Audio Narratives and Scripting for HIMSS 2015
i-Home/Intelligent Medical Home
V5- 3.31.15
Welcome to the home of the Allens
Elizabeth, the elderly mother, also known as Beth, lives here with her son Robert Allen who was just discharged from the hospital yesterday after open heart surgery.
Likewise, Beth has been home only 6 weeks after a fall resulting in a fractured hip that required a total hip replacement. Beth also has early dementia. Both Beth and Robert have multiple chronic conditions, so they are under the care of Sally in their own home.
Living Room
When you enter the Allen residence, you are greeted at the front door by Sally, the Caregiver. Beth, the elderly mother and Robert the son are also present. (seated in the room)
SKYLIGHT- Use Case #1
(Sally and Robert sit down at the home computer and begin to review health education and instructions)This first solution you will observe adds to the growing movement to engage patients and provide better care and communication outside the four walls of the hospital.[Skylight_Living Room1_hospital]Patients like Robert and their families can access procedure-specific education, pre-procedure instructions, complete pre-admission forms,[Skylight_Living Room1_Forms], and prepare for their hospital stay from the comfort of their own home. (Robert reviews his exercise video, and also scans his to-do list) The personalized system provided Robert with a pre-admission To Do schedule[Skylight_Living Room1_ToDo]preparing him for his recent hospital stay.
SKYLIGHT- Use Case #2
This interactive home solution is also designed to capture patient reported outcomes (Sally watches as Robert completes standard Pain assessment form and also view the aggregated results from his surgeon)across the continuum of care with standard or custom survey instruments. [Skylight_Living Room2_Survey]With a focus on reporting of quality outcomes, patients like Robert are engaged and encouraged to participate with his providers. This provides better feedback to patients, communication, and reporting outside the hospital. In addition to completing these forms, Robert can interact with the post-discharge to do list which includes exercise and therapy, medication, appointments,[Skylight_Living Room2_Appointments] and and other key events and education leading to a more complete healing process. (Robert and Sally conclude their form and view the patient education material).
VOCERA- Use Case #1
Robert and Sally are preparing to start the at-home treatment plan as detailed by the nurse in the hospital, but need to review the information (Sallypicks upVocera tablet for Robert). Sally logs into the online link for the hospital audio recording of their discharge instructions from a notification they received via email or SMS on a computer or tablet and enters the secure password provided by the hospital. (Sallyappears to enter the password on the tablet)They are now able to replay the audio of the discharge instructions, and review the detailed plan of medications, diet, and follow up appointments they need to follow. (Sally and Robert listen to the instructions)Robert may also dial a toll-free number to listen to their audio instructions if they don’t have access to the internet.
AMC- Use Case #1
By incorporating device-reported biometric monitoring of blood glucose and blood pressure with IVR telephony to collect patient self-reported symptoms, remote clinicians now have a powerful tool to manage Robert’s diabetes. The devices demonstrated here are the blood pressuremonitor (Robert pulls the cuff up your arm and show the BP display),andglucometer. (Robert picks up glucometer with adapter attached).These use Bluetooth technologyto collect biometric data, which is transmitted to a secure telehealth platform via a mobile gateway (Robert lift and show the tablet), where it is stratified against patient goals and set priorities. The patient also receives an IVR call triggered by biometric readings, and a televideo counseling session occurs between the patient and the remote care manager (Robert is speaking on tablet and show screenshot/video of clinician speaking on tablet). Trends and symptoms are detected early enough to intervene as needed, preventing more costly acute episodes such as trips to the Emergency Department or hospitalreadmissions.
ASCOM- Use Case #1
Both Beth and Robert can obtain immediate assistance if needed. Wall mounted call buttons or a wireless wristband or pendant is used to summon help (Beth presses red button on station). The request may be dispatched in various manners including visual indicators (Robert points to flashing dome light), to a central operator, or to a mobile caregivers wireless device (Robert hold up Ascom Wireless phone) This Emergency Call system has an audio option (Beth points to wall mount call buttons and speaker/mic) allowing the dispatcher to immediately speak to the resident stating support is on the way and prepares responders of the situation. This system offers both wired and wireless architecture. It leverages IP-based communications and precision event location technology. The system enables residents to enjoy an active life style with the confidence that assistance is available when and where they are needed.
(Beth cancels the call)
VA- Use Case #1
It is time for Beth [ SS#1 – Web Page Menu ] to take her medications so she receives a reminder via a verbal prompt[SS#2 – Watch \ ScreenClientWeb\ Speakers]from speakers in the house as well as an audio and visual cue on her watch.(Beth looks at her watch)Because of Beth’s cognitive condition and recent repaired hip fracture, her risk of further falls is calculated in a risk prediction algorithm.(Beth begins walking toward Kitchen with her cane in an erratic manner) Beth’sposition[SS#3 – Movement & Path]is always being monitoredand recorded by the transponder in her watch. As Beth heads toward her medication Box, her gait position, velocity and total movements are recorded. This data can be used directly by a remote caregiver or analyzed by a Smart Home system to look for unfamiliar trends. The data can be used in more complex algorithms to analyze her gait patterns.[SS#4 – FractalD] One algorithm currently used is fractal-D which determines how curvy the person is walking
Kitchen
(Beth walks into Kitchen toward Med Box and water bottle)
VA- Use Case #2
The same tracking system records when Beth is within a couple of feet of the area where she takes her medication. [SS#5 – Medication Evidence] There is a tilt sensor in the medication box(Beth picks up med box), which allows the system to record when Beth picks up her medication box.(Beth takes a pill and holds up water bottle to mouth)Another sensor in the water bottle stand allows us to detect and record when Beth takes her pills since it is likely that Beth will need water to take her medication. The final evidence that Beth is taking her medication is a Kinect that monitors when her hand is near her mouth.(Beth points to the Kinect system)The system can use this evidence to conclude that Beth has indeed taken her medication. If additional evidence is needed, a web cam (Beth points to mounted web cam) may be pointed to the medication area and a snapshot or recording triggered when Beth is in the area or the Medication Box is tilted
IN TOUCH- Use Case #1
(Robert walks toward InTouch Viewpoint device mounted on Kitchen counter)
Robert’s physician decided that due to Robert’s description of recent symptoms post-hospitalization and his prior history of hypertension and cardiac surgery, he wanted to see Robertvirtually[SS#1 – InTouch Health Overview]to accurately assess the situation. The doctor was able to “beam-in” to Roger’s home through a portable technology.(Robert picks up the InTouch Viewpoint and positions in front of the patient in view of the audience The doctor is able to see, speak and interact with Robert and can be moved throughout the home and positioned in place. Also, the doctor can pan, tilt and zoom in order to perform a more thorough diagnosis. (Robert shows the USB cable connected to the device and then lifts up the stethoscope)More importantly, since the device allows active patient monitoring, the doctor can connect peripheral devices that feed data back to the doctor from Robert’s home. In this case, the physician utilized Robert’s medical history, the verbal description of his symptoms and visual observations to quickly identify Robert’s situation. This could be an emergency and the physician could direct an ambulance Robert’s homeif needed. (Robert points to the images of heart waves being shown on the screen)
LOGICNETS – Use Case 1
(Robert now sits at Dining table. Sally grabs LogicNets tablet and begins filling information out while asking questions to Robert.)Sally knows that Robert has just returned from the Hospital and needs special attention paid to managing his diabetes. Sally can access the free site for diabetic management from the medical center. There she can follow its guided questionnaire about Robert’s medications and history to generate instructions based on his specific needs. The system intelligently responds to her input, drawing from the hundreds of possible factors and sequence of steps required in Robert’s case. (Sally shows Robert the tablet with the results and gesture to him if he would like a copy email or printed.)Once done, Sally reviews the Patient Instructions report and emails it to herself. She also prints a copy to review with Robert. (Sally walks to the printer and retrieves document)Sally is unaware that the application she just used isn’t a vendor module or the work of a special programming team. Instead, the specialists at the Medical Center have used a Decision Support Platform to quickly and visually model their protocol for Robert.
ACUPERA- Use Case #1WAITING ON SCREEN SHOTS
After returning home from his cardiac surgery, Robert reviews with Sally another care plan created by a care coordination platform based on Robert’s clinical and behavioral care gaps(Sally picks up Acupera tablet and points to the care plan).They will receive a call from the nurse navigator within 48 hours of discharge to review his care plan, discharge medications, and any other issues that might require attention. The medication reconciliation is performed using the care pathways embedded in the care coordination platform. Robert’s pre-admissions home medications from the outpatient EHR (Sally points to the outpatient medication list)and inpatient discharge medications list (Sally points to the inpatient discharge medications screen)are compared. As you can see the system has highlighted a discrepancy and the most likely reasons for the discrepancies, and allows the nurse navigator to confirm or change the reason, and guides the nurse navigator to the best course of action based on the selected reason(Sally points to the screen showing the reconciled medication list). The care coordination platform has an integrated record of Robert’s health data, including data feeds from home monitoring systems and interprets the data in context of Robert’s overall care goals. It alerts the nurse navigator with any negative information or trends and also recommends the appropriate course of action. The nurse navigator schedules an appointment for Robert with their primary care physician to ensure optimal care and a full recovery from Robert’s surgery. The care coordination platform creates a Visit Agenda based on the key clinical and behavioral issues identified using its intelligent clinical and behavioral care engine.(Robert points to the planned visit agenda screen)
Acute Bedroom- (Robert leads Beth, Sally and group to Acute Bedroom)
As you enter the first Bedroom, you will notice the hospital bed (STRYKER)that allows for additional monitoring and safety features since Robert was recently discharged after his heart surgery
SKYLIGHT- Use Case #3
(Robert picks up the Skylight tablet and is viewing his login instructions)This interactive patient solution enables providers to continue caring for their patients after they leave the hospital. After arriving home and using a platform that leverage both high tech and low tech solutions,by logging in [Skylight SS1_AcuteBedroom3_logging in]Robert continues to access his essential conditions, medication and recovery information, update his status, and manage his appointments using an online calendar. (Robert is interacting with a series of questions on the tablet about his condition. After answering the questions, Robert sees the calendar pop up.[Skylight SS2_AcuteBedroom3_calendar]Providing access to the same educational information[Skylight_AcuteBedroom3_information]that Robert received in the hospital after his discharge allows Robert to more readily absorb and understand his continued care requirements.Based on clinical data and feedback, a series of alerts via text, phone, and even the home TV prompt patients like Robert to take actions to prevent readmissions.(Robert indicates to Sally they need to call his physician.)
JOHNS HOPKINS- Use Case #1 Resp (EQ)
(Robert sits on the side of the bed, places CPAP mask on nose and lays down pretending to sleep)If untreated[SS#1]Robert’s obstructive sleep apnea can lead to dangerous nighttime[SS#2] oxygen desaturations, elevated sympathetic activity, metabolic disturbances, and even an increased risk of cardiacevents. (Robert rolls over dislodging the nasal mask while remaining asleep){Continuous positive airway pressure, or CPAP, is the gold-standard treatment for obstructive sleep apnea[SS#3], although adherence to this therapy is often poor. Doctors, healthcare providers and equipment suppliers need to track adherence in order to motivate and educate patients while reducing the costs associated with ineffective treatment.(Robert sits up, removes mask, placing it on bedside table, stretches arms and yawns as if had a bad nights sleep –then reaches to pick up smartphone)[SS#4]Currently used systems are restricted to proprietary devices and software platforms rather than universally applicable to any device. This CPAP Adherence Monitor[SS#5]delivers accurate, high quality data and fits universally to all CPAP devices. (Robert nods and acknowledges the information displayed on the smartphone)Thismonitor provides [SS#6] seamless integration into the Robert’s care plan and includes patient motivation and engagement programs[SS#7]. Robert is pleased to be able to immediately [SS#8] share his data and receive helpful feedback and timely advice.
ASCOM- Use Case #2
The emergency call system in this bedroom enables residents to move about their home, (Robert points to pendant around neck)utilizing a wireless pendant or Wall mounted room station (Robert points to sconce on wall)enabling them the ability to call for help. If living in a senior apartment facility, a sconce will illuminate when resident places a call for help giving visual indication.(Robert turns off light)
HID GLOBAL- Use Case #1
Clinicians are providing an ever-increasing amount of care to patients in their homes. With this shift, additional challenges arise. (Sally approaches light switch with her phone). Home healthcare agencies, insurance companies and family members need confidence that care is actually taking place and for the prescribed amount of time. Sally uses a secure Electronic Visit Verification and digital documentation solutionthat requires minimal(Slide 1: Elements in home & caregiver tools) infrastructure and easy to use caregiver tools to perform her assignments, Sally simply taps[Slide 2: Image of ID Card & Mobile phone]her NFC enabled badge (Sally taps her badge to her mobilephone) to her smartphone to sign into the documentation anddocument[slide 3: Document a visit image Landing Page]her visit using theweb application. She documents her visit to Robert’s home by choosing NFC[Slide 4: Select NFC Image].Now Sally will tap [Slide 5: Tap the NFC image, UI]her NFC enabled phone to a secure trusted tag inside the patient’s room (Sally holds smartphone close to tag on light switch on wall). She now selects the client receiving[Slide 6: Show image choose patient and confirmation image]the care and the activitybeing performed (Sally uses phone)and she confirms the care was given. This allows in real-time a detailed secure audit trail of the care being provided[Slide 7: Detailed history of visit]
CAREVIA- Use Case #1
Robert also has a history of CHF, (Robert picks up tablet and steps on scale and checks pulse ox) his care plan post release is remote monitoring of weight, blood pressure and pulse ox.[SS #1 shows Robert's vitals] Robert’s weight has increased 2 pounds. The alert is sent to Sally, his Caregiver, his adult son who lives out of state, and to his primary care physician. Robert's son is concerned when the alert reaches his mobile device and he checks in through video conference (Robert holds tablet up for video call) with Robert and Primary Care Physician. [SS#2 shows 3-way video chat with Robert's son and Doctor]. The Doctor tells Robert and his son that he has already spoken with Sally, the Caregiver, and she will be picking up a revised prescription . Robert and the entire family[SS#3 - Robert and son single video chat]feel less stressed because he’s connected virtually in real time with his care team, physician, pharmacist, and especially each other.