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Jan 13, 2021

Redefining transitions of care – extending where and when care happens

By Roy Jakobs
Chief Business Leader, Connected Care, Philips

Estimated reading time: 10-12 minutes

One year ago, I was holding a press conference in Las Vegas, Nevada at the Consumer Electronics Show, one of the most influential tech events in the world and, as they describe it, the proving ground for breakthrough technologies. I was there representing the personal health portfolio of Philips which was spotlighting meaningful innovation in the home. Shortly thereafter, the baton was passed to me to take up a new journey: connecting the many transitions of care inside the hospital but also beyond, including acute and chronic patient care management inside the home. 

 

We enter 2021 deep in a global public health crisis which has exacerbated an already strained healthcare environment. The promise of a vaccine does not begin to address our holistic problems: chronic conditions are rising, staff shortages are mounting, and a complex, aging population is growing. To add to this burden, we’ve seen another crisis brewing as hospitals manage COVID-19 surges: emergency department and ongoing care visits have declined due to patient concerns around infection transmission. We know because we have experienced this before. 

 

Ten weeks after COVID-19 was declared a national emergency in 2020, visits to the ED for heart attacks and stroke dropped 23% and 20% respectively [1]. While that may seem like a good thing for an overburdened health system, it means patients in need are avoiding care which could lead to a second crisis that overwhelms systems across the health continuum. We cannot take a “wait and see” approach. Instead, the solution is to proactively meet patients where they are, create meaningful connections between clinician and patient from within their homes, and effectively help guide transitions of care. 

 

Healthcare is at a pivotal moment in connecting care across settings. Effective transitions of care can be highly influential on a patient’s outcomes, and it’s up to us to help ensure these shifts don’t lead to blind spots. More than ever before, health informatics like data integration and artificial intelligence can provide connected patient care management whenever and wherever care happens – helping to keep patients out of the hospital, improving patient outcomes for those discharged, and helping health systems manage their patient load and resources. 

Care transitions in the hospital

 

As the pandemic pushed telehealth in the spotlight with exponential adoption, many people equated telehealth with a video call with a clinician from the comfort of our homes. But the power of robust data integration enables so much more: a new virtually-driven care model that provides clinicians with access to meaningful patient insights and trends when and where they need them. The intelligence that comes with collecting, analyzing and representing data that allows caregivers to act on it with confidence plays a critical role in managing the care of our sickest patients and informing resource allocation decisions within the hospitals. These insights act as a guiding light for determining the most appropriate care setting for a patient and when is the optimal time to activate this transition. By offering a data-driven, holistic view of a patient’s journey, clinicians can effectively decide where a patient will have the most successful outcomes. 

 

By leveraging these insights, health systems are now implementing centralized command center models to improve care transitions. By generating real-time analytics and proactive recommendations, centralized care solutions can help ensure patients are transitioned to the most appropriate care setting. For example, tele-ICUs, led by an intensivist team in a central monitoring facility that acts similarly to an air traffic control center, can extend critical care resources to the bedside, no matter where the hospital is. With time-critical data capture, these intensivists can be responsible for 50-1,500 remote ICU beds at a time, and quickly intervene should the data and trending indicate early signs of deterioration.

 

Particularly during the pandemic, tele-ICU solutions became absolutely essential in response to ICU surges for many of our customers. Hospital leaders quickly discovered that telehealth’s ability to access patients remotely not only applied to being miles away, but also from five feet away. By extending monitoring capabilities beyond the bedside, clinicians could avoid repeatedly entering a COVID-19 patient’s rooms while maintaining line-of-sight into their wellbeing. 

 

AI-enabled monitoring and clinical decision support tools can also help guide care transitions, by turning data into actionable, digestible insights. Whether they’re at the bedside or offsite, clinicians can have a holistic view of a patient’s condition and catch health trends at a glance to identify patients who are ready to be transferred to another care setting, or transition care outside of the hospital, providing end-to-end oversight. Telehealth solutions that empower staff with continuous data capture, advanced data visualization and predictive analytics allow for proactive rather than reactive care and guide timely interventions. 

Achieving smooth hospital to home transitions


Before the pandemic, engaging patients in preventative care at home via telehealth was already helping to reduce hospital readmissions. Now as hospital capacity becomes more strained, the ability to send patients home with hospital-grade services is essential to support safe and timely discharge. Interoperable, cloud-based solutions that inform data-driven decisions can allow clinicians to maintain visibility into patients’ wellbeing and detect issues before they lead to a readmission. By regularly transmitting critical patient data through connected devices and translating it into relevant actionable insights, remote patient management helps keep patients away from the hospital if possible, and can limit both patients’ and clinicians’ exposure risk to the virus. 

 

We’ve seen our customers deploy technology to help manage patients with COVID-19 who may not require critical care but need routine monitoring. For example, patients who are discharged from the hospital, have COVID-19 symptoms or are suspected to have COVID-19, could wear stick-on biosensors patches that enable continuous, effortless monitoring at home. These solutions collect minute-level data across a broad set of vital signs and physiological biometrics for up to 30 days – from skin temperature, resting heart and respiratory rate, activity levels, cough frequency, and so on. This data can then be aggregated and fed directly to clinicians to make informed decisions about next steps for their care, allowing proactive management of a patient’s condition at home to reduce risk of readmission. 

Activating hospital at home


As COVID-19 cases fluctuate, we’re faced with two critical situations for patients in need: those who avoid in-hospital care because of fear of infection and those whose hospitals struggle to care for them due to resource constraints like bed availability. 

 

We’ve seen federal regulations pave the way for acute care delivery, with the U.S. Center of Medicare & Medicaid Services recently announcing unprecedented flexibilities around providing hospital-level care at home via telehealth, as part of their “Acute Hospital Care at Home” program. This move is the result of the growing examples of acute care services being delivered at home with the proper patient monitoring. For those with chronic conditions, this expanded approach to managing acute phases of their conditions will allow patients to be treated at home through the power of hospital-grade wearables and data integration. By activating acute monitoring and management within the home, clinicians can determine if and when it is essential for a patient to transition back into a clinical setting for further care. 

 

Thinking about proactive care to help keep patients with chronic conditions out of the hospital in the first place, remote patient management and predictive algorithms can provide clinicians with a holistic view of a patient to help fill the gaps in patient data between patient visits. In fact, by 2022, 60% of chronic disease pathways will involve remote patient monitoring [2]. 

 

For example, physicians could employ predictive algorithms using CPAP data from telemonitoring to help predict adherence among their sleep apnea patients, allowing them to identify those at-risk of nonadherence earlier and offer support to improve adherence and ultimately outcomes. COVID-19 has also elevated the need for at-home care for those with respiratory diseases. A recent survey found 56% of COPD patients reported COVID-19 has made it difficult for them to get the treatment they need. Giving patients and their caregivers tools to navigate home respiratory care will not only ensure continuity of their care, but also free up hospital beds, conserve PPE, protect vulnerable patients from other viruses, and prevent readmissions. 

 

The visibility these connected technologies enable for providers is invaluable in guiding confident decisions about the most appropriate care setting for each patient and when intervention may be needed.

Extending where and when care happens


Redefining where and how transitions of care take place is a part of redefining the delivery of healthcare overall – all with the goal of enhancing the patient experience, improving health outcomes, lowering the cost of care, and improving the work life of care providers. Healthcare does not need to be defined by the walls in which it takes place. Through effective data integration, AI-enabled clinical decision support tools, and wearables, the physical proximity between the patient and their provider can be de-coupled from the notion of what quality care means. 

 

The innovation awards won by Philips at this year’s CES tell this story of an industry forever changed: an ICU in-a-box for surge capacity, in-hospital remote patient monitoring to reduce staff exposure to infections and ICU readmissions, and the first and only clinically-validated CPAP mask selector which enables 2D remote fittings. The pandemic has shown our resilience, and our growing reliance on telehealth strategies. With the right solutions, care doesn’t have to be defined by a place, but instead by the needs of a patient and his or her condition. Extending the reach of patient care through technology means we empower providers to confidently guide patients across multiple settings and transitions of care, driving better health outcomes and, ultimately, strengthening the healthcare system we urgently need. 

 

Follow @PhilipsLiveFrom during the all-digital CES 2021 for live updates throughout the event. as we showcase new telehealth innovations via an interactive experience.

 

[1] Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions – United States, January - May 2020

 

[2] Gartner market guide for virtual care solutions. Accessed November 9, 2020. https://www.gartner.com/doc/reprints?id=1-24GWT8KN&ct=201027&st=sb

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Roy Jakobs

Roy Jakobs

Chief Business Leader Connected Care

Roy Jakobs is Executive Vice President and Chief Business Leader for the Connected Care businesses of Royal Philips, effective January 28, 2020. He is also a member of the Executive Committee of Royal Philips. Connected Care comprises the Connected Care Informatics, Monitoring & Analytics, Population Health Management, Sleep & Respiratory Care and Therapeutic Care businesses. Prior to this, Roy led Philips’ Personal Health businesses.

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