Part 1 interview/Podcast with Robert Herzog, Founder & CEO of eCaring, a web-based home health care monitoring and management system that delivers real-time information from the home to care managers, providers, and family members.
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HIT Consultant: So if you can tell us about eCaring and how it works.
Herzog: Sure, eCaring, it really grew out of…starting with my personal experiences, taking care of my mother and seeing that you would, at the time, when you go through that very difficult, transitional moment when someone you love needs homecare. And what I discovered was that you can get strangers come into your home, very well meaning strangers, homecare aids and you kind of hand the keys to your mom’s house over to them, the door closes and then that home then becomes a black box. You really don’t know what’s going on. And not knowing what’s going on can be harmful and can be hurt in terms of the overall care quality for a homecare recipient in terms of tracking trends as they emerge.
Are they sleeping or eating differently? Are they not taking their medications? Are they more in pain? Are they depressed or anxious more frequently? Or for that matter, are they happier? Are they watching TV, more or less? Exercising? Visiting friends? And you have no way of knowing this information under current systems. So I went through that with my mother and she ended up going through all the catastrophes that happen to elderly people in those circumstances and passed away. And I thought, “Gee that was kind of weird. Went through all this, learned a lot of lessons, we’ll never use them again”. And then I saw other people going through the same things.
Then I realized that there was a real need here and that people deserved more than what they were getting. And I have a very strong background in digital media, not in healthcare IT so much, but certainly in a lot of other spaces, with regard of how you use transformational tools, including the web and the internet and electronic media in order to enter and convey information. So, I worked with artists and with technology people and with social workers and people who provided homecare aides, and who used them and patients and we really pulled together a system which is a web-based, home healthcare managing and monitoring system so that for the first time, you can get comprehensive, real-time, extensive data about the care conditions, status and activities of the homecare recipient…and in real time and in a way that is useful and a digital format so that you can track all the kinds of things that are critical for what’s going on in their life and that’s what’s eCaring does.
HIT Consultant: What are the current data sources for tracking the care of high-risk populations including geriatric patients, those with chronic conditions and post discharge patients?
Herzog: Well, the post discharge situation is really strange. Hospitals are faced with penalties now, or will be faced for Medicare for excessive re-admission rates as well as lack of patient satisfaction for patients who are discharged, as they come back in within thirty days, and if it’s greater than certain levels then Medicare is going to penalize them. But, there’s no data that comes from the home. All the risk stratification that hospitals do to attempt to determine who is the greatest risk for an early re-admission, whether it’s going to cost them money, penalty but also the cost of care…who is the greatest risk for that? All of that information is basically pre-discharge. It’s from the hospital experience itself, it’s from the patient medical history up to that point. They try to do some in-hospital teaching for post discharge to say, “Hey, you know, if your blood pressure spikes or your blood glucose spikes, give us a call” but people don’t remember in a hospital situation a lot, it’s a very stressful situation.
So, when a patient leaves the home, all the risk stratification data stops and at that point, the next thing that happens from the hospital perspective is that they learn that the patient is coming back in, but they have no way of tracking particularly, you know, “Gee, did they get their medications? Are they taking their medications? Has one of their clinical vital signs, such as say glucose for a diabetic, has it spiked? Have they been experiencing other kinds of difficulties? Have there been significant changes, patterns or trends in their behavior?” There’s no way of assessing that.
So, I think the real point is…everybody is moving towards a model…people talk about a model of comprehensive care management where you have, trying to get a fuller picture of a patient, not just when they’re in the hospital and they’re outside the hospital, but how can you have comprehensive care management if you don’t have data that’s coming out of the home? You can get an electronic record that talks about what happened inside of the hospital, some doctor’s offices can contribute electronic data, but there is no good data source, certainly not in electronic form, digital form that tells you everything that’s going on inside of the patient’s home. So, right now the dominant forms of tracking, if it’s a patient that’s receiving homecare, then an agency will use a paper form which is used primarily to just check off things that are done for reimbursement purposes, they’re not, at best, reviewed every two weeks.
There are telephone dial-in systems where aides can phone in and say, ”I’m here” for billing purposes and have a limited amount of information they can enter in at the end of a shift, maybe you’ll know whether or not a patient was supposed to have done the things they were supposed to have done with the aide, whether it’s bathing or eating or those kinds of things. And again, they’re not very useful, because they’re not accessible to family members and friends and all the care providers and care givers for that patient. So, those are the dominant forms of communication right now. There’s nothing that generates a digital, real-time comprehensive record out of the home.
HIT Consultant: What are the limitations to gathering relevant care and clinical data in the current healthcare system?
Herzog: Well, as I’ve said, I mean, how do you have comprehensive care management if you don’t get that out of the home? What it means is that you’re guessing. With regards, say, to the likelihood, that somebody’s going to be a re-admit a patient. Any hospital population, for example, on discharge, there are people they call frequent fliers; they’re heavy users of the system. And that’s true among any sort of care or patient population. And so, you’d like to be able to figure out how do we keep those frequent fliers a little more grounded so that they use less of the services and how do you keep people from escalating to become frequent fliers. And the way you keep people from escalating or using less services is being able to establish in their…in the environment that they’re living, what’s normal for them, then be able to spot trends and changes in conditions as they occur so you can anticipate and intercept early, or you can spot events in real-time that require immediate response, such as a fall, or glucose spiking or refusing medications several times in a row. The current systems don’t enable you to do that.
There’s no easy way to determine what’s normal over time. There’s no easy way to spot trends or changes. And there are no good alert systems to tell you, “hey, pay attention now!” because if you do that, then maybe you can keep, have something which was a mini stroke, a TIA episode or just a little fall, you can keep that from becoming a serious event that requires use of an ambulance, an ER visit, a hospital visit and movement from the home to an institutional care setting. So, the IT infrastructure right now doesn’t accommodate getting a complete information picture, getting all the data that you need in order to make really good decisions about care management for a patient.
HIT Consultant: Now what are the gaps in care coordination and care management that eCaring fills?
Herzog: We’re the unique ability to generate comprehensive data from the home. Just that simple. Right now, as I said, you can get information from other sources, you can get it anecdotally from family and friends who are visiting; there is an HR record that is produced in the hospital, but there is no way of getting information from the home. So, there’s no way of making a determination as to what the level of services the person is receiving. By the way, it’s not just for homecare recipients; it’s also for post discharge patients who are taking care of themselves. You have somebody that is released from the hospital with a congested heart failure, very common condition and one that Medicare will be penalizing for early re-admissions on. So, you know, weight gain is very significant for a congested heart failure patient and weight gain can be subtle. Maybe it’s a little bit over a day, over the course of a week, it’s a couple of pounds, it’s significant. If they’re retaining water, they’re a greater risk. There’s no way of getting that data in real time right now, out of the home.
So eCaring enables you to input that information, as well as tell you what’s the mood of the person. There’s a lot of evidence that if somebody is depressed or anxious or whatever, they might be taking their medication less which, of course makes them more depressed and they go into a downward spiral. So, these are ways…what eCaring does is provide you with real time information, out of the home, so that you can intercept critical conditions early, and if you do that, you can keep small problems from becoming big problems and if you can do that then you can keep costs down for an individual patient and for a total patient population.
HIT Consultant: Now why is the home a valuable source for health-related information and how can we, as HIT professionals, tap into it more?
Herzog: Well, the home…what happens when the patient leaves their doctor’s office? Or when a patient leaves the hospital? Where is that person spending most of their time if they’re not under the institutional care setting? They’re in the home. And who spends the most time with those patients? If they’re getting homecare, it’s the homecare aide. It can be family and friend members and of course, obviously the patient themselves spends all that time with themselves.
So here you have this enormous treasure trove of potential information about what’s the actual care status of that patient. Are they taking their medications? Are they eating and drinking properly? Are they getting their exercise? What are their vital signs relative to their condition. If you don’t have know that information, you can’t, you don’t have good decision support. You don’t have a good way in which, for an IT infrastructure, to generate the information that would be completely useful to really manage that patient well, to minimize their cost and maximize their health.
So eCaring is a way in which you can generate that data. The way it works is we’ve created an icon based language, it’s a very visual system, so that a home health aide or a family or friend member or that patient themselves, frankly, regardless of their computer skills, even if their English literacy, can enter this enormous amount of information about what’s going on in their life. And when you get that information, that’s then translated, it goes into a database and then it’s translated so that another family member or a care provider, whether it’s a doctor or nurse practitioner…whether it’s a case coordinator, a care manager in any kind of a care management entity whether it’s within the hospitals themselves managing post discharge or accountable care organization or a medical home…patients sent to a medical home. Anyone who’s responsible for care management can view that information. And they can view in very easy formats.
This is not one of these big hospital EHR systems that takes weeks to learn and tons of people to implement. You can understand and use this system in minutes. But with this system, you can then be looking and say, “Ok, what happened to this patient over the last day or week or month? What is their eating pattern been? What’s their pattern of taking medications? Let’s look at their vital signs over time. Gee, somebody fell. They had a fall. What were they doing before the fall? Had they not eaten? Had they had just gotten up from a nap? Had they taken insulin?” What are their conditions and sequence of events that’s leading to either problems or conditions in the home. And this information can be sliced and diced however you like it. You can just track eating patterns, you can look at sleep patterns, you can see how much a person has been outside, whether they’re getting their exercise. You can track what their mood is. We’re the only system that captures mental states. And you can view that over time.
So a care professional, a case manager, case worker can view this information and now has this tremendous data base for decision support to make determinations as to whether or not interventions are necessary or not and what kind. If everybody came home from the hospital with a social worker holding their hand, going in to their medicine cabinet, walking in to the pharmacy, making sure they took their pills, we’d have lower readmission rates. But that’s too costly; it’s too expensive to make that work. So, what we’ve introduced is a low-cost, first phase filter so that you can make a determination as to who does require high touch, high cost services which can be effective but also who doesn’t. So you can avoid the costs of providing unnecessary services to the large part of the population that probably doesn’t need them. And that would be true for post discharge people. It’s true for adults with chronic conditions who are being treated in a community health center or by a physician practice. It’s true for veterans and it’s certainly, of course true for the geriatric population.
So, this information can really be incredibly useful. It’s a new and novel source of information, it’s never been generated before, can be integrated with the information you get from other sources to give you a complete portrait of that patient and what their needs are in a way that enables you to manage them, to keep their costs down, keep them at home longer and keep the quality of their care as high as possible.
Part II of this interview/podcast with Robert Herzog will be posted on 8/30/12
Podcast is also available in our iTunes store.
About Robert Herzog:
Robert has an extensive background in digital media and creative enterprises as an entrepreneur and executive. For several years he was deeply involved in the home and extended care of his mother Grace, which gave him an understanding of the problems eCaring is designed to solve. He has been a pioneer in applying new technologies to business ventures, working as a senior executive with startup companies such as Motionbox, Diva, ON2 Corp, Softcom, Granite Films and City Winery, major corporations including JPMorgan Chase, Cahners Communications and the Sarnoff Research Center, and not-for-profits including New Jersey Appleseed and Ecotrust. In public service, he was the creator and Director of New York City’s Energy Office, and also taught public school. Robert is also an author and filmmaker. He graduated from Williams College and has a Master’s from the New School.
