Healthcare systems and hospitals are embracing the new concept of Hospital-at-home. This enables patients to receive hospital-level care from the comfort of their homes by installing biometric devices and tablets to communicate with clinicians. This concept was mainly developed for those who do not need intensive care to ease the burden on hospitals, reduce costs, and improve outcomes.
The hospital-at-home concept got an additional boost due to the COVID-19 pandemic. As of November 2021, the federal government approved more than 66 health systems and 144 hospitals to provide hospital services in a home setting. By November 2022, the number of participating health systems and hospitals nearly doubled to 114 and 256, respectively.
Here is a breakdown of the hospital-at-home concept:
- A bedside tablet that acts as a hub, displaying patients’ daily schedules, providing information on their conditions, allowing them to take pictures of their physical symptoms, and communicating via video with nurses and physicians.
- This tablet data, in turn, is fed into a central command center, which the health system uses to coordinate virtual visits and dispatch on-staff clinicians to patients’ homes twice a day to administer treatment such as injections.
- Thus, technology combined with in-person visits has paved the way for the transfer of care from the emergency department or an inpatient bed to home.
Healthcare systems and hospitals implementing this concept should take into consideration the patients’ and their family’s technological literacy. They should rule out any candidates who are not comfortable with the tools outlined above. The large amount of data generated by these systems can also be overwhelming for healthcare practitioners. As such, health system leaders should guide practitioners on which vital signs to focus on and prioritize those. It also requires the health practitioners to be very observant of how the patient is appearing in the video, ask the right questions, and correctly analyze the situation.
Another area of concern is the accuracy of the technology. For example, findings by the University of Michigan indicated that the pulse oximeters used in hospital-at-home settings did not accurately read the oxygen levels among darker-skinned people. Also, connectivity can be an issue in areas with incomplete broadband infrastructure.
Moreover, due to limited outcome data available and insufficient peer-reviewed research, private insurers have been hesitant to reimburse hospital-at-home care. At the same time, quality experts and nursing organizations haven’t yet declared hospital-at-home care a safe substitute for in-person services. To deal with these issues, Wi-Fi-enabled devices are provided, and the at-home kits are designed for the typical “92-year-old with fever” in mind.
Health systems and hospitals should include contract provisions related to legal liability. Provisions about proposed technology downtime or breaches and related consequences in contracts with vendors should be present also. Moreover, careful vetting of patients to evaluate how clinically stable they are and how safe their homes are for medical care is of crucial significance. Leaders in the medical community are coming together to work with government officials to help write the rules for quality and safety standards for hospital-at-home care.
Medically Home is one such ‘hospital-at-home’ company. It helps identify the right physicians and nurses to participate in the model. Medically Home also installs devices and ensures that the data is sent to the patient’s electronic health records.
In 2021, Mayo Clinic, along with Oakland, a California-based Kaiser Permanente, invested $100 million in the company. Mayo, in turn, expects to save 10% to 15% in costs while implementing the program at scale. However, to break even or at least make it affordable, it requires managing an average of at least 25 to 30 patients daily. Over the past 2 years, Medically Home has served approximately 3,500 hospital-at-home patients with approximately 7,500 days’ worth of at-home services, and more than 90% of the patients have reported being satisfied with the experience.
To conclude, the hospital-at-home concept is the future of patient care. Improvements in this area will significantly push this project forward. Aspects that are being worked on include non-invasive devices and wearables that can capture a large number of patient metrics at the same time, advanced camera technology, and smart Wi-Fi. Any of these would greatly facilitate enabling the treatment of patients across a continuum, not siloed to an institutional setup.
