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Using data to help home healthcare workers

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For Kaiser Health News


There is little in Ruby’s life that is easy. Nearly blind and unable to walk more than a step or two, the 39-year-old struggles to raise three sons while dealing with a daunting array of health conditions, from diabetes that recently landed her in the hospital to pain from bulging spinal disks.

Without support, odds are she’ll end up back in a hospital. But Ruby, who asked that her last name not be used to protect her family’s privacy, is part of a growing effort to reduce those odds by arming home care aides and other non-medical workers with the power of data.

On a recent Monday, health coach Nhaomie Douyon visited Ruby in the small, rented two-story row house where she lives with her children. Douyon works for the Coordinating Center, a Maryland-based nonprofit that helps organize medical and social needs for clients like Ruby, who live in designated medically underserved areas.

The two chatted in the living room, where a couch and chairs share the space with a bed. White curtains obscure the view outside, where small groups of young people cluster on front steps and some homes have boarded-up windows. Douyon, 28, came equipped with a tablet loaded with a software program that uses predictive analytics to generate patient-specific questions.

The software was developed by Care at Hand, a privately held firm that is among a small but growing number of companies touting products they say can help spot potential medical problems before they require hospitalization. The software was created for use by non-medical workers like Douyon and home-care aides who care for millions of elderly, ill or disabled people.

Skeptics note that there are few studies confirming whether the technology accurately predicts problems, prevents hospitalizations or saves money. Still, the business has attracted the attention of venture capitalists and may lead to more healthcare applications for consumers.

Was Ruby having trouble paying for her medications? Did she feel nauseous? Were her ankles more swollen today? Those were some of the 15 questions the program that Douyon’s agency uses generated for Ruby.
“It’s like bringing a pocket nurse Chris with you,” said Douyon, who is also studying for a master’s degree in public health and has previously worked for groups doing health outreach in Ghana and Haiti. When she typed in Ruby’s answer that her ankles and legs were definitely more swollen, it triggered an alert to the nurse manager back at her office.

Within a few minutes, nurse Chris Parsons called from the Coordinating Center’s headquarters, asked more questions and directed the pair to contact Ruby’s doctor’s office for medicine that might help. Try to elevate your feet, she told Ruby, and go to the emergency room if the swelling gets worse.

“It doesn’t just go through medical questions but asks about resources they might need and helps us pick up on certain red flags or the barriers they face,” she said of the tablet.

Another firm, eCaring, is aimed more squarely at home-care aides and their agencies. The company’s software allows aides to note a patient’s well-being hour by hour, using colorful icons, such as a toothbrush for recording personal-care activities and a happy or sad face for documenting their mental state. It, too, uses the information to predict which patients might be at high risk and send an alert back to a care manager.

“It’s a portrait of what is going on in the home,” said Robert Herzog, CEO and founder of eCaring, a privately held firm that has contracted with home-care agencies in New York to use its software programs. “It transforms the home from a black box into a data-rich environment.”

Other firms, such as Honor in California and Hometeam in New York, offer more consumer-directed services, such as apps that home-care aides use to log their daily observations. The companies have each drawn low, double-digit million dollar funding from well-known venture capitalists, including Marc Andreessen, a cofounder of the Silicon Valley venture-capital firm Andreesen Horowitz, Yelp co-founder and CEO Jeremy Stoppelman, and emerging technology investor Lux Capital. The apps help families hire and schedule home-care aides, and then keep the family informed about how mom is doing with texts, pictures and updates on daily activities.

One big question is who will pay for the technology? Agencies using programs aimed at consumers can build the cost into their home-care services, charging consumers more than agencies that didn’t use the technology. Herzog at eCaring says that his firm pays for the tablets and gets a low-cost data package for internet use — which the tablets require — from Verizon. It then builds those costs into its contracts with hospitals or insurers. The Coordinating Center, which uses Care at Hand in Baltimore and other locations in Maryland, similarly builds those costs into its contracts. It also receives grant money from the state and other agencies for its care coordination efforts.

Thomas Scully, the former top administrator at the Centers for Medicare & Medicaid Services and now a a lawyer who advises clients on healthcare issues and a general partner in a private investment firm, said the idea behind these firms is good. But, he added, their growth potential may be limited because the expense of the tablets and software will make the home-care services more expensive. “All of this is part of the answer, but it has to show economic savings,” said Scully.

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