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“After we knew we had dedicated staffi ng, the techni- cal infrastructure and a group committed to the project, we entered the planning phase,” Marcus says. “From there, we had to reengineer our workfl ow.”

Julie Cheitlin Cherry, R.N, MSN, is director of clinical development, Intel-GE Care Innovations. For more on Intel-GE Care Innovations solutions:

Rather than training all Humana Cares nurses to use the Guide with a fraction of their patients, Humana restructured the telehealth

program to include “Guide-only” nurses who only managed patients that had the Guide in their home. Workfl ow, target patient population and technology all came together to pro- duce the desired results.

“The nurses who managed patients that had the Guide in their homes completely changed how they worked. Instead of calling these patients at a pre-determined interval to check in with them as they would in their traditional work process, these nurses were able to prioritize their efforts and deliver personalized care based on the daily needs of their patients,” says Marcus.

The Guide can transmit patient biometrics on a daily basis and allows nurses to identify any abnormalities, such as a patient gaining three pounds in a day. At the fi rst sign of trouble, the nurse can intervene in a variety of ways, includ- ing videoconferencing with the patient to discuss why the change may have occurred and obtaining visual cues that would indicate the seriousness of the situation. Moments like these encourage what Humana Cares calls “just-in-time”

opportunities, which are extremely effective in producing long-term behavior change. “Achieving our goals will require more informed clinical care and changing patient behavior, and these ‘just-in- time’ opportunities are instrumental to our success,” says Marcus. “We increase our chances of catching a problem before it becomes a true emergency. Our nurses also found these moments are especially powerful in changing behavior because the nurses can talk with the patients at a time when they are motivated and engaged about what exacerbated the CHF symptoms, and then determine solutions that fit their lives, to avoid the problem hap- pening again.”

Humana has seen signifi cant results among CHF patients. While it’s too early to quantitatively measure these results, Humana Cares is optimistic about the program’s effective- ness. Humana has deployed 1,000 Guides, and the nurses report the device is valuable and truly having an impact on patient care. The program has high patient adherence rates – 80 percent by members who opted to have daily biometric measurements taken. Humana also reports high patient- satisfaction rates, including 94 percent of members saying the Guide was easy to use, 90 percent reporting they felt more connected to their nurse and 93 percent saying they would recommend it to their friends.

Shifting the mindset to focus on the people implementing and using the technology, rather than the technology itself, will make all the difference in developing a successful program that incorporates a sustainable, new model of care. HMT

How does workfl ow management impact the bottom line and the quality of patient care?

Jean Broberg R.N., M.N., special projects, client operations, CliniComp, Intl.

The need to focus on continuous quality improvement at the bedside while decreasing the cost of care is at the core of many healthcare policy initiatives. This will require more than just transitioning to a digital environment – workfl ow must also be optimized to fully transform healthcare delivery, which entails determining what data and capabilities are needed to support clinical decision making and seamless communication within a patient-centered model. For example, streamlined workfl ow is enhanced when the clinician is able to capture the information easily with accuracy and appropriate alerts supporting best practices. It is essential that the system is available without down time to avoid any interruption to the

delivery of care or preventing access to the information to support decision making. To fully realize the potential productivity and bottom- line gains that the transition from a paper-based environment can generate, individual departments must evaluate and, when appropriate, modify their workflows. EHRs should accommodate unique departmental workfl ow patterns from areas with the highest acuity, such as critical care and the emergency department, to those with great variability, such as perinatal units. To further maximize efficiencies, clinicians should have immediate enterprise-wide access to longitudinal patient records to facilitate and improve care coordination while eliminating duplicate tests and procedures. The results will be worth the effort: enhanced clinical, operational and fi nancial outcomes.


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