Home Health Monitoring Unfolded: Nurse Talk
Published: July 1, 2021
I first learned about home monitoring of heart failure patients at a conference for cardiac nurses that I attended in 2004. “Brilliant,” I thought. “Exactly what we need!” At the time, I was a cardiac nurse for a home health care agency, and much of that care was focused on trying to help my patients stay out of the hospital. Not because of CMS penalties or bundled payments, but because my patients begged me to help them stay away from the ER and hospitals.
I was limited in how often I could visit home-health patients because Medicare and other insurance providers did not consider monitoring patients a skilled service. This new technology offered a way for the patient to send their daily weight, blood pressure, and O2sats* to a clinician for review.
*Abbreviation for oxygen saturation
Two Decades of Home Monitoring, Yet Still Not Widely Adopted
In short order, we had a program up and running with a terrific nurse monitoring the dashboard. It worked wonderfully—when we could convince a patient to adopt it. Convincing patients to agree to be monitored was much more difficult than I ever imagined it to be. Here we are, twenty years later, and we are still struggling with the very same issue.
Is it because our older population is averse to technology? No, I don’t think so. According to the AARP, 51% of the older population have reported purchasing some tech product. Most of my over 50 home health care patients were using tablets, laptops, or smartphones. So why is it that adoption of home medical telemonitoring technology has not been easy?
A Personalized Experience is Essential
In my humble opinion, it is because of two things. First, every user has preconceived expectations of how they want the technology to work. Some patients want to see their readings on a screen in real time, and access to the data; others do not.
Second, not everyone wants to be an active participant in their health monitoring. What clinicians need is a product that can be flexible and is capable of pleasing the many different, and often conflicting, expectations of users. Simply, a product that does not require the patient to actively participate, even after they lose interest after a few weeks or “nothing changes.”
Integration into Daily Habits
Having a device that is integrated into something we all use every day, takes up no other space in the home, and sends data usually only recorded in the ICU by highly trained nurses is a game-changer.
Mitigating Common User Errors will Save Tremendous Effort and Headache for All
What about the clinician who will be setting up and monitoring the information? I can attest to having spent thousands of hours demonstrating and coaching patients on how to correctly use the equipment. Frequently, abnormal readings are often because of user error, resulting from something as simple as taking a patient’s blood pressure reading over their shirt sleeve or sweater, wearing sneakers, or leaning on the counter when measuring their weight. Troubleshooting these errors often leads to frustration and a lack of trust in the data.
What if we used a tool that, by design, would be very difficult to make a mistake? No more frequent follow-up calls to ask, “Did you take your Blood Pressure on your bare arm? Were you wearing something different when you got weighed today?” It may seem like a quick call would not take that much time, but what if you multiply that time spent by 100 or 1,000? Then, the clinician is taken away from the important work of customizing treatment for those who have had a true change in condition.
DISCLAIMER: Blood pressure is currently under development. The Heart Seat is not FDA cleared for blood pressure at this time.
Casana’s vision is to create effortless, in-home health monitoring solutions that allow care teams and their patients to achieve better health outcomes. The Heart Seat™ is Casana’s first product and is currently pursuing FDA clearance.
Remote patient monitoring: Nurse Talk
Nancy Carlson Weik, BSN, RN, Notes from The Field
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