Call9 and an ’embedded’ approach to emergency response in nursing homes

Back in March, this Editor noted the substantial $34 million raise over the past three years by Call9. The Brooklyn-based company has pioneered an innovative approach filling a non-glamorous but badly needed gap in care–providing in-facility emergency care in SNFs and rehab facilities. Embedded in-facility first responders summoned by SNF nurses provide immediate care at a higher level than nursing home staff, married to telehealth capability that connects to remotely located emergency medicine doctors via a video cart and diagnostics.  The goal is to provide care immediately, avoid unnecessary and potentially harmful ER/ED admissions (estimated at 19 percent of ambulance transports), and generally keep SNF patients healthier while on site.

The numbers are there. Call9 reported in their studies a 50 percent reduction in ER admissions and a savings of $8M per year for a 200-bed nursing facility. Even if these numbers are high, a reduction is welcome news to SNFs, payors, Medicare, and one would think nursing home patients and families. Hospital readmissions within 30 days are also a CMS quality measure important to SNFs–the lower the better.

The Hunter College Center for Health Technology in their blog reported that one Call9 feature is special training for staff at their in-house Call9 Academy in the unique emergency care demands present in a SNF. These were initally learned first hand by the founder, Dr. Timothy Peck, who lived three months in a Long Island SNF’s conference room in order to better understand staff and patient needs.

It not only saves money, but fills other gaps in care and social determinants of health. Part of the Academy training covers the gap in palliative care with residents, and can facilitate Medical Orders for Life-Sustaining Treatment (MOLST) preparation with families. Last year, Call9 partnered with Lyft to provide transportation for family members of nursing home residents who have had a change in condition. Other partnerships serve the needs of community paramedicine services to connect with telehealth services as part of CMS’ ET3 model. The company currently covers over 3,700 beds in New York State, recently expanding to Albany, its third city.

A similar company, Third Eye Health, based in Chicago, covers about 15,000 beds but is a ‘lighter’ system that concentrates on remote care without the embedded staff and purely tablet based remote consults initiated by staff nurses. Both indicate through their growth and funding a surge in realization that both improved care and major savings to healthcare can be realized here.

Nintendo’s next move: entertaining healthcare

Nintendo, which has sold 100 million Wii consoles but is facing a shrinking market and increased competition in video gaming both from established companies like Sony and mobile gaming providers, has announced its intention to shift the notion of ‘entertainment’ into ‘quality of life’ (QOL) and health. This will be set up as a separate new business area. CEO Satoru Iwata said that Nintendo wants to “create an environment in which more people are conscious about their health and in turn expand Nintendo’s overall user base.” Although this sounds terribly vague, this Editor recalled that the Wii console had a brief vogue a few years ago in senior communities for fitness and that Editor Emeritus Steve had written about its use in rehabilitation and telehealth as far back as April 2008! (Additional articles here) One wonders what corporate imperatives discouraged the initial exploration of Wii for health. Now the field is thick with competitors from fitness bands (Jawbone, Fitbit, Misfit) to smartphones to Samsung’s new iterations of the Gear watch. Venture Beat.

Could virtual reality in games like Wii be useful therapy in relieving the phantom limb pain (PLP) from amputation? A recent Swedish study published in Frontiers in Neuroscience (abstract) indicate that it might. Researchers Max Ortiz Catalan and his colleagues developed an augmented reality therapy where muscle signals from the amputated arm activated a virtual arm that performed virtual tasks, and relieved the pain in a subject who had painful PLP for 48 years. “The patient reported that his pain gradually reduced, and he experienced pain-free periods over the course of his virtual reality treatments. He said his hand changed from feeling painfully clenched to feeling open and relaxed.” According to the article in Scientific American, the Swedish team has developed an at-home version if approved, and the technology may be adapted for other rehab such as post-stroke or spinal cord injury.  Also FierceHealthIT.

‘Candy Crushing’ stroke rehab

A development that deserves more attention is the use of ‘gamification’ in rehab. In one program, it’s using a combination of incentives, brain stimulation and robotics. The popular Candy Crush Saga game uses a moving candy target, rewards (to higher levels) and reduced reaction times at the harder levels. The Manhasset, New York-based Feinstein Institute for Medical Research at North Shore-LIJ Health System is testing this notion with rehab for paralyzed limbs. Instead of concentrating on training other limbs to compensate for the paralyzed ones, the Non-Invasive Stroke Recovery Lab program focuses on gaining more movement in the affected limbs. Using robots to move the limb at first, then sensing when the patient is moving them on their own, they gradually train the brain to move the limb for whatever motion can be achieved. Therapists use these programs with patients to gain the “just-right” amount of challenge to maintain motivation and attention. According to their website, several programs are being tested using devices for the wrist, shoulder-elbow, hand and an anti-gravity one for the shoulder. A fifth one is in early development to improve gait post-stroke. Also in test is coupling this with trans-cranial direct current stimulation. mHealthNews. Feinstein Institute and researcher (Bruce Volpe) website.

Drug manufacturer Pfizer is also testing gamification for a different sort of rehabilitation–using Evo Challenge from Akili Interactive Labs in determining the status of and improving the abilities of those with cognitive impairments, Alzheimer’s disease (with and without amyloid in the brain) and ADHD. The game, which involves navigation around obstacles and rewards, is designed to improve the impaired processing of cognitive interference, a/k/a distractions. MedCityNews