In recent years, there have been more articles written about population health management than about the entire Kardashian clan.
The first version of population health management had a lot of good intentions but few measurable results. Now comes the hard part: turning mission statements into successful programs. And it’s becoming increasingly obvious that telehealth is an essential ingredient for success.
In a recent article in Executive Insight, Dr. Yulun Wang noted that one of the six pillars in the AHA’s population health roadmap is “seamless care across all settings,” which is practically a Webster’s definition of telehealth. If the population you’re managing happens to be Bear River, Wyoming (population: 521), there are probably not enough locally based primary care physicians, much less specialists, to handle the job. An enterprise telehealth platform is the force multiplier that can solve the problem, while also improving quality and lowering costs.
Dr. Wang’s article also made it clear that many telehealth solutions fall far short of being enterprise platforms, which need to provide:
- Scope to accommodate sub-acute services (clinics, SNFs) in addition to high-acuity service lines like ICU, neurology, etc.
- Scalability to make it easy and cost effective to add new service lines and organizations
- Ease of use in capturing and viewing clinical data across a wide range of environments and applications
- High quality and reliability because high-acuity cases often involve life-or-death decisions
- Access controls to safeguard data integrity across multiple time zones
- Superior analytics and reporting, both historical and real-time
Any organization that’s serious about population health management must also be willing to implement – or be affiliated with – an enterprise telehealth platform that meets these criteria.
Most health systems grow through mergers and acquisitions, which is a costly and complex process. Merging the existing operations and cultures of healthcare organizations can be an overwhelming task.
Mayo Clinic thinks there’s a smarter way: reaching millions of new patients through technology. In just four years, the Mayo Clinic Care Network (MCCN) has grown to include dozens of affiliated facilities in 18 states, Mexico and Puerto Rico. Bear in mind that Mayo doesn’t own any of these partner organizations. It’s a relationship that’s based primarily on information sharing – and telemedicine plays an important role.
A great example is the Altru Health System in Grand Forks, North Dakota. Neurologists there conduct frequent e-consultations with Mayo specialists. This allows many more patients to be treated close to home, without requiring a trip to Mayo’s headquarters in Rochester, Minnesota.
Last year, MCCN reached seven million patients, which means that Mayo’s clinical footprint has increased threefold to about 63 million people. Mayo CEO Dr. John Noseworthy has set an organizational goal for that number to reach 200 million people by 2020. That’s nearly two-thirds of the U.S. population.
Mayo isn’t alone when it comes to adopting this “growth through technology” approach. The new Memorial Sloan-Kettering Cancer Alliance has found a pioneering partner in the Hartford Healthcare system in central Connecticut. Just like the Mayo network, the Sloan-Kettering alliance will allow cancer patients to get expert care without having to go to New York City for weeks or months of treatment.
Mayo and Sloan-Kettering are two of the biggest “brands” in healthcare. By demonstrating telemedicine’s many clinical and financial benefits, they’re setting the stage for similar partnerships in the near future.
For decades, the entry point in healthcare was the primary care physician’s office. That’s changing rapidly as retailers like Walgreens and Walmart ramp up their efforts. The first wave of retail medicine has been described as a “nurse practitioner in a closet.” But in 2015, we’ll be seeing many retail locations that offer everything a traditional PCP does…and often a whole lot more.
This trend is great news for telehealth providers. Most retail medicine operations are just barely beginning to make a profit. They can become more successful by partnering with telehealth companies that don’t have a comparable investment in brick-and-mortar offices and can leverage scalable, cloud-based technologies.
For example, if nurse practitioners at a retail site wants a quick second opinion, they can get one via telehealth without having to send the patient to a nearby primary care doctor. That keeps more money in the system, both for the retail provider and the telehealth partner.
The rapid growth in both retail medicine and telemedicine is fueled by patients’ desire for greater convenience and faster access to care. A recent Advisory Board story highlighted some of the reasons why Americans have so quickly warmed to retail medicine:
Easy online scheduling – The appointment portals at places like CVS and Walgreens are simple to use – and provide far greater convenience than what most urgent care clinics and EDs currently offer.
Extended hours – Unlike most PCPs, the caregivers at retail clinics work evenings and weekends.
Monitoring chronic conditions – Retail clinics are already adept at helping patients manage and monitor ongoing health problems like diabetes and hypertension.
Deep pockets for clinic upgrades – Retail giants have far more cash than your local PCP for things like the newest medical devices and EMR enhancements.
This will be the year when the synergy between retail medicine and telehealth becomes mutually profitable. The public has made it very clear: give us greater access and more convenience beyond the 9-to-5 limitations of traditional medicine.
The legendary rock group The Who once had a song entitled, “We Won’t Get Fooled Again.” That should be the theme song of the thousands of healthcare organizations that paid too much and waited too long for EHR systems that haven’t produced the promised savings and interoperability.
In a recent Black Book Market Research report, 94% of hospitals that are struggling financially say that it’s due to botched or delayed IT projects. And 75% of the CFOs surveyed say that they can’t afford revenue cycle management tools because they overspent on EHRs.
This means that struggling hospitals are likely to fall further behind their well-off competitors who do have the funds to invest in a variety of new projects.
Bear in mind that this was a massive research project that polled more than 2,300 hospital CFOs and CIOs. The report provides ample evidence that the fastest way to become a “have not” hospital is to embark on a poorly executed EHR implementation.
Fortunately, hospital leaders don’t have to repeat the past. There’s now a golden opportunity to “get it right” when implementing telemedicine by avoiding all the potholes and problems that have plagued EHRs so far.
When hospitals and health systems make wise telemedicine decisions, they can achieve things that EHRs promised but didn’t deliver: interoperability, ease of use, and timely implementation.
The painful lessons learned from EHR projects will help more healthcare organizations choose the right telemedicine partner – and get things right from the very start.
When the prestigious Cleveland Clinic unveils its “Top 10 Innovations” for the coming year, it’s like thumbing through a holiday catalog from Neiman Marcus. All those snazzy new products and technologies are bound to be on many hospitals’ wish list for 2015.
Some of the items on the Cleveland Clinic list sound like something you might one day order from SkyMall, including wireless pacemakers and totally pain-free diabetes blood tests. There are some that have instant commercial appeal (cholesterol-lowering injectables for people who can’t tolerate statins). And the #2 innovation on the list is noble and world-changing: a dengue fever vaccine.
But the innovation that ranks #1 (drum roll, please) is the mobile stroke unit – high-tech ambulances that use telemedicine to bring the ED directly to the patient on the scene.
That’s quite an honor when you consider that The Cleveland Clinic is virtually synonymous with “innovation” – and the list was created by more than 100 of its most celebrated physicians, scientists and visionaries. Reaching the top spot on this list is like winning a Nobel Prize and Oscar on the same night.
This proves that telemedicine is no longer an outlier in the U.S. healthcare system. It’s something that’s being touted as the top innovation for next year, outpacing new treatments for heart failure and pulmonary fibrosis.
It’s a real achievement to make this select list…and even sweeter when you rank #1!
One of the main reasons why Ebola has been halted in the U.S. is that we’ve got the technology to help prevent its spread. For example, the New York physician who came down with Ebola checked his temperature daily and reported it (via cell phone) to other doctors. When his temperature hit 100, he knew it was time for quarantine.
So here’s the question: does West Africa have the cell network and 4G Internet reliability to effectively use technology to combat Ebola? The answer is a resounding yes.
Cell signals in West Africa are so reliable that Microsoft co-founder Paul Allen recently donated 10,000 cell phones to West African authorities and physicians combating Ebola.
In 2011, French Telecom and other providers began installing the Africa Coast to Europe (ACE) cable system. More than 10,000 miles of high-speed fiber-optic cable now connects West Africa with Europe.
West Africa fiber-optics
So there’s already an infrastture to support sophisticated telemedicine networks throughout West Africa. Everything needed to use an RP-Express robot is already in place.
In our view, there’s nothing to prevent telemedicine from playing a much larger role in the effort to stop the spread of Ebola.
Polls consistently show that “access” to healthcare is a high priority for most patients. But a patient’s definition of access is a far cry from how providers see it.
For most hospitals and health systems, the Patient Access department is a large and complex operation. In many cases, it includes the call center employees who schedule appointments and all the folks who handle patient registration, insurance verification and payments.
In short, this team preps the patient to see the doctor, but do their efforts really ensure that you’re getting access to the right care at the right time at the right place? What happens if the specialist you’re scheduled to see is sick or stuck in traffic?
Most providers approach “patient access” either as a workflow issue or an opportunity to get upfront payment for services. They may have a check-in kiosk to expedite the process, but that’s about as far as their technology goes.
So here’s a novel idea: why not take greater advantage of telemedicine technology?
Let’s say that you visit your ophthalmologist, who’s baffled by a retinal condition she’s never seen before. It would clearly be advantageous to have “access” to a retina specialist who is familiar with it so you could get the right treatment without delay.
That’s the sort of improved access that health reform is aiming for – not just a faster way to get an appointment.
As technology-enabled consultations become more commonplace, we may not need an on-site army of registration and billing people anymore. Telemedicine is redefining “access” to mean something very simple: putting the patient in touch with the best provider, whenever and wherever needed.
In sci-fi movies, people infected with intergalactic viruses are usually treated by contagion-free robots. In similar fashion, technology is playing a role in the battle to prevent the spread of Ebola…but it needs to be deployed in a more robust way.
Currently, some of the CDC’s special biocontainment units across the country are using technology to connect Ebola patients and caregivers inside with consulting physicians and family members at remote locations. The most recent example is that of Dr. Richard Sacra, a U.S. doctor who contracted Ebola in Liberia and was taken to a biocontainment unit in Nebraska.
That’s a smart – but fairly limited – use of technology. Telemedicine would be immensely more effective if used in the danger zone. Imagine, if you will, that the government of Liberia has just built a special Ebola clinic equipped with telemedicine robots and supporting technologies. The robots could allow a remote clinician to watch the attending physician put on and take off protective apparel, reducing the risk of accidental exposure.
Robots can glide right into harm’s way, and obviously don’t require any of the fancy air filtration and ultraviolet light environments that are standard in U.S. biocontainment units.
Using robotic helpers would be an incredible “force multiplier” for the courageous doctors and nurses helping to contain the outbreak. It’s likely that fewer of them would be needed on the front lines, which would mean fewer quarantines for returning caregivers.
The prefix “e” (for electronic) is used everywhere these days: e-commerce, eBay, and so on. Maybe it’s time to thwart a deadly disease with an eBola strategy using telemedicine.
In a recent article in EHR Intelligence, InTouch chairman and CEO Yulun Wang made a simple yet profound observation about healthcare’s so-called “triple aim”: the only way to increase access, improve quality and lower costs is with telemedicine.
In his view, telemedicine has a vital role to play in both preventive care and acute care. Telehealth technology helps monitor patients with chronic diseases, making it easier to prevent problems before they spiral out of control. And when acute care is needed, telemedicine helps ensure that the right expertise gets to the right place at the right time.
Here’s how telemedicine – and only telemedicine – can achieve the triple aim in the fictional community of Needadoc, Idaho, population: 700.
Access and Quality – In Needadoc, the nearest neurologist is 280 miles away. It would take four hours to transport a stroke patient that far, which means that tPA could not be administered on arrival. But with telemedicine, the patient can be seen by a topnotch neurologist in a matter of minutes – without even leaving town.
Cost – Many rural hospitals have become “stabilize and ship” facilities. If they lack the expertise to provide care locally, Medicare (or other payers) must foot the bill for transporting patients to a larger hospital. But with telemedicine, the patient gets high-quality care close to home. Transport costs drop dramatically, and more revenue stays in the community hospital. Tertiary care hospitals benefit financially, too, by avoiding the cost of treating transported patients who don’t require admission.
Whether you call it “value-based care” or “triple aim,” there’s simply no way to get there if you take telemedicine out of the equation.
The Federation of State Medical Boards (FSMB) recently released its final version of an interstate medical licensure compact that makes it faster and easier for physicians to get licensure in multiple states. Although the compact doesn’t meet all of ATA’s goals, it’s certainly a step in the right direction.
The compact allows physicians to obtain an “expedited” license in states other than their own without having to provide the massive documentation required in a formal application. Physicians would still have to pay a hefty fee (up to $2,000) for each expedited license.
To take effect, the FSMB compact must be approved by seven state legislatures. That should be fairly easy to achieve in 2015, since three state medical boards have already approved the compact and others are leaning that way. Very few legislatures are willing to buck their own medical boards.
The compact will help streamline multi-state licensure not just for doctors practicing telemedicine but for the thousands of locum tenens physicians who take short-term assignments in underserved communities across America. The compact will also make life easier for physicians whose service area straddles multiple states, like those in Washington, D.C., Memphis and Kansas City.
The compact falls short of the ATA’s desired goal: a single medical license honored across all 50 states. Both FSMB and the American Medical Association still staunchly insist that a physician must be licensed in the same state as the person receiving care. That’s like requiring a Seattle stockbroker to get additional licenses for helping clients in Florida and New York.
Although the compact isn’t perfect, it shows that attitudes are changing quickly. The fast-track licensure gaining momentum will hopefully pave the way for the ultimate prize: one license honored in every state.