safely.

This helps reduce unnecessary hospital and emergency visits. For older adults, this can slow progression to long-term nursing home care. This is something we will need to do more, especially since 10,000 people turn 65 every single day.

Healthcare organizations across the country are understaffed and overwhelmed. To navigate the switch to home care, they need to find ways to extend their reach into the home without increasing the burden on staff. Technology is one way to overcome this challenge.

Q: What experiences have you and your company had with remote patient monitoring when it comes to aging in place?

a. Studies show that bone People feel safer when they receive care in the confines of their homes and report greater satisfaction with the care they receive when they are in familiar and comfortable surroundings.

Right now, we don’t have enough nurses, doctors and home health workers, so technology must foster greater efficiencies and interactions.

By activating remote patient engagement tools, we can connect different points of care and different care providers and align them with the same goals, all while keeping the patient centered. This positively affected the results and kept more patients safe and well cared for in their homes.

It’s not just about passively collecting data but remotely engaging in timely conversations with someone, for example, asking how they’re feeling, how diabetes is progressing, or whatever the case may be.

They are not directed to visit a portal but instead engage in a dynamic conversation. And through these conversations, we can determine if they need to escalate to the appropriate care team member who can determine next steps.

Our technology uses triggers from predictive modeling and patients to help determine in real time who may need intervention or support with specific social issues. Care teams are important to guide and intervene when signals indicate a need for escalation. Technology’s use of “manage by exception” ensures that no one falls through the cracks.

It maintains the connection and undoes these thoughts about social, behavioral, and occupational health, and then works on them in real time. I think it’s a progressive model of care, and we’re excited to help more people get care on their own terms, in their own homes, and maximize their healthy days at home.

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Contact the author: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.


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