Although telehealth is often thought of in the context of synchronous video visits, in reality, virtual care encompasses a wide range of opportunities to connect patients with medical care beyond brick-and-mortar facilities.  

One such expansion involves the provision of advanced care outside of in-person settings, sometimes known as "hospital at home."   

Several major healthcare organizations, including Kaiser and Mayo, have put forth efforts in this direction via advocacy and pilot programs. Other health systems, including Intermountain and Ascension, have made similar moves.  

But some experts say that to maximize patient care, hospital-at-home programs should do their best to view patients holistically and to recognize virtual care, not as an add-on to in-person services, but as a distinct modality that requires its own strategic investments.  

"As with anything with healthcare, as we're trying to make changes, it's tempting to try and bolt this onto existing healthcare strategies," Jeff Fuller, vice president of analytics solutions at CipherHealth, said in an interview with Healthcare IT News.   

"But I think when it comes to hospital at home, it's so different and unique that you need to implement it carefully," he said.  

Fuller noted that hospital-at-home care isn't simply a way to increase the number of beds available. 

Rather, he said, "You're providing a more personalized approach that, in some ways, could have new outcomes."  

He pointed out that many patients might prefer being at home to being in a facility. At that point, he said, the question becomes one of scale.   

"Don't have a formula that's based on supply sides – 'Oh, we're full, so we have to do hospital at home,'" he said. "That would be a nightmare."  

Fuller noted that choosing the right patients for at-home care requires involving the individuals and care team in the decision-making process.   

He also stressed the importance of keeping in contact with patients outside a hospital setting, which he says CipherHealth enables via automated outreach programs. 

"The context that you capture in these types of communications is beyond a clinical transaction," he said. "It's getting to the root of patient behavior and attitudes about their health."  

Dr. John Frownfelter, chief medical officer at Jvion, also noted the importance of approaching appropriate candidates for at-home care. One potential issue, he said, is drawing incorrect conclusions about patients based on limited data.   

Housing stability, for example, is a helpful measurement of health for most of the population – but for an elderly single patient isolated at home, housing stability may mask other concerns.  

"If we can understand patients holistically as individuals and a population," he said, "then when we see a patient with vulnerabilities, those can be mitigated."  

Frownfelter pointed to Jvion's use of artificial intelligence as one way to identify the intersecting factors that can pose obstacles to getting care at home. AccentCare is currently using the vendor in its post-acute healthcare services.  

He noted that health literacy, distance to hospital, and access to good internet connectivity and social support are important criteria to consider when evaluating a patient for hospital-at-home suitability. At the same time, falling short in one of those criteria doesn't necessarily have to be a disqualifier.  

"If I don't see the patient holistically, I can cherry-pick patients who [I know] will do well," he said. "A lot of people will end up hospitalized when they could have been at home."

When asked about objections from nurses' unions to Kaiser's advanced care at home strategy, Frownfelter said he couldn't personally foresee a threat to the profession.  

"If there's a better patient experience, fewer hospital-acquired infections and outcomes – it seems like it would be good for healthcare," he said.  

"If we put patients first, then the setting becomes irrelevant," he said. 

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.