Serving the home health, home care and hospice industry since 1999.

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by Tim Rowan, editor

When an aging family member is hospitalized, admitted to a skilled nursing facility, or is simply living at home alone or with a spouse of the same age, what the rest of the family wants more than anything else is information, accurate, regularly updated information. "When will she be discharged? Does he have a private or shared room? Is she eating well? Should we pay for a home care attendant? Is he taking his meds on schedule?"

A new collaboration tool is on the cusp of being released into the home health, home care, and hospice market by Citus Health, a technology company founded in 2015 by Melissa Kozak, RN, a longtime post-acute care nurse. During a recent product demonstration, VP of Business Development Rob Stoltz took us on a tour. The short version: we have not seen a product exactly like this one before and we do feel comfortable recommending it to our readers. Here is why we came to that conclusion.

The first thing we noticed is that the Citus Health app defies categorization. At first, it appears to be another device-agnostic app used by clinicians to consult with each other, in a HIPAA-compliant environment, about a patient's diagnosis, progress, and status. As the demonstration progressed, however, it became clear that this is not just a secure text solution.

Customizable groups

As easy as selecting names from a smartphone's contact list to be included in a text, a case manager can add members to a patient's care circle. Members can include physicians, family members, home health nurses, anyone else from the home health or home care agency, and the patient. We watched as Stoltz excluded the intake coordinator from the group, then added in the patient's pharmacist when that expertise seemed to be needed. As soon as the new person was added, he had the entire conversation on the screen, not only from the moment he joined.

Daily wound care

The demo moved then to what might happen during a one-on-one conversation between a patient and her wound care nurse. When the patient's verbal description seems inadequate, the nurse instructs the patient to click her phone or tablet's camera button and take a close-up. "The hi-res photo of the wound is immediately available to the nurse for examination," Stoltz explained, "but it is not copied to the camera roll or gallery on the patient's device."

Video visits

Seeing the streaming video on the demo patient's device as the camera was moving into place to capture an image of the wound, the question naturally arose about using that feature to talk with the patient. "Absolutely," Stoltz assured us. "Our home infusion clients have been using this as a telehealth system. Now that we are making it available to hospice and home health agencies, we fully expect they will deploy that feature as well.

"The nice thing is that it requires no specific device on the patient side," he continued, "because it can work across any mobile platform or in a browser-based mode without downloading an app. They can do those video visits with anyone else in the care group, including family members, all at once."

Eliminate inefficiencies

The best example of the ROI that can be achieved with this solution came from Rob Stoltz's personal experience with a family member who moved from home health to hospice. "I watched seven phone calls take place to get a hospital bed into his house," he remembers. "The nurse called the hospice; the hospice person called the DME; the DME person called the hospice back to say they could do it; the hospice office then called the nurse, who had since left the home; so the nurse called his wife; later that day the DME called his wife to set up the delivery."

With the Citus Health communication tool, he concluded, that would be one conversation. "Plus, the DME does not have to be a Citus Health customer. Once the home health agency or hospice implements the solution, it can extend the use of it to partners without an additional charge."

Case Management

In-home care workers, from nurses to therapists to aides, can use the app to record patient information, including unstructured data such as text chats. Those notes can be uploaded to the agency's Electronic Medical Record. Once the Citus app is connected to an EMR, patient demographics and history can be transferred to the app without additional manual data entry.

When a patient needs assistance outside a normal visit time, it is easy for the patient to send a request through the app. The agency will have a person assigned to receive those message and either answer them if they are simple — when is my next visit? — or forward them to the appropriate clinician if they are more complex or urgent. Any patient request can be forwarded to a nurse, a primary care physician, or a family member. The on-call triage person has access inside the app to all care team members.

Multi-lingual Communication

Another feature we have not seen before is the ability of the Citus app to translate, real-time, to and from more than 90 languages. "Each person in the conversation speaks or types in their native tongue," Stoltz said. "You could even use that feature in person, during a visit."

Targeted broadcast messages

Some agencies will use the app to send educational messages to patients and families. Groups can be created by tagging patient accounts. Usually that will be done by diagnosis. Messages can be sent to all diabetes patients or all heart patients. There is no ability to respond to this type of message, they are intended to be one-way communications.

In the case of an emergency weather event, a "masked" broadcast message can be sent to everyone. It might say, "We are anticipating a serious weather event that may have a 3-day impact. If you need supplies, or if you plan to move to another location until the weather passes, please let us know in advance." When the patient replies to a masked message, it goes only to the agency, not to everyone in the group.

Custom forms

In the demo, we experienced the app's form building feature. It appeared to be fairly simple to create, for example, a COVID-19 screening form, or an employee onboarding form, or even a telehealth-style daily vital signs questionnaire. Forms can include branching logic, responding differently if a patient answers 'yes' or 'no' to a question about traveling outside the country or living with someone who tested positive. The app will automatically send reminders every few hours or few days if a form has not been completed and returned. One feature that can be added to a form is a space that captures a patient's signature. Completed forms can be uploaded to an EMR, either as a PDF or as discreet data elements.

Electronic physician signatures

Once a referring physician has joined a Citus Health care team for a patient, the system can deliver documents that must be signed before a Medicare claim can be submitted. When integrated, documents created in the agency EMR can be delivered by the Citus app rather than recreated there. The physician — or today his or her Nurse Practitioner or Physician Assistant — receives an email or SMS, absent all PHI, which links to the document, then signs the document electronically without ever having to download an app or log in to a portal. Stoltz envisions this app-less signature as an effective means of overcoming the objections the industry has struggled with for years. The physician receives a text with a link, taps the link, and enters a secure space, unique to that physician, to see the document. Citus calls it "App-less Document Signatures."

A document escalation feature provides that a document can be automatically forwarded to a second or third person, perhaps the newly authorized NP and PA, if the physician has not signed and returned the document with a specified number of hours or days.

Patient satisfaction

Custom forms can also be developed to send satisfaction surveys to patients and their families while the care episode is still fresh in their minds. When the agency's official CAHPS survey arrives in the mail a month later, odds are increased that the patient will complete and return the CAHPS survey and that the answers there will be more positive.

Other uses

Considering the flexibility of a tool like this, it is likely that additional ways to use it will be discovered over time. Some came up in the conversation during our product demonstration.

  • Automatic medication and appointment reminders
  • Bereavement: staying in touch with families more personally than via an annual letter
  • Mid-episode hospital stays: communicating with family and referring physician may increase the likelihood a patient will stay with the same home health agency after discharge
  • Patient Notice of Non-Covered Benefits: (coming in October) a custom form can be designed and sent and returned with a patient's, or power-of-attorney's signature without requiring a trip to the home
  • Disseminate educational materials to a patient's education center, based on diagnosis. Citus does not create educational material but can deliver the agency's documents through the app. If a delivered educational document includes a link to a video, that video will play within the platform.


Citus Health bases its fees per patient rather than per user. Stoltz told us this encourages home health and home care agencies and hospice to use the system with every patient and client and does not penalize them when large numbers of family members, physicians, pharmacists, and others are included in the communications circle.


©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. One copy may be printed for personal use; further reproduction by permission only.