One of the best ways to reduce the cost of care while improving its quality, particularly for older Americans, is to support people getting medical care while remaining in their own homes. Visiting nurses, therapists, and home health aides make it possible.
One way of making home healthcare more effective is to make it more collaborative, with better coordination among all the members of the care team to spot patterns (such as mental health issues or clients failing to take their medications) that might indicate a more dramatic intervention is required. Visiting nurses often need to coordinate their activities with housekeepers, social service workers, physical therapists, home health aides, and their supervisors. Yet because they spend most of the workday outside the office, they rarely have opportunities to meet with other members of the care team.
A 2002 study of home healthcare published by the American Medical Informatics Association found that communication and collaboration breakdowns are common. “The difficulties inherent in information sharing and collaboration often force clinicians to make decisions and carry out treatments without access to the full range of relevant information that is available about their patients, write the authors, David Pinelle and Carl Gutwin, from the University of Saskatchewan.
In the fictionalized stories below, we have used some of the problems outlined in that paper to suggest ways that RingCentral Glip can help. As part of RingCentral Office, Glip can now be configured as a “HIPAA conduit” for secure communications, including communications about private patient health information as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and related regulations.
The RingCentral and Glip mobile apps allow home health workers to communicate with coworkers and members of the extended care team throughout the day. With Glip, they can send secure text messages either to individuals or teams. Meanwhile, RingCentral calling means they can make and take calls from a smartphone using a business phone number, rather than a personal mobile phone number. They can also start a conversation via text messaging and switch to a call or a conference call with one click.
Below, we suggest ways Glip could be part of the solution to problems mentioned in the AIMA paper.
Problem: Visiting nurses often stop in the office early and leave early or bypass the office entirely and go straight to their first appointment. As a result, they have few opportunities to interact in person with physical therapists, occupational therapists, and social workers who will see the same patient.
Solution: Cathy is a visiting nurse who has long been frustrated about poor coordination with other members of the care team, which makes her motivated to give Glip a try. She starts a Glip team conversation for each client, inviting all the other members of the care team who interact with that individual.
This allows them to share information even when they are not able to get together in person or connect on a conference call. This allows them to share observations from their last visit and plans for their next. By comparing notes, they are able to spot emerging problems more quickly. If a client was acting forgetful on one visit, other care team members can help confirm that they noticed the same thing or, on the other hand, suggest that it may have been an isolated incident.
Although Cathy took the initiative to improve her collaboration with other care team members, one of the benefits turns out to be that they also work better with each other. For example, in the past there were times when the occupational therapist would perform exercises with a patient in the morning, leaving the individual too tired to participate in exercises the physical therapist planned to lead during an afternoon visit. With better coordination of both schedules and plans among the caregivers, everyone is able to make their visit to the home more productive.
Meanwhile, nursing supervisor Viola begins giving nurses and home health aides their assignments through Glip, posting them as tasks in conversations with the individuals. From the Glip Dashboard, she can see an overview of how many tasks have been checked off as the day goes on. When things do not go as planned, the workers in the field can also report back through Glip text chat or use Glip click-to-call to quickly get Viola or another member of the care team on the phone.
Team Communication and Coordination
Problem: In addition to working different schedules, some care team members are much easier to reach by one communication method than another: mobile phone, pager, or a note left on their desk. Because disseminating information to all team members is difficult, information deemed useful but not urgent often falls through the cracks.
Solution: RingCentral Glip is optimized for team messaging and other aspects of running a remote-friendly healthcare practice or service—most messages are posted into a team conversation that is accessible to all members. Home health agency employees who work at a desk can communicate with people in the field using the same work chat method. Team conversations can occur in real-time, but the chat messages are also stored for later review. In other words, Glip works well for a wide variety of communication styles and work functions.
Visiting nurse Cathy is pleasantly surprised by how often she will get an immediate response to a question she posts to a care team conversation, and she in turn tries to respond promptly whenever possible. The time savings add up, speeding the delivery of care and allowing her to fit more visits into her day.
On the other hand, there are many times in the day when she cannot be interrupted, for example, while re-dressing a wound. She might hear the chime of a Glip message arriving while in the middle of a procedure like that — and at least it would be less of an interruption than a phone call — but reading and answering it will have to wait. Typically, after leaving home but before leaving for her next appointment, she takes a few moments in the car to review any messages that have come in. If she is pressed for time, she may only read a conversation if she sees she has been specifically mentioned in it.
Some of the chat messages she gets require no response, while others might be questions that another team member has answered in the meantime. If Cathy needs to respond, she can do so either with a Glip chat message or by placing a call from within Glip.
Going Beyond the Medical Record
Problem: Although recording updates to a patient health record is one way for care team members to collaborate, they often hesitate to record information they do not believe should be part of the official medical record — and sometimes the information does not get shared at all.
Solution: Like a phone call, a Glip chat message is treated as a transitory communication under the law — not a permanent medical record — as long as the proper security and data retention policies are in place.
This allows the care team to carry on conversations about issues related to pets or problems with family members or other aspects of the environment that are important to the patient’s well-being even if they are not medical data per se. Patient health issues are often part of the same conversation, and home health workers need a single way of communicating all the issues they encounter.
For example, Cathy notices that an elderly woman’s home is becoming increasingly cluttered, presenting many tripping hazards. The housekeeper who formerly cleaned the home has been fired (too expensive, the woman says). Cathy reports the issue to a social worker who acts as a liaison with city social services and shares a photo of the cluttered home as evidence of the need. She explains the clutter is particularly a concern because of the patient suffers from Parkinson’s Disease, is already prone to tripping, and broke an ankle within the last year.
In response, the social worker arranges for a subsidized house cleaning service that will fit the patient’s budget.
Engaging Family Members
Problem: The participation of a caregiver who is a family member, rather than a healthcare professional, is often essential to allowing a patient to remain at home. Yet it can be challenging for a spouse or a child to keep track of the comings and goings of all the other care team members and the roles that they play.
Solution: The care team invites the family caregiver into a private Glip conversation about their loved one, treating them as a true member of the care team. As a guest user, the family member only has access to that one team conversation. In addition to getting regular updates from the nurses and other home health workers, the family member can post questions or concerns to the conversation from a computer or a smartphone.
For example, a daughter who does her mother’s shopping and visits everyday spots a pattern of increasing forgetfulness. Though she is rarely in the home at the same time as the visiting healthcare workers and often finds it difficult to get them on the phone, she reports her concerns immediately through the conversation in Glip. Cathy reassures her that the issue is not necessarily alzheimer’s — instead, the culprit could be a urinary tract infection the patient is already being treated for. Because such infections can mimic the effects of dementia, Cathy advises waiting to see if there is an improvement once the antibiotics have run their course.
- The care team holds regular staff meetings via RingCentral conference calling. The agenda is shared in Glip team prior to the meeting and the discussion often continues afterward, either in a company-wide team or more focused conversations. This means visiting nurses and others who work in the field can attend the meetings without necessarily coming to the office — and can get to their assignments for the day more quickly.
- A shared group calendar makes it easier to see who is taking time off and when meetings are scheduled.
- The agency invites general practitioners, internists, gerontologists, and other specialists it deals with regularly into a Glip team as guests. While not all are willing to try collaborating this way, those who do discover it can be an effective way of working more effectively with an extended care team. Some of them begin experimenting with using Glip in their own practices, once they are assured using the service will not violate HIPAA.
Each of these scenarios addresses very real problems. If your home healthcare agency adopts RingCentral Glip, we hope you will share your real life examples of how it helps you in your work.