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.
Bryan Coffey, CEO of Hamilton County Hospital in Syracuse, Kansas, recently had a guest commentary in Modern Healthcare outlining the many benefits of remote presence technology in the rural hospital setting.
This Critical Access Hospital (CAH) is located in a rural stretch of Kansas that’s a one-hour drive to the nearest Walmart store. Yet they’re using an RP-Lite to perform some amazing things like:
- Telestroke consultations in partnership with hospitals in Denver and Wichita
- Remote access to specialists in pediatrics, obstetrics and dermatology so patients don’t have to drive eight hours each way to see a specialist
Since acquiring the robot, the hospital’s volumes have increased 30 percent over the previous year – and Medicare outpatient reimbursement has increased by 16 percent.
In the article, Coffey notes that any critical access facility can afford remote presence because of Medicare’s cost-based reimbursement. In his estimation, if a CAH has just one patient per month remain in the hospital versus getting shipped out to a larger facility, the hospital has more than paid for the robot that month.
Coffey has written a case study that provides a complete analysis of how a CAH can cost-justify both a telemedicine robot and contracts with telemedicine providers. It’s a great resource for CFOs at small hospitals, going line by line through things like Rural Health Clinic cost reports.
When Coffey first weighed the telemedicine option, he ran the numbers by some experts at two of the top healthcare audit firms. They took a close look and agreed: telemedicine is a solution that makes financial sense for any critical access facility in the nation.
There are plenty of ways to squander millions of dollars. Making a movie of “Hamlet” starring Vin Diesel is one. Launching a new search engine to compete with Google is another.
But nothing is sadder than the spectacle of a healthcare system blowing millions of dollars on an Electronic Health Record or other technology venture without getting input from clinicians. When these projects get turned over solely to hospital IT people, it’s a runaway train of quality nightmares and cost overruns.
Take, for example, the case of Athens Regional Medical Center in Georgia, which partnered with Cerner (one of the biggest and best EHR vendors in the business). Both Cerner and hospital physicians complained that there wasn’t enough upfront clinical guidance, but hospital leadership didn’t hesitate in handing the reins to the IT staff.
How bad did things get? A recent news story from The Advisory Board chronicled some of the mishaps, including numerous medication errors and one admitted patient who didn’t see a physician for five days.
As the multimillion dollar fiasco continued, both the hospital CEO and CIO got axed. Now, with Cerner’s help, the hospital is starting over and getting plenty of physician help. This underscores a basic truth in healthcare technology: most projects require comprehensive planning and are the shared responsibility of clinicians, hospital operations, and the IT staff. A “go it alone” strategy usually backfires.
What happened at Athens should be a wake-up call for healthcare systems that are considering “homegrown” telemedicine programs. Letting the IT staff make an investment in videoconferencing carts is not a telemedicine program, which requires just as much planning and clinical input as an EHR.
When IT plays the role of conductor – and clinicians are left in the caboose – there’s no stopping that train until something bad happens.
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.