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Telehealth Enters The Mainstream

We’ve all heard the term “mainstream media,” which differentiates network TV and the New York Times from, say, blogs intended for a niche audience. We often view healthcare in the same way, where primary care and acute care are the “mainstream,” leaving things like concierge medicine and palliative care on the margins.

For too long, telehealth has been relegated to the margins. Now it’s time to quit viewing telehealth as a boutique service for sophisticated consumers. In other words, it’s time to treat telehealth as just “health” – no different from any other form of medicine.

InTouch Health founder, Dr. Yulun Wang, has long emphasized that telehealth plays a critical role at every point in the care continuum. Just look at the continuum diagram above and you’ll see that telehealth is involved at every “mainstream” point possible – from intensive care to ambulatory surgery centers to rehab facilities, long-term care, pharmacies, and even the patient’s home.

That’s why it’s strange that some people still see telehealth as a niche service, useful only for someone who has a stroke while fly-fishing in some rural stretch of Montana. But the truth is that telehealth is becoming commonplace and ubiquitous, improving outcomes in inner-city clinics, urgent care offices, operating rooms, skilled nursing facilities, and a host of other places.

That’s about as mainstream as you can get. So maybe some day we’ll drop the “tele” entirely and start simply calling it “health” – safeguarded at every step by seamless technology.

Telehealth Enterprise Evolution

The 10th InTouch Telehealth Innovation Forum was a showcase for many health systems that are moving beyond telestroke to an enterprise vision for virtual health.

That was the primary focus of a presentation by Chad Miller, MD, the system medical chief for neurocritical care at OhioHealth, where the telestroke program was being underutilized. Most incoming calls did not involve tPA decision-making, but were non-stroke neurological problems like seizures and hypertensive emergencies.

Under Dr. Miller’s leadership, OhioHealth restructured the program to become a round-the-clock virtual health network, spanning 12 hospitals and 20 spoke facilities. This gave doctors the ability to do remote workups and assess a wide range of neurological conditions.

In the OhioHealth network, a neurologist can now provide coverage at a hospital 70 miles away, rather than having to drive, losing valuable time. For cases involving carotid revascularization, a patient can be promptly seen by a vascular neurologist both before and after the procedure.

Miller then turned the podium over to Stephen Klasko, MD, President and CEO of Thomas Jefferson University and Jefferson Health. In a high-energy keynote address, Klasko sang the praises of enterprise virtual networks, noting that enterprise-wide virtual rounds and patient self-scheduling are starting to be utilized. His organization is also rolling out an innovative direct-to-employer model that uses telehealth technology to create strong partnerships with Philadelphia area employers.

At the InTouch Telehealth Innovation Forum, speakers from HCA, The Cleveland Clinic, and Mayo Clinic also discussed how their organizations have successfully transitioned from a telestroke-centric perspective to comprehensive virtual care networks.

Telehealth’s future can perhaps best be described in the title of the Mayo Clinic presentation: An Enterprise Connected Care Strategy. Connected care is the key to a better future for healthcare and must be designed by those who are experts in the telehealth space.

Telehealth Enterprise

Telehealth Enterprise

 

Telehealth Lessons from Space

Providing telehealth services to the International Space Station, 250 miles above the earth, circling the globe every 90 minutes, is about as “remote” as it can get –. That’s why the World Health Organization is using the lessons learned from telehealth in space to improve remote care in some of the world’s most underserved areas.

In a recent WHO bulletin, Dr. Alfred Papali concludes that medium-tech works nicely when high-tech isn’t available. The first responder in space is typically a crew member whose training is comparable to that of a paramedic – and there’s no advanced diagnostic equipment on board. Astronauts use a point-of-care ultrasound device to diagnose ailments, then seek the counsel of earth-bound physicians. Data transmission from space, however, isn’t continuous.

Papali notes that those same constraints are common in many impoverished places on earth. The WHO is already using the equivalent of paramedics to provide antiretroviral medications in sub-Saharan Africa. Plus it’s easy to get portable ultrasound devices into remote areas where it’s impossible to lug a CAT scan machine.

NASA has begun to address data transmission lagtime by providing astronauts with “virtual remote guidance” – a fancy name for pre-recorded instructional videos.

The WHO will soon use the same approach in Haiti, where caregivers will receive just-in-time instructions on how to perform endotracheal intubation and other difficult procedures.

Whether in space or Himalayas, some patients don’t have the luxury of getting transported to a fully equipped medical center. It would take 24 hours and millions of dollars to get a sick astronaut back to earth. Likewise, it’s usually impossible to airlift a patient from rural Nepal to a hospital in New Delhi. Providing the best available care on-site – aided by telehealth technology – can still be a lifesaving option.

Telehealth in spcae

Telehealth in space

Telehealth Transforms India

Nipun Goyal is the co-founder of Curofy, which makes an app that connects more than 50,000 doctors across 300 cities in India. The Times of India recently hailed Curofy as “one of the 5 best Android apps for doctors.”

Goyal recently gave a shout-out to the InTouch Vita, citing it as a famous example of telehealth technology in action. Telehealth is already playing a key role in Indian healthcare, like in the aftermath of the 2014 Kashmir floods that interrupted medical services to more than 2,000 villages.

Here are Goyal’s thoughts on the five ways that new health technologies are improving patients’ lives across India:

  • Building online health repositories that are easily accessible. Goyal sees this as essential to reducing the information gap between India’s urban and rural providers.
  • Robot-assisted remote care. He sees this as particularly important for patient monitoring before, during and after medical procedures.
  • Health & fitness apps and wearables. Goyal feels that we’re in the early stages of this revolution. There are now apps that accurately assess hydration levels and calorie intake – with much more innovation on the way.
  • Greater real-time collaboration between physicians. In Goyal’s view, it’s getting much simpler for physicians to get second opinions and specialty expertise, helping improve outcomes and save lives.
  • Improving physician access and scheduling – Like in the U.S., patients in India can now go online to search for a doctor and schedule an appointment just as easily as they can arrange a cab ride or schedule a haircut.

Goyal’s comments show that Moore’s Law is true the world over: computing power is doubling every two years, allowing telehealth technology to do increasingly amazing things – from Bangalore to Boston.

Telehealth in India

Telehealth in India

Global Trends In Telehealth

If you think that telehealth in America is a crazy quilt of conflicting state regulations, then you should take a look at the international picture.

Telehealth adoption and regulations vary dramatically from one nation to the next. In Africa, the pacesetters seem to be South Africa, Nigeria, and Uganda. The latter just announced plans for a cutting-edge telemedicine center, a joint venture of the Ministry of Health and Apollo Hospitals.

There are also telehealth initiatives underway in India, but India lags far behind the U.S. in telehealth law and privacy safeguards.

Last year, the National Health and Family Planning Commission (NHFPC) of the People’s Republic of China outlined a far-reaching plan for a national telehealth network. But that program is still a work in progress.

Fortunately, there’s a new report from GBI Research that sheds light on global telehealth trends and the fast-changing regulatory landscape. The study examines not just the current telehealth regulations and guidelines in North America, Europe, and Japan, but in China, India and South Africa as well.

The report concludes that countries around the world are launching telehealth initiatives to reach common goals: reducing readmissions due to chronic conditions, eliminating unnecessary Emergency Department visits, etc. The study also takes a closer look at obstacles to global telehealth adoption, including inadequate data security and lack of IT expertise in many developing economies.

It’s been nearly 15 years since the pioneering Lindbergh Operation allowed doctors in France and the U.S. to collaborate on a surgery in real-time. Telehealth technology continues to outpace international consensus on how best to regulate those innovations. But as this report makes clear, there are serious efforts underway to standardize and simplify global guidelines.

Telehealth

Global Healthcare

 

CCM’s Huge Potential

Last year, CMS began reimbursing providers about $42/month per patient for spending at least 20 minutes in non-face-to-face Chronic Care Management (CCM) consultations. Yet surprisingly, many providers – including telehealth clinicians – have been slow to take advantage of this supplemental source of revenue.

If a provider offers CCM-defined services to, say, 400 eligible Medicare patients per month, that’s bonus income of more than $200,000 per year. And in most cases, that revenue doesn’t affect reimbursement from Evaluation & Management (E&M) and other services. It’s additional income, pure and simple.

According to the National Chronic Care Survey, there were two major problems with last year’s rollout: many clinicians were spending up to 35 minutes per consultation (when only 20 is required) and about half the participating providers used registered nurses for the checkups (when less expensive clinicians could do the job).

As providers become more efficient in CCM care delivery, it’s likely to gain popularity rapidly this year. That means that CMS auditors will be paying close attention to ensure compliance – and that’s where telehealth has a key advantage: thorough documentation.

Telehealth software makes it easy to identify and document the clinician, patient and length of consultation for each CCM encounter. That’s more than enough to satisfy any Medicare auditor.

The chronically ill Medicare population is the fastest growing patient demographic – and CCM participants appreciate what telehealth delivers: high-caliber, interactive care that’s also very convenient. That gives telehealth a competitive edge because CCM enrollees get to choose their own providers.

It’s time to familiarize yourself with CPT code 99490. It’s the Chronic Care Management billing code that holds enormous promise for telehealth providers in 2016.

Chronic Care and Telehealth

Chronic Care Management

How Telemedicine is Transforming Senior Health Care

How Telemedicine is Transforming Senior Health Care  

 

By Julie Potyraj – Guest Blogger

Polly, age 78, and suffering from obesity-related health issues, is sitting on her sofa on a snowy afternoon. At 3 p.m., it’s time for her wellness appointment. Polly turns on her iPad (supplied by her doctor’s office), and sees her physician’s face smiling back at her. The doctor has already received information on Polly’s blood sugar levels, heart rate, and blood pressure via a remote monitoring system that sends the data directly to his office. After chatting for a bit, Polly shows the doctor a mild rash on her arm. Upon evaluating the condition—made possible by high-definition video conferencing equipment—her physician recommends a round of antibiotics and transmits a prescription to the local pharmacy. Thirty minutes later, the appointment is over, and Polly hasn’t left the warmth and comfort of her home.

This scenario is not from some futuristic film—it’s telemedicine, and it’s gaining momentum in health care settings across the world. Also referred to as telehealth, telemedicine is defined by the industry as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” This is more than just a trend; 52 percent of hospitals already use remote technologies to deliver clinical services.[1]

The Impact for Seniors and Health Care as a Whole

For aging adults with mobility and transportation problems, telemedicine can offer a welcome respite from in-person office visits. Frequent doctor’s appointments become less of a strain for seniors as well as their caregivers, who often must take time off work to accompany their loved one.

The early intervention afforded by telehealth also helps prevent unnecessary emergency room visits and hospital readmissions. While this is good news for patients themselves, it also helps ease the burden on America’s health care system by improving efficiency and reducing costs. Consider the following real-world examples:

  • An Illinois-based skilled nursing home chain is using telemedicine to minimize readmissions and eliminate unneeded ER visits, saving the health system hundreds of thousands of dollars annually. Through this program, which involves using video teleconferencing to enable bedside evaluation by board-certified physicians, approximately 81 percent of patients using the technology can be treated on-site.
  • In North Carolina, telemedicine is helping seniors diagnosed with diabetes, COPD, and heart failure remain in their homes and out of the hospital for longer periods. This is accomplished by monitoring these patients remotely in between skilled nursing visits using specialized telehealth technologies.

Medicare is Warming to Telehealth

In 2015, the Centers for Medicare & Medicaid Services (CMS) delighted telemedicine advocates by adding seven new payment codes covering additional telehealth services, such as annual wellness visits and psychotherapy. However, there is still work to be done. In an effort to help all Medicare recipients enjoy the benefits of telemedicine, organizations such as the American Telemedicine Association continue to actively encourage CMS and Congress to eliminate the arbitrary restrictions that limit coverage.
Would you like to be on the cutting edge of telemedicine and other health care issues? Learn more about MHA@GW, the online master of health administration from the Milken Institute School of Public Health at The George Washington University.

 

[1] American Hospital Association. The Promise of Telehealth For Hospitals, Health Systems and Their Communities. Trendwatch. January 2015.

 

Telehealth for Seniors

Skilled Nursing Facility using telehealth

No Crystal Ball Needed

For far too long, telehealth has been touted as a future miracle that’s just out of reach. So it’s significant that the theme of a recent U.S. News Hospital of Tomorrow conference was “Telehealth Isn’t The Future – It’s Changing Care Now.”

From beginning to end, the conference highlighted what telehealth is doing in the present: improving care, lowering costs, reducing hospital readmissions and much more.

You don’t need to be H.G. Wells to realize that most Americans are perfectly comfortable getting technology-enabled remote medical treatment. But what is surprising is the scope of what’s already being done nationwide. For example, you don’t automatically think of ophthalmology as a prime candidate for telehealth. But conference speaker Dr. Julia Haller chronicled how Wills Eye Hospital in Philadelphia is using remote home monitoring for patients at the highest risk for the progression of blindness.

Another present-day achievement is how telehealth is transforming the rules of engagement. It’s knocking down the barriers that have long existed between doctor and patient. At the conference, University of Pittsburgh Medical Center telemedicine director Dr. Andrew Watson discussed how today’s patient portals are bringing new spontaneity to physician-patient communication – something not seen since the heyday of house calls.

The recent Disney movie Tomorrowland was only modestly successful at the box office. Maybe what we really need is a movie called Present World – one that celebrates what telehealth is achieving in the here-and-now.

 

Telehealth

Telehealth Today

 

 

 

 

 

How CIOs Can Fund Telehealth

Several recent CIO surveys indicate that many of them would like to move more boldly into telehealth, but they’re facing a host of challenges, including:

  • Numerous “must-have” implementations like ICD-10 and data security updates – CIOs can’t ignore the Oct. 1 deadline for ICD-10 – and they’re scared that their facilities will experience costly data breaches like the ones that have hit healthcare giants like Community Health Systems.
  • A huge amount of “technical debt” – Most health systems have made major investments in EHRs and revenue cycle systems, not to mention all the servers and network hardware to support them. The ongoing optimization of these systems can be staggeringly expensive.

Some CIOs are dealing with these challenges by implementing “lean” initiatives and arranging innovative financing (like obtaining telehealth software and hardware on a subscription or rental basis).

When CIOs try to fund telehealth programs in cash-strapped organizations, two strategies are the most promising:

Demonstrating how telehealth directly impacts the quality of care – While it’s hard to make the case that a new HR or billing system improves patient care, every dollar spent on telehealth boosts care quality: greater access, less wait time, fewer hospital readmissions, and much more.

Getting clinician buy-in – Many physicians aren’t sold on EHRs because they seem like a more cumbersome way to document what they’ve always done. But telehealth technology clearly makes clinicians’ jobs easier (e.g., the ability to do telerounds without ever leaving home). Once clinicians get past their initial reservations about telehealth, they really love what the technology can accomplish.

It’s true that IT budgets are tight, but CIOs can find the telehealth funding they need by documenting its impact on patient outcomes and long-term financial performance. Telehealth is something that clinicians can get excited about…which isn’t the case with back-office applications like purchasing and timekeeping systems.  And when clinicians clamor for something, they usually get it.

Telehealth Investment

Chief Investment Officer Telehealth

 

 

 

Growing App-etite for Telehealth

Walgreens’ TV slogan is “At the corner of happy and healthy,” but you don’t have to visit the Walgreens on the corner to get prompt care anymore. The retail giant is expanding its partnership with MDLive to offer telehealth services via a smartphone app to customers in 25 states by year end.

According to the ATA, about 15 million people will receive telehealth care this year – and the most explosive growth is in primary care. Half a million patients will see a primary care physician using a secure Internet connection this year – and that’s twice the number seen in 2014.

A Walgreens remote consultation is much easier to schedule than an in-person visit. A recent Accenture study found that scheduling an appointment by phone takes over eight minutes on average – and 63 percent of that time is spent transferring the call from one staff member to another.

Another study by the Medical Group Management Association found that people who connect to doctors via apps are far less likely to cancel. That’s a big improvement over the in-person option, where 12 percent of patients either don’t show up or cancel at the last minute.

A Walgreens virtual visit costs $49 and there’s no wait time like in the doctor’s office. That makes the total cost (time and money) much more attractive to today’s price-sensitive consumers.

The Walgreens/MDLive program has been so successful already that the nation’s top two insurers – UnitedHealth and Anthem – are launching similar programs that aim to bring telehealth convenience to 40 million consumers by the end of next year.

Walgreens executives already have a buzzword for what the new app provides: “anytime anywhere care.” Don’t be surprised if that slogan replaces the old one in the company’s TV ads. It’s catchy and concise – and perfectly captures what healthcare consumers are seeking.

 

Telehealth Apps