Home healthcare offers benefits to patients and healthcare providers, but it also introduces new challenges for maintaining medical devices.
By Steven Martinez
In April, the U.S. FDA launched its Health Care at Home initiative to support the growing shift toward home healthcare. Accelerated by the pandemic, healthcare—along with sectors like food delivery, remote work, and shopping— has adopted a more decentralized model to meet Americans’ needs. This shift is driven by factors such as an aging population, a rise in chronic disease, and hospital staffing challenges. Clinically, the rise in home healthcare also reflects a recognition that hospitals are not always the ideal setting for recovery.
“It just provides a better environment for them to heal and overcome the illnesses that they may have,” says Mike Busdicker, CHTM, FACHE, system director of clinical engineering for Intermountain Health in Salt Lake City. “We’re even seeing patients in intensive care who are moving into the home setting because there’s a comfort factor, and it helps them from a medical and mental standpoint.”
But transferring adequate treatment and monitoring of chronic conditions or recovery from surgical procedures to a home environment still requires proper medical equipment and clinical expertise. To offer home healthcare, hospital systems must expand their capabilities and assess what is possible and what is still lacking within the growing space.
“This transition to home health, the model is still being developed,” says Diane Wurzburger, executive of regulatory affairs and quality, as well as developed markets and strategic policy at GE Healthcare. “So, I think all stakeholders are trying to work together, understand how to do this, and find the best way forward.”
Inside Home-Based Care
Home healthcare covers a wide range of treatments, from something as simple as remotely monitoring a patient’s progress through video chats to as complex as ventilation support. At Intermountain Health, Busdicker says they started with oxygen concentrators, smaller equipment, and patients receiving minor treatments at home before expanding services. These days, they install dialysis units in patients’ homes and even move ICU patients home with remote monitoring.
“We’ve got patients that are doing chemotherapy treatments in their home,” says Busdicker. “We’re starting to see hip replacements and knee replacements become an outpatient surgery. So, they go into an outpatient setting, they have a knee replacement, and then they go home that night, and their physical therapy is being done in the home.”
Cherie Pardue, CHCIO, associate vice president/associate chief information officer of clinical technology at Children’s Hospital Philadelphia, explains that home healthcare now includes seriously ill and complex patients who require long-term care, with some needing ventilators for many years. For health systems, home healthcare can help reduce patient care costs, benefiting the facility, insurers, and patient. After all, hospital treatment costs can encompass room and board, equipment and supplies, as well as physician and staff expenses.
“A hospital stay is much more expensive than caring for a patient at home,” says Pardue. “You can save quite a bit of money on both the patient costs and the payer costs if you’re able to move a patient appropriately into the home setting versus having them stay overnight in the hospital facility.”
Shifting patients to a home healthcare setting also allows health systems to free up bed space and reduce the workload on staff. The challenge lies in ensuring that health systems offering home healthcare are making this decision based on clinical benefits for the patient.
Pardue explains that her facility follows a protocol to determine if a patient is suitable for a home environment. They assess therapeutic goals to decide if the patient is ready to transition off-site and evaluate whether the patient’s home can support the required equipment and care. “It’s a lot more clinically oriented than it is about saving money,” says Pardue. “To move from an acute-care environment into the home setting, there is a slew of clinical and home assessment readiness items that have to be done to even be considered.”
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Who Maintains the Equipment?
As medical equipment moves into the home, a key question arises: Who will manage and maintain it? Should existing teams take on responsibilities, with efforts to hire more staff as needed, or should a new department be established specifically to focus on home healthcare?
Busdicker says Intermountain Health has taken a proactive approach. “We have a pretty significant and substantial home health department and operation here in our organization,” he says. “We have a significant amount of equipment in the inventory and a team that’s dedicated to home health.”
Managing medical equipment in a centralized setting, where biomeds can address issues and perform regular maintenance with supplies on hand, is different from a home healthcare environment. In the latter environment, staff are not onsite, and monitoring equipment and performing necessary maintenance require a mobile workforce.
“There’s a different skill set,” says Busdicker. “We’re not in an acute-care setting where we can grab the equipment and take it back down to the shop and work on it, or where we can go in at 4 a.m. and do the PMs.”
Technicians will also work in a new setting that requires soft skills, as they will interact with patients and their families instead of office staff. Busdicker notes they may face questions about the equipment and its functions. Biomeds will need to adapt to each situation, understanding not only service and maintenance but also equipment operation and requirements like disinfection.
Then there are safety concerns. “What happens if [a biomed] gets to a patient’s house, walks in the front gate, and there’s a German Shepherd standing there?” Busdicker posits.
Even if a healthcare system can train its biomeds for this new environment, manpower remains a concern, especially in an industry facing an employee shortage. For a health system unprepared for home healthcare services, this shift could further strain the HTM workforce.
“We’re going to need, in the future, a lot more people going into the biomedical industry than what is currently happening,” says Pardue. “Where do we need to be augmenting or thinking about new ways to bring people into the industry with different skill sets so that we can provide these services?”
Medical Equipment in an Unfamiliar Setting
Currently, vendors are not designing equipment specifically for home use. As home healthcare is still in its early stages, industry stakeholders are learning what works and what doesn’t in this new setting. Monitoring methods developed for inpatient care may not be optimal for home environments.
“There’s still a lot of problems with equipment and the standardization of equipment,” says Pardue. “There are so many variables in the transition of technology information from the home to the endpoint where clinicians are taking care of patients. That technology is still in its infancy.”
Cybersecurity is another major concern, as data breaches are more likely with a patient’s less secure home Wi-Fi. Patient data could be exposed, and an infected device might pose a risk to the entire health system if returned, according to GE Healthcare’s Diane Wurzburger.
“One scenario to think about is the possibility of a medical device becoming infected with malware while it’s on a patient’s home network, and then, if it’s reconnected to the hospital network right, potentially infecting the facilities network more broadly and causing disruptions or compromising data security,” Wurzburger says. “It’s going to be important for HTM teams to understand how to best quarantine devices when they reconnect to the hospital network, making sure they’re isolating those devices and running the right security scans to detect any malware or any kind of potential risk there before creating full network access.”
To address this issue, some groups are exploring partnerships with local telecom providers to enhance the reliability and security of home connections. One proposed solution is a dedicated secure device that continuously collects data, allowing it to store information during internet outages and transmit it once the connection is restored.
Still, Cherie Pardue cautions against a one-size-fits-all approach. “That’s the problem with where we are today and everyone wanting to do home care, especially when the acuity of the patients and the complexity of the devices increases,” she says. “These things are still very early, in their infancy. People have to be very thoughtful about the cohorts of patients they’re looking at monitoring using current technology solutions.”
Despite these challenges, home healthcare is expected to continue growing. Managing complex medical equipment outside a clinical setting will require solutions, but the advantages of allowing patients to stay at home with their loved ones are hard to overlook.
To Mike Busdicker, it’s easy to see why home healthcare is compelling. “My dad is in the hospital right now, and my family goes up in the morning to see him and leaves in the evening,” he says. “If he could get his treatment at home, they’d be there all the time, 24 hours a day, and he wouldn’t feel alone at night with nobody there.”
Steven Martinez is associate editor of 24×7 Magazine. Questions and comments can be directed to [email protected]
