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Melanie Cole: (Host): Welcome to the show. Our topic today is the advancements in technology that have affected short-term rehabilitation and skilled healthcare. My guest is Rick Hoffman. He's the Chief Information Officer at The Alden Network. Rick, welcome to the show. So how is technology breaking onto the scene in short-term rehab and skilled healthcare?

Rick Hoffman (Guest): Well first of all, good morning and thank you. Technology has really become the forefront of all different healthcares in hospitals, post-acute settings, long-term care, and it really has become a data driven industry. Faster information, faster care, faster patient information being entered into things like electronic medical records. Anybody who goes to a hospital now or a skilled facility, you enter the information in one place and it transmits electronically to those other facilities or different types of post-acute or long-term care settings. So it's really data. It's data that makes good decisions on patient care, it's giving the doctors the availability of having the orders electronically transmitted to a tablet so when they walk into the facility, all of the patients are right there, all the orders are right there, all of the needs are right there.

Also things like electronic medical records that span across different ancillary companies. For instance, the pharmacies, the therapy companies, the durable medical equipment companies call all look at the electronic medical record for a patient and get the information they need in a real time environment. And that's really what it is now. It's all real time decision making. We've done things at The Alden Network like eliminated physical fax machines so that paper can't sit around, so when a referral comes in from a hospital, the electronic document is then transmitted to multiple people simultaneously, so very quick responses to the hospital for admissions, for instance. Also things like real time reporting and dashboards that are available to not only the facilities but to the decision makers of the company.

Melanie: Rick, is there a distinction that can be made among some of these types of technologies as to whether they're active or passive? Like somebody has to operate an active technology, or whether it requires training, is there a distinction there?

Rick: Yeah, there is. Most people now that are coming into healthcare have to be more technologically savvy. Long gone are the days of basically a doctor just seeing the patient, writing the notes, and giving it to somebody to transpose. Information is done in real time. So there is some training. In our facilities with our electronic medical record, we have passive things like when you take a vital sign, that vital statistic or that vital information from blood pressure, temperature, all goes into the electronic medical record by itself. Automatic. We don't have to worry about transposing a blood pressure number or a temperature. The information is taken right from the machine and put into the system. So that's passive to the person that's entering the data. There's more active things that are engaged in understanding where the ancillary companies such as the therapy company or the pharmacy will come and get the information they need, which is all entered in one single place. So there's education on the forefront of entering the information, but the transmission of the information is all done electronically and seamless throughout the environment.

Melanie: So how can they also help monitor patient function, detection of emergencies, falls, things that people are actually wearing. Are these considered passive or active? How is that monitored?

Rick: Great question. The more and more we get into understanding the patients in the environment and what they need such as fall prevention, or looking at heart monitors, and things like that, we're getting into more and more of that and the future is really in that telemedicine where you could be wearing a bracelet that would give you all of your statistics, and if there's something that spikes or something happens, all the appropriate people are notified simultaneously from the nurse right outside the room to the doctor that might be across town.

So there are more of these passive type things - bracelets, pendants - that are going to become more and more prevalent in all of the different facilities be it a hospital, be it a short-term facility, or even a long-term care facility. Bed monitors to make sure that when people are getting up and leaving, or getting out of their bed, people are alerted to the fact to make sure that they're there to assist. So those are all the technologies that we're using now to prevent things that could possibly be harmful.

Melanie: So how do you evaluate some of those new technologies to see if they're user friendly or patient centered. When you talk about bracelets and things, who is learning this to help the patient with these things? And how are you evaluating that?

Rick: Another great question. So technology for technology's sake has been a detriment to a lot of companies, not just healthcare, there's problems looking for solutions. And so when we're looking at certain technologies, the first and foremost is the patient care. Is it going to improve patient care? Is it going to be better for the family member to keep alert of what's going on with their loved one?

Second is the education around people in healthcare that have to use it. One of the things- I come from a technology background, and one of the things I learned when I got into healthcare is people got into healthcare to take care of people, not necessarily to become a technological wiz. And with that, you have to make sure that when you're evaluating these technologies, they're not too difficult to deploy, and they're not too difficult to educate, and if it takes more than an afternoon to get somebody up and running on it, it's probably too complicated for a real time deployment.

Melanie: Can they also be used for social interactions through social networks or self-perceived cognitive function? Even for sensor-based systems that can track visitors or sedentary lifestyle? You know, more of sort of a social and psycho-social mode.

Rick: Absolutely. We've deployed technologies now that engage the family member in knowing what their loved one is doing in assisted living or an independent living type environment. And those are things that can show their schedule, they can interact with video, or audio. They can really keep track from wherever they are from an iPhone or from a tablet and they can see exactly what their loved ones are doing. They can communicate with them, they can- through social media, we have all the different platforms covered with social media to alert of things that are going on in the facility or going on in the community, as well as what's going on with their loved one. So it's a real interactive method now that we've deployed to keep the families more engaged with somebody that may be in a long-term setting, or even in a short-term setting. If they're only there for a few weeks, and they want to know when they're in therapy, or what's going on with them, or what they had for lunch, these are all things that we've been able to do to keep the family and the person that's in a facility more engaged.

Melanie: So if it is a short-term rehabilitation situation, then we want to have potential transition period. So how can the technology help with that? And through this transition, what information do you feel these sensors and monitors should be conveying as someone is transferring whether it's to home, or to a longer rehab stay from wherever they were?

Rick: So one of the things that we'll look at is as you transition from the acute setting, which is a hospital setting, to a post-acute setting, which could be short-term or long-term, and then back to your home or to a loved one's house, we want to make sure all that information is transferred seamlessly.

So we make sure that the information we get from the hospital is put into our electronic medical record, and then any home health agency that may be taking the patient's care over from us, all of that information is then transferred. And we try to eliminate any double entry of any data to eliminate any possible problem in entering that data or transposing the data. So we want to make sure that if it's in there one time, it transmits all the way through, and then we can alert the home health agency where if we knew that there was an issue that they may have that they need telemonitoring, we also have that so we'll help set up the telemonitoring on the home health side, and all of those doctor's orders, and all of those things that they had that they experienced in our setting is all transferred electronically through the technology that we've deployed into their home to monitor exactly what needs to be monitored.

Melanie: Do you feel in this age of multi-disciplinary, so many different providers whether it's physicians, nurses, physical therapists, social workers, there are so many people involved in one person's care, that this technology can be helpful to make a more cohesive so that everybody kind of is on the same page?

Rick: Yes, absolutely. And long gone are the days of that one piece of paper that transmits with the patient from the hospital to us or to a post-acute setting, and then at home where you get that thick folder of discharge papers. Really now it's that transition is a seamless- the information is as seamless as the transition itself. So I feel that in the future as we go forward, more and more integration, more and more collaboration will be between the hospital setting, the post-acute setting, and the home health setting so that we see as seamless as a transition of the person, we also see all of the pertinent information that needs to go.

There will always be competitive technologies out there. There will always be different electronic medical record companies, but there are some emerging standards that we're seeing now that will allow for more and more of the collaboration and more and more of the integration of all of these dispersant systems.

Melanie: As far as success and outcomes, do you feel that this is going to improve a patient's success, whether it's in transition period or long-term outcomes as everybody is kind of working together and understands whether their vital signs are being kept track of, or their lifestyle, their exercise sessions? Do you feel this is really going to affect outcomes? Have you seen that happen so far?

Rick: Absolutely. Absolutely we have seen it happen. The seamless integration of all the different technologies and keeping track of the patient's activities, their improvements, or any issues that may come up, it's all done now in real time. Doctors can be alerted via electronic methods where they can see the patient, they can see the records, they can see the orders that the facility is recommending, and they can approve them electronically and remotely. No longer do they have to be called in the middle of the night, get in their car, come to the facility to physically see the patient. They can see the patient via a video feed, or they can look and read exactly what the nurses are entering in real time. We have all the security measures in place so that that transmission is protected and transmitted in a very, very fast and real time setting so that decisions can be made much, much faster than they were able to be just a few years ago.

Melanie: And where do you see it going or what would you like to see happen in the future? Wrap it up for us, in how you see technology breaking onto the scene for skilled care and short-term and long-term rehabilitation. What do you want to see happen, Rick, and what do you think is going to happen?

Rick: So what I would like to see is even more tighter integration. I feel like the hospitals will always have their systems, and the post-acute setting will always have their systems. Right now they're separate and they're integrated via different types of integration points that are basically maintained.

I would like to see a much better seamless integration so that when the patient record needs to be transmitted, there's not an IT person that has to be in there to make sure that that linkage is always sustainable. I think that the software companies are all working together in a much more collaborative way now to understand that it's all about the patient care, and less about the technology, so I feel like that is coming to fruition.

Also what I see is a larger presence in the whole telemed or telemedicine where we can have a little robot that works at the foot of the bed which will have a doctor that's 24/7 that can be there, that can see what's going on, so that we can do a much faster evaluation of an issue before it becomes anything more serious. And then when they transition to home, they can still have that same linkage with that same doctor so that the history follows with the patient.

So telemedicine, collaboration, real time data, and more of it I feel is what we're needing, and it's coming, and I feel like we're almost there, and there's a few more little pieces, but in the next few years I feel like the patient care is going to even get better with more and more of this integration in the technology that's becoming available.

Melanie: And what do you want the listeners to know about how The Alden Network is using this technology? Give us a little summary, Rick.

Rick: So Alden has really adopted the latest and greatest in technology, and because I'm the one that's deploying it, I can say that. But I really do feel like we have taken the data-driven technologies that healthcare is demanding and really put them to good use. Our electronic medical record can be spanned across all of our different ancillary services that are needed for the patient care, decisions are made much faster based on the fact that the orders are given to the doctors electronically. Very, very little paper. We are a very paperless organization allowing for multiple people to see the same document electronically simultaneously so that decisions can be made much faster. So I feel Alden has really grasped the idea that technology and the decisions that are made via the technology really does increase patient care and allowing for decisions to be made much faster.

Melanie: Thank you so much, Rick, for being with us today and sharing your expertise on this fascinating topic. It'll be so interesting to see how this all works out. You're listening to The Alden Network Podcast. For more information on today's topic, or any of our other services, please visit www.TheAldenNetwork.com. Or to hear more podcasts in this series, please visit www.TheAldenNetwork.com/podcast. That's www.TheAldenNetwork.com/podcast. This is Melanie Cole, thanks so much for listening.