At the dawn of the computer age, there were all sorts of Orwellian predictions that humans would one day be frightened and oppressed by these awful machines. But now that computers are part of the everyday fabric of life, studies show that many people prefer digital interactions over human encounters.
Case in point: being completely honest with your doctor. Who among us hasn’t told a few fibs to our friendly physician? Things like “I’m going to the gym four times a week” and “I haven’t been to Krispy Kreme in over a year.”
In some studies, nearly one third of patients say they haven’t been totally honest with their physicians – and most doctors feel the percentage of truth-benders is much higher than that. This obviously makes it far more difficult to make accurate diagnoses.
It should come as no surprise, then, that a recent study in Computers in Human Behavior found that patients are more honest with “virtual humans” than with their real-life physicians. They’re much more willing to disclose personal information because there’s no embarrassment or fear of disclosure.
These findings echo a study in JAMA Surgery that found that two-thirds of patients in post-operative surgical rounds prefer to see their own doctor via “telerounding” technology rather than get an in-person visit from a physician they don’t know.
The old science fiction predictions about menacing computers and robots wanting to probe your mind (and other parts) have proven to be ludicrous. Remote presence technology is helping to capture and share patient information that’s often more honest and accurate than face-to-face encounters.
A new JAMA study confirms that the sepsis problem in U.S. hospitals is growing dramatically worse. Although sepsis occurs in just 10% of hospital patients, it’s responsible for about half of hospital deaths.
These findings are giving new impetus to the field of TeleSepsis, which is already helping to reduce sepsis mortality and hospital length of stay.
Remote presence can indeed play a preventive role because sepsis is not exclusively an ICU issue. Kaiser Permanente Northern California recently tracked six million hospitalizations and found that more than half of sepsis deaths were in patients with less severe cases, many of whom were treated in non-ICU settings. The study also revealed that sepsis was often present at time of admission.
Here’s how the Missouri-based Mercy system (highlighted in our previous blog) is using remote monitoring to look for warning signs of sepsis in the community setting:
Some sepsis cases can be identified prior to hospitalization by monitoring patients at home. The data gets uploaded to Mercy’s electronic health record, which has 800 red flags to spot patients at risk for sepsis. The team then alerts the local doctor, who takes the right actions to prevent it.
For patients already admitted to Mercy’s network affiliate hospitals, those who are at risk are placed in a virtual sepsis unit for closer monitoring. Caregivers at the outlying hospital can remotely consult with specialists at Mercy’s hub facility, who help identify patients who need an IV replacement or may be at risk for blood clots.
Modern Healthcare reports that Mercy’s TeleSepsis program has produced a nearly 50% reduction in deaths from sepsis – and is saving $25 million annually by reducing ICU length of stay.
For most hospitals, the sepsis crisis is deadly and expensive. TeleSepsis may be the magic bullet we’ve been waiting for.
The 42-hospital Mercy system based in the St. Louis area recently announced plans to build a $50 million virtual care center – a 120,000 ft. command post that HealthLeaders reports will offer 75 telemedicine programs to serve more than three million patients.
This is truly a Big Deal in capital letters – similar to a large medical center announcing a prestigious new cancer institute or cardiac hospital. It’s pretty obvious that telemedicine has arrived as a standard of care when a leading healthcare system makes an investment of this magnitude.
When completed next year, the virtual care center will house 300 physicians, nurses, specialists and IT staffers. Their task: to bring quality healthcare to the vast expanse (mostly rural) of Missouri, Kansas, Oklahoma and Arkansas. Mercy serves many communities that lack specialists of any kind – and are often short of primary care physicians, too.
Even though Mercy already offers a comprehensive range of telemedicine services, the system keeps piloting new initiatives (like its new pediatric behavioral health program that lets kids get top-quality local care and offers big-time savings on transportation).
When Mercy holds its formal ribbon-cutting ceremony next year, it will truly be a watershed event in telemedicine history. A major healthcare system in the “Show Me” State is about to show all of America that telemedicine has the power to transform healthcare delivery.
If you think that Target and other retailers are easy pickings for hackers, they’re like a digital Fort Knox compared to your average U.S. hospital.
Wired magazine recently reported on a two-year study that shows how ridiculously easy it is to hack hospital devices. Scott Erven, head of information security for Essentia Health, was allowed to roam several large hospitals in the Midwest looking for security weaknesses that might attract hackers.
What Erven uncovered is truly a horror show:
- Drug infusion pumps that can be remotely manipulated to change dosages
- Lax security on Bluetooth-enabled defibrillators that can be hijacked to shock those who don’t need it (and fail to shock those who do)
- Unprotected medical records that can be remotely altered so that a doctor prescribes the wrong care or medication
This highlights why hospitals – now more than ever – should work with tech-savvy partners like those in telemedicine, who understand the world of AES 256 encryption, FDA Class II clearance, and the latest HIPAA rules regarding security and privacy.
Most hospital leaders aren’t aware that the maximum fine for a HIPAA security violation involving willful neglect has recently risen from $25,000 to an astounding $1.5 million. And a single data breach typically involves multiple HIPAA violations.
We’re learning the hard way that https:// sites aren’t as secure as we once thought – and hackers worldwide are working diligently to perfect the next Heartbleed-style onslaught.
Telemedicine companies are in the forefront of making data transfer standards like HL-7 and SIP less vulnerable to digital intruders. A telemedicine network has plenty of security safeguards. That’s often not the case with the defibrillator down the hall.
When you scan the telemedicine headlines, there’s always cause for celebration – along with moments that make you scratch your head in disbelief.
Let’s start with the good news:
Last month, the Federation of State Medical Boards (FSMB) approved a model policy on telemedicine that is strongly supportive of today’s acute care telemedicine. One excerpt reads, “Generally, telemedicine is not an audio-only telephone conversation, an e-mail/instant messaging or a fax. It typically involves the application of secure videoconferencing to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between a provider and patient.”
Audio-only telehealth providers immediately put up a big howl, but FASB got it right. A phone call is no substitute for being able to clearly see and interact with a patient.
And now for the troubling news: the medical licensing board in Idaho doesn’t share the enthusiasm for telemedicine seen in other states. In fact, the Idaho board recently placed serious sanctions on Dr. Ann DeJong for simply prescribing an antibiotic over the phone. The sanctions included a license restriction (preventing her from doing long-distance consults) and a $10,000 fine.
Mind you, those sanctions took place in a state that has one of the most innovative telemedicine programs in the nation: the St. Alphonsus Idaho/Oregon Telemedicine Network.
Ironically, the Idaho legislature recently passed a bill calling for healthcare stakeholders to set new – hopefully, more progressive – standards for telemedicine.
Maybe it’s time for the Idaho board to read the entire 11-page FSMB model policy report – and consider reducing the penalties for Dr. DeJong.
Thanks to Turbo Tax and Home Depot, there are now millions of Americans who think they can do a better job than their local accountant and carpenter. Sometimes a healthcare system gets caught up in this do-it-yourself spirit, only to discover that implementing an acute care telemedicine (ACT) network is far more difficult than it first appears.
Our own Rob Fisher and Greg Brallier have an excellent article on “The Dangers of Do-It-Yourself Telemedicine” in the current issue of Executive Insight magazine. Step by step, they examine why acute care telemedicine is not for well-meaning novices. Here are some typical problems that DIYers run into:
Getting sidetracked by tech features – It’s easy to fixate on things like a camera’s zoom capabilities and ignore important success factors like clinical program development and physician engagement.
Difficulty getting fast answers – If a PACS imaging server goes down in the middle of the night, who do you call to get it back online fast? Who has the expertise to determine whether a problem involves the WiFi in a doctor’s home or the firewall at the spoke hospital?
Building a team from scratch – Prior to ACT, an IT team at a hub hospital seldom if ever contacted their counterparts at a spoke facility. Now they have to become part of one cohesive team.
Why do healthcare systems even contemplate cobbling together their own ACT network? It’s often an attempt to save money (which backfires), combined with technical overconfidence. In their article, Rob and Greg examine the comprehensive strategy needed to successfully operationalize an ACT system. Before your hospital goes down the do-it-yourself path, read what they have to say
As hospitals are rapidly adopting acute care telemedicine it is easy to see why healthcare organizations are reaching out to attorneys well versed in telemedicine law.
The Office of the Inspector General (OIG) vigorously enforces the Anti-Kickback (AKB) Statute intended to root out fraud and abuse in the healthcare system. It is worthwhile noting that the OIG issued an advisory statement that recognized the cost-saving potential of telemedicine and indicated they would not prosecute any hub/spoke relationship that balances what each party contributes. Nonetheless, these hub/spoke contracts must be carefully constructed with regard to federal AKB law.
When properly structured based on legal advice and appropriate intention, a hub hospital can in most cases subsidize a significant portion of a spoke hospital’s acute care telemedicine program with very low AKB risk.
Healthcare organizations should be very careful in crafting these contracts since a violation of AKB law is a criminal offense that can result in fines and even jail sentences. Every detail of a hub/spoke contract should be thoroughly evaluated by legal professionals with expertise in telemedicine and e-health law.
And please remember: this is NOT legal advice. It’s just a blog letting you know that the AKB waters can be successfully navigated. But please don’t make that journey without legal counsel.
In a recent blog, Dr. Joseph Kvedar from the Center for Connected Health discussed how three “megatrends” are combining to give new impetus and immediacy to telemedicine.
The first trend is the sea change in healthcare reimbursement – from volume to value. For decades, many patients seeking treatment for severe heartburn were put through a dizzying array of tests and scans to rule out possible heart problems. Those tests were obviously of little value in determining the root cause of the problem. We now have a healthcare system that’s moving steadily toward a more sensible reimbursement paradigm.
The second trend is that consumers are getting increasingly smarter about healthcare costs, provider options, and ways to get personally involved in their own well-being. Thanks to the Internet, patients are much more engaged in the process rather than being passive participants.
Finally, most patients are now completely comfortable with mobile technology, which makes them much more receptive to innovations in connected health. Smartphones, tablets and touch screens are now commonplace – and most patients have no problem with a specialist on the East Coast assessing their condition in the Pacific Northwest. Most patients now readily agree that a provider’s time zone is far less important than the timeliness and quality of treatment.
When powerful megatrends merge, the world is forever transformed. For instance, when cheap oil and modern logistics came together, FedEx and Walmart became pioneers in the global supply chain. In similar fashion, the confluence of three megatrends is fueling telemedicine. Like the rivers that feed the Mississippi, these trends are creating a movement that can’t be stopped.
It’s very easy to be on the wrong side of history. When IBM dismissed the personal computer as a passing fad, it lost its chance to be an enduring player in that market. And the same is true for physician organizations that take a short-term view of telemedicine’s transformative power.
Case in point: the Florida Medical Association staunchly opposes the Florida Telemedicine Act, a proposed bill that would allow physicians licensed in other states to treat Florida patients via telemedicine. In fact, the FMA recently conducted a statewide patient survey to try to bolster its position.
More than half of the 600 patients surveyed were “strongly opposed” to letting out-of-state physicians treat them. But it’s highly unlikely that any of those patients have had a life-saving encounter with a remote physician. If you were to survey stroke patients in rural Idaho who have been administered tPA by a physician thousands of miles away, you’d get a much different story.
The FMA is obviously taking the myopic stance that physicians in Boston or Chicago might take business away from Florida doctors – or might deliver inferior care. That’s absurd, of course, and it overlooks telemedicine’s long-range potential.
The FMA’s line-in-the-sand opposition reminds us of the roadblocks faced by early proponents of laparoscopic surgery, which is now a worldwide standard of care. One of the pioneers in that field, Dr. Erich Mühe, was nearly hounded out of the medical profession in the 1980s.
Like Dr. Mühe, telemedicine advocates are on the right side of history, even though they’re facing many obstacles at the moment. Twenty years from now, medical students will scratch their heads and wonder why telemedicine had its critics in 2014. Some breakthroughs – like personal computers, laparoscopic surgery, and telemedicine – are too pivotal and important to resist.
Last year, a Montana hospital filed a lawsuit against its EHR vendor for failing to meet Meaningful Use deadlines. It’s believed to be the first lawsuit of its kind – and Modern Healthcare recently noted that this may be the first of many such cases.
In this litigation, the company being sued happens to be one of the most experienced EHR vendors in the country – an organization that focuses solely on healthcare. So just think how many lawsuits are waiting to happen when hospitals partner with healthcare novices.
Billions of dollars are still pouring into health IT projects, and that’s enough to attract companies that have little or no healthcare expertise. Let’s take the example of videoconferencing companies. If something goes wrong with a normal videoconference (such as a quarterly call to investment analysts), no one is likely to sue. But when people’s lives are in the balance, it’s another story.
Attorneys are also likely to pounce if a hospital has unforeseen problems treating patients using freeware like Skype. The question becomes: Could they have done more to safeguard the well-being of their patients?
At this year’s annual HIMSS conference, you’ll hear endless talk about mobile health technologies, many of which are not FDA cleared and have been developed by healthcare newcomers. For acute care applications, that’s an open invitation to costly lawsuits.
Most patients have two basic expectations when it comes to telemedicine. First, they expect to be treated by an expert, not an intern. Secondly, they assume that the technology connecting doctor to patient is also the work of acute care experts. When those expectations aren’t met, it’s just a matter of time until lawyers get involved.