Health Technologies Driving Hospital-at-Home Programs

September 07, 2023 - Healthcare is moving increasingly outside the walls of hospitals, spurred by the popularity of outpatient and virtual care modalities. During the COVID-19 pandemic, healthcare provider organizations stood up or scaled various care delivery options to extend care access, including hospital-at-home programs.

One of the early adopters of the care model, Baltimore-based Johns Hopkins Medicine, tested it in the 1990s and early 2000s, publishing a study in the Annals of Internal Medicine in 2005. The study showed that the hospital-at-home care model not only met quality standards at similar rates to acute inpatient care but was also associated with a shorter length of stay and lower mean costs.

Though some organizations implemented the model in the following decade or so, adoption received a significant boost in November 2020. To bolster care access amid in-person care restrictions and lockdowns, the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home initiative.

The initiative allows hospitals to apply for a waiver that suspends numerous Medicare Hospital Conditions of Participation, enabling hospitals to provide acute-level care in patient homes. As of August 24, 296 hospitals in 37 states had been approved for the waiver.

Though the initiative has only been extended through December 31, 2024, the popularity of hospital-at-home services indicates that the model will likely be around for far longer. Survey results published in May show that 74 percent of US healthcare leaders are prioritizing solutions to support moving care delivery from the hospital to the home.

Here, mHealthIntelligence will take a deep dive into the key technologies supporting the hospital-at-home model.

REMOTE PATIENT MONITORING DEVICES

Remote patient monitoring (RPM) underpins most hospital-at-home programs. Under these programs, patients receive care outside the hospital, meaning clinical decision-making relies on access to real-time patient data. RPM tools can record and transmit continuous or intermittent patient data to care teams, according to a 2023 article in npj Digital Medicine.

Hospital-at-home programs employ a wide array of RPM tools. These can include wearable devices such as blood pressure cuffs, pulse oximeters, and biosensors. They typically collect vital signs, which are measurements of the body's most basic functions. For example, pulse oximeters measure the saturation of oxygen carried in red blood cells, while blood pressure cuffs measure blood pressure — which isn't technically a vital sign but is often measured along with them.

Biosensors are devices that measure "biological or chemical reactions by generating signals proportional to the concentration of an analyte in the reaction," an article published in Essays in Biochemistry states. Within the RPM arena, these tools can be used to measure heart rate, temperature, respiratory rate, and activity levels. Most of these devices are Bluetooth-enabled, transmitting data directly to clinicians in healthcare settings.

There are also ambient RPM tools that support hospital-at-home services. According to the 2023 article in npj Digital Medicine noted above, these technologies include cameras, thermal sensors that capture infrared waves, and radio sensors, which use radio frequencies to track gait, sleep patterns, and progression of movement disorders.

These technologies can guide clinical decision-making within the hospital-at-home model by enabling clinicians to intervene in real time if complications arise.

For instance, the article notes that wearable RPM tools can help clinicians detect complications like postoperative tachycardia or a fever among home hospital patients receiving post-operative care following a sleeve gastrectomy. Further, ambient sensors can provide care teams with information on postoperative mobility and patients' ability to perform basic functions.

The use of RPM technologies in hospital-at-home programs offers numerous benefits. An article published earlier this year in the Journal of Medical Internet Research states that collection of vital sign data via RPM could help expand patient eligibility for home hospital programs as it creates a "digital health safety net."

In addition, the article states that RPM improves patient safety during a hospital-at-home episode of care as it can help care teams develop enhanced mitigation strategies.

TELEHEALTH TECHNOLOGY

Telehealth is a critical component of at-home hospitals, providing a direct connection between clinicians and patients.

Telehealth technologies connect patients and clinicians in various ways, including synchronous and asynchronous methods. Synchronous telehealth modalities include videoconferencing, audio-only conversations, and real-time messaging between patient and clinician. Asynchronous telehealth modalities connect patients and clinicians but not in real time. These include platforms that allow patients to send messages, videos, and pictures to their clinician, which the clinician then views and responds to at a later time.

Most at-home hospital programs employ a hybrid telehealth and in-person care model. The telehealth aspect of this model allows clinicians to observe patients remotely and engage with them regarding the treatment plan and potential changes.

For instance, the University of Chicago Medicine's hospital-at-home program includes a daily telehealth visit with a physician, twice-a-day in-person visits by a nurse at the patient's home, specialty consultations when needed, and a daily call from a nurse navigator. The nurse navigator ensures treatment is going well and provides ongoing support for 30 days after discharge.

Similarly, the University of Utah Health Huntsman Cancer Institute deployed a hospital-at-home model that leverages telehealth to manage symptoms of cancer treatment, such as nausea or dehydration, and other complications that may arise as a result of the cancer itself. A registered nurse conducts virtual visits with patients in their homes and facilitates visits with other providers if necessary.

A study of the program shows that participants had 45 percent fewer emergency department visits than their counterparts outside the program. Those in the program were also 55 percent less likely to be admitted for an unplanned hospitalization.

ANALYTICS SOLUTIONS

Hospital-at-home programs require data analytics to be successful. The large amounts of structured and unstructured data generated from the RPM tools and telehealth solutions must be analyzed to allow clinicians to track patients' progress and make clinical decisions.

A common type of data analytics used in hospital-at-home programs is clinical risk prediction, according to the 2023 npj Digital Medicine article. Clinical risk prediction involves an analysis of retrospective observational data and the use of statistical methods to predict a patient's likelihood of a certain clinical outcome.

The article states that these models can add value to hospital-at-home programs in two ways: predict complications to help care teams preempt clinical deterioration and intervene and identify patients who may benefit from hospital-at-home services compared to inpatient care.

In particular, machine learning can help boost hospital-at-home operations. Machine learning, a subset of artificial intelligence, refers to models and tools that can make accurate predictions about future outcomes through pattern recognition, rule-based logic, and reinforcement techniques.

Hospital-at-home programs can leverage machine learning to "learn" patients' baseline biometrics, adjust for various activities, identify deviations from the baseline, and alert care teams when patients are at risk of an adverse event.

Vendors supplying hospital-at-home care technologies often offer some analytics capabilities. For example, Medically Home, a company that collaborates with healthcare provider organizations to operate hospital-at-home models, utilizes a platform that provides automated insights into care quality, utilization, cost, and other metrics. Another vendor, Current Health, provides a clinical dashboard that combines data from multiple sources, analyzes the information, and offers clinicians insights and alerts about patients requiring attention.

While using these technologies, however, healthcare provider organizations must be wary of potential challenges. Researchers have noted several risks, including alarm fatigue and accuracy issues resulting in too many false positives or false negatives.

INVENTORY MANAGEMENT PLATFORMS

Efficient inventory management is critical for hospital-at-home program operations. As described above, hospital-at-home programs utilize various types of technology, making inventory management complex.

According to a whitepaper by healthcare consultancy Chartis, hospital-at-home programs need to transport the technology and equipment necessary for treatment to patient homes, set up and test the devices and tools, replenish any equipment that can no longer be used, deploy diagnostic testing resources and coordinate reverse logistics for specimens, troubleshoot technical issues with patients, and collect the technology and equipment and prepare it for re-use.  

To ensure these protocols run smoothly, healthcare provider organizations often partner with supply chain companies or work with home hospital vendors already offering these services. Vendors like Health Recovery Solutions — the top 'Best in KLAS' vendor for RPM in 2023 — aim to simplify inventory management by building and shipping RPM kits to patients and managing kit returns and sanitization.

Last year, Cardinal Health announced the launch of Velocare, a hospital-at-home supply chain network. Launched as a pilot with Medically Home, the network manages orders for common items, such as RPM technology and medical waste containers, from routing and delivering the order to collection.

As healthcare provider organizations grow their at-home hospitals, their supply chain and inventory management processes must also grow and evolve, Chartis stated.

"Committed and well-coordinated health systems can meet the supply chain and logistics challenges by clearly defining clinical and operational requirements through an early, collaborative, and iterative process," the report authors wrote.