For about $1,000, the units including an iPad, a stand, and software connect Cornerstone’s patients to doctors, as seen above.


December 06, 2013

Healthcare facilities across the country are struggling to juggle two balls in the air at the same time, keeping patients at home and healthy simultaneously. And providers are increasingly turning to mobile solutions for the answer.

Driving this effort, of course, is the Patient Protection and Affordable Care Act (PPACA), which tightens the screws on hospital readmissions by reducing Medicare reimbursement rates to facilities that have a higher percentage of readmissions within 30 days than the national mean readmission rate. For hospice and palliative care operations with a large at-home census of what is understandably anxious patients and their families, allowing them to stay home is an even bigger challenge.

Like many other providers Central Florida’s Cornerstone Hospice, with 800 at-home patients, has turned to mobile communications to improve patient care. Now Cornerstone is broadening the scope of its mobile communications capabilities on two fronts with Apple iPad Face Time for visual mobile interactions and My Talk, an application designed for those who are unable to speak.

Cardiac patients with life-limiting conditions are especially tempted to call 911 when they perceive a change in their state of health. As part of its Face Time trials, Cornerstone will augment its current Rhythms mobile communications program for cardiac care by adding face-to-face communications with a nurse after hours almost instantaneously, to determine if that 911 call is necessary, according to DJ Hamilton, director of IT at Cornerstone. To assist a nurse in making that determination the Face Time program will be augmented with additional FDA-approved devices that attach to an iPad such as an oxygen saturation reader, a hi-res digital stethoscope, smart blood pressure monitor and a glucose monitoring system.

[See also: Is it time to nail down a clearer mHealth definition?]

Studies like that done by the Department of Emergency Medicine, University of Southern California, have shown that even simple text messaging reduces the anxiety level of patients and lowers the readmission rates. Early indications are encouraging: in 2012 Cornerstone saw a 30 percent reduction in readmissions.

The hospice currently has an IT staff of eight for its 800 patients. If and when the pilot program proves itself, IT director Hamilton does see the need for additional staff including an IT Patient Services person to assist with setup at home and to troubleshoot issues for users.

The program was made possible by a $10,000 grant from J. Milton Hoffa and Nellie E. Hoffa Memorial Foundation as well as support from Sprint, said Brian Sabol, solutions engineer, at Sprint.

Sprint assisted in setting up the communications links which gave Cornerstone the capability to deploy iPads in hospices, rather than the Blackberry system they were currently using.

Cost was $1,000 per unit which included the iPad and an iPad stand for patients that allows them to adjust the height and bend the stand in different directions as needed.

Hamilton also added one more component to the mobile solution by using a program called My Talk for patients whose conditions took away their ability to speak. The program has an author mode that can be used by a speech pathologist or a family member and a user mode for the communicator.

My Talk allows the designer to add his or her own images, cells, sounds and words to customize it to the needs of a patient. The patient uses a board with the pictures displayed and can click on a single image or a series of images to communicate, using text-to-speech with the addition of the Acapela TTS voice program. The mobile version has another add-on tool for a web-based, remote authoring.

For the patients at Cornerstone, Face Time and My Talk have a benefit that perhaps is not quantifiable by a study of mobile healthcare. It gives critically ill patients, their family and friends who are unable to make a personal visit the ability to say good-bye.


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