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Care Coordination, VA-Style

The Department of Veterans Affairs has taken a lot of heat lately, but one thing they’ve done right is to be an early and enthusiastic advocate for telehealth.

Veterans with traumatic brain injuries require care coordination that goes above and beyond. The VA starting using telehealth technology in 2003 to foster greater communication between the veteran’s family members, clinicians and rehab providers.

Here are some lessons we’ve learned from the VA’s head start in telehealth:

  • Be decisive – There’s nothing wishy-washy about the military. Once the VA saw the potential in telehealth, the organization jumped in with gusto. That’s the polar opposite of how Accountable Care Organizations (ACOs) have implemented telehealth. The eHealth Initiative found that just 23 percent of ACOs surveyed were actively using telehealth technology. That’s partly because Medicare’s Pioneer ACO model didn’t initially contain enough telehealth incentives. CMS is trying to remedy that in its soon-to-launch Next Generation ACO model. But so far, ACOs haven’t come roaring out of the telehealth gate like the VA did.
  • Have a vision – When the VA began using telehealth twelve years ago, its stated aim was to “improve the health of designated individuals and populations with the intent of providing the right care in the right place at the right time.”

That last phrase has since become the mantra of telehealth: right care, right place, right time. The VA had a vision for what telehealth could provide – and now it’s a reality around the world.

The VA is the poster child for what it means to be an “early adopter” of telehealth technology for care coordination. Now it’s time for CMS and other influential healthcare organizations to likewise have a dream for what telehealth can accomplish — and to move confidently in that direction.

Veterans Affairs

Telehealth Veterans Affairs

 

 

 

 

Skype Is Still Scary

It’s hard to believe that some health systems are still relying on Skype for remote consultations. This Microsoft-owned technology is great for chatting for free with a friend in Sweden, but it’s not even close to being HIPAA compliant.

Hoala Greevy, CEO of an encryption company called Paubox, recently concluded that “Skype is not HIPAA compliant, and if you’re a covered entity (hospital system or payer), stay away from it.”

The HIPAA Omnibus Rule requires all healthcare providers and their associates that transmit Protected Health Information to have Business Associate Agreements (BAAs) in place. But Microsoft doesn’t have any BAAs for Skype. In fact, one Oklahoma doctor was recently sanctioned for using Skype, mainly because there wasn’t a BAA covering its usage.

Then there’s the issue of data security. Skype was hacked last year by a group calling itself the Syrian Electronic Army. Despite that ominous name, the hack wasn’t exactly sophisticated. CNN reported that it was a simple “phishing” scam, where Skype users clicked on an email link and revealed their names and passwords.

Bear in mind that the average cost of a data breach is now roughly $3.8 million. The cost per compromised record is highest in healthcare: about $363 per record. So even a relatively small breach of 500 patient records would cost over $180,000 (not counting possible lawsuits), and the hospital’s name would get listed on Health and Human Service’s infamous “Wall of Shame.”

In an era when there are superb, HIPAA compliant telehealth networks, it’s hard to fathom why any health system would take the huge financial risk of using Skype.

Communication software isn’t “free” if it leaves an organization vulnerable to multi-million dollar data breaches and regulatory penalties. Don’t give your CFO and legal staff an unnecessary headache. Steer clear of Skype.

Doctor with notebook

FDA Cleared Devices Only

New Mission For CMIOs

The Advisory Board recently released a report on the changing roles and responsibilities of Chief Medical Information Officers – and it predicted that these folks will play a vital role in the rollout and maturation of telehealth systems.

For the past five years, CMIOs have primarily dealt with the herculean task of implementing and fine-tuning EHRs. As more organizations enter Meaningful Use Stage 3, CMIOs can now turn their attention to things like telehealth, population health management and analytics (all of which are intertwined).

The report concludes that CMIOs are ideal candidates for overseeing the design and implementation of innovative projects like telehealth networks. Most CMIOs are seasoned practitioners, not computer nerds. They have the clinical, operational and strategic experience to ensure that telehealth systems will be easy for physicians to use – and will complement what’s being done in population health management and predictive analytics.

In the Advisory Board study, none of the CMIOs interviewed were computer scientists – and almost all of them had backgrounds in physician leadership. They shared a passion for process design and improvement, which means that we’ll see steady yet significant enhancements in the telehealth networks they oversee.

There are three things that every organization should do to help their CMIOs succeed:

  • Offload some of their current EHR work (especially optimization) to other members of their team so they have more time to focus on telehealth.
  • Send them to clinical informatics conferences – Most CMIOs are self-taught and relish opportunities for ongoing education.
  • Give them a greater voice in strategic planning for telehealth, population health management and predictive analytics.

Fortunately, tomorrow’s telehealth networks will be shaped in large part by CMIOs who have years of clinical and operational experience, not by techies who don’t understand that world.

CMIO Telehealth

CMIO Telehealth

Retooling Primary Care

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.

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The Do-It-Yourself Disaster

Some hospitals mistakenly think that you can create a telemedicine program as easily as someone can build a patio by going to Home Depot.

Good luck with that.

These healthcare do-it-yourselfers make two big mistakes from the get-go: they underestimate the complexity of the job and they overestimate what their IT departments can deliver.

For starters, any hospital that tries to jimmy-rig its own telemedicine system is automatically considered a manufacturer by the FDA. In its 2011 MDDS ruling, the FDA made it crystal-clear that devices that perform active patient monitoring are Class II devices requiring far greater regulatory scrutiny. It’s very costly and time-consuming to get FDA clearance – and why on earth would a hospital want to assume that kind of liability exposure?

Secondly, many hospital IT folks think that creating a telemedicine network is as simple as connecting two tin cans. They fail to realize that telemedicine technology is vastly different from videoconferencing. In telemedicine, a hospital must manage outside networks where there’s no on-call IT person. And the endpoints aren’t static, like in a boardroom-to-boardroom video conference.  But that doesn’t stop many overconfident hospital IT people from biting off more than they can chew.

Starting up a telemedicine program is far more complicated than most hospitals ever expect.

When hospitals try do-it-yourself telemedicine, their IT staff often gets so befuddled by technical issues that clinical workflow becomes an afterthought – and the end result is a system that clinicians hate to use.

We’ve all had neighbors who thought they could build a deck or patio worthy of Town & Country magazine – only to wind up with something that looks like a bomb site. That’s why we urge hospitals to avoid the temptation of do-it-yourself telemedicine. Let the pros do it.