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


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




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

Fresh Start In Health IT

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.


An eBola Solution

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.



Triple Aim, One Answer

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.


Is TeleSepsis The Answer?

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.

When Hacking Turns Deadly

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.

Is Your ED a Hub?

Telemedicine can help unclog crowded Emergency Departments.

There are basically two ways to run an Emergency Department. Most are designed like the Department of Motor Vehicles where you sign in and wait for service. The emerging way is to use the Grand Central Station model, where the ED is the service hub. People don’t hang out at Grand Central; they get quickly routed to the places they need to go.

Today’s most innovative EDs are using this hub approach to better serve patients – and remote presence plays a vital role in that process. For too long, Emergency Departments have seen themselves as the hospital’s front door, not the center of the entire enterprise. But a hub-style ED offers a host of benefits: more efficient workflow, better resource utilization, greater throughput, and higher quality care.

In a hub-style ED, the idea is to quickly triage and route each patient to the most appropriate care setting. How does telemedicine help? For starters, it provides better service for the ED’s most frequent users: behavioral health and pain management patients, plus those who rely on the ED for routine primary care. Because those patients aren’t in critical condition, they often sit for hours waiting to be seen. But with remote presence, they can get high-quality care without clogging up the ED. A remote physician can quickly make an assessment through devices like the RP-7i robot. That means that ED physicians have more time for patients with life-threatening emergencies.

It’s obvious that the most expensive resource in today’s ED is the provider. Highly trained ED physicians and nurses have more pressing things to do than treat sinus infections or try to determine whether a patient is depressed (especially when a behavioral health professional can be reached quickly with remote presence).

So the choice is clear: your ED can either be a plodding DMV or a fast-paced hub capable of delivering higher throughput and better care while improving the hospital’s bottom line.