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.
You could call it a “tipping point.” A recent study by the Affiliated Workers Association found that more than 36 million Americans have already used telemedicine in some fashion. And now a tech entrepreneur is helping to make telemedicine downright trendy.
Oscar Salazar, a former engineer at on-demand car service Uber, has introduced a new iPhone app called Pager that’s available now in New York City and soon in Boston. The app lets users search for the nearest available doctor, just like Uber looks for cars. The screen display shows the doctors’ photos and specialties. Phone consultations cost $50 and house calls are $300 (which is only slightly higher than the cost of an urgent care clinic visit). And best of all, these on-call docs are available from 8 a.m. to 10 p.m. every day of the week.
The Pager app isn’t meant to put hospital EDs out of business. It’s primarily designed to relieve wait times at walk-in clinics (which can be quite lengthy in Manhattan).
Pager is already getting some serious competition. The Medicast app does pretty much the same thing for people in South Florida, Los Angeles and San Diego. Then there’s the new Virtual Visits platform from Verizon, which is selling the technology to providers and employers who then offer the apps to their patients and employees. This allows any smartphone user (not just Verizon customers) to conveniently consult with doctors and get prescriptions and referrals.
A century ago, roughly half of all doctor visits were house calls. But by the advent of Medicare, the house call had all but vanished (just like pay phones have disappeared in U.S. cities). But Pager reminds us that it’s refreshing to interact with a physician in a non-clinical setting. It’s a whole lot better than reading magazines in a cramped waiting room.
The Sepsis Alliance has designated SEPtember as its Sepsis Awareness Month, and Sept.13th as World Sepsis Day. We’ve blogged before about telemedicine’s role in early detection of sepsis, but it’s a topic worth revisiting.
Sepsis is caused by complications from an infection, and 100 years ago it wasn’t much of a problem worldwide. But today, many seniors in their 70s and 80s are having major surgeries that weaken their already fragile immune systems making them vulnerable to infections. That’s why most cases of sepsis occur during hospitalization. Each year, more than a quarter of a million people die from sepsis – and it costs the U.S. healthcare system $20 billion annually.
Advances in pharmacology are making the problem worse by potentially making millions of people more prone to sepsis. You’ve probably seen pro golfer Phil Mickelsen’s TV ads for Enbrel, a rheumatoid arthritis drug that alleviates inflammation but also weakens the immune system. There are similar drugs that combat other types of arthritis, psoriasis and a host of other ailments – most of them marketed to seniors in well-funded TV campaigns.
People who take these medications – particularly those who already have diabetes, HIV or chronic liver or kidney problems – are more susceptible to sepsis. As we reported several months ago, a significant number of sepsis deaths occur in non-ICU settings. That’s where telemedicine can help. By monitoring more patients at home, and matching their data with the hundreds of sepsis “red flags” we know about, many sepsis cases can be prevented.
The Missouri-based Mercy Health system already has a TeleSepsis program where community caregivers consult with sepsis specialists at the hub hospital. The program has dramatically lowered ICU costs and, more importantly, produced a nearly 50% reduction in sepsis deaths.
This September, let’s pause to remember that teamwork and telemedicine are helping to reduce the staggering costs and number of deaths from sepsis.
Telemedicine opponents often claim that patients aren’t comfortable interacting with a remote physician. But that’s utter hogwash if you look at the latest research and market trends.
Telehealth companies that offer remote consultations via smartphone apps are growing by leaps and bounds. Even big-name health systems are getting into the act. Last year, Cleveland Clinic performed nearly one million remote consultations by smartphone and e-mail. That was done primarily to meet the needs of millennials who would rather get a same-day smartphone consultation than wait weeks to see a doctor. But a growing number of Boomers are also quite comfortable getting a tele-consult rather than enduring the long wait and high cost of the ER. It’s also handy when people are traveling and don’t want to see an unfamiliar physician at an urgent care clinic.
Several recent studies show just how quickly remote consultations are gaining acceptance. A new study from MDLIVE found that a whopping 82 percent of adults, age 18 to 34, feel that a smartphone consultation is the best option, not just an emergency choice.
That’s confirmed by Intel’s recent Healthcare Innovation Barometer, which found that 72 percent of those surveyed were happy to see a doctor via video-conference or mobile device for non-urgent cases. Worldwide, 84% of respondents said they would gladly share personal health data remotely if it could help lower healthcare costs.
And here’s a sure sign that people trust Big Data: more than 70 percent of those surveyed globally are willing to use toilet sensors, prescription bottle sensors, and even swallowed monitors to make remote diagnoses faster and easier.
These findings are the perfect rebuttal to stodgy organizations that gather anecdotal evidence and make the phony claim that people aren’t ready for telemedicine.