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Solutions To ED Boarding

Telebehavioral or telemental health care took center stage at the 10th InTouch Telehealth Innovation Forum. Presenters demonstrated how telemental health programs are improving outcomes and lowering costs – from Critical Access Hospitals all the way to the nationwide HCA network.

A recent study by The Commonwealth Fund found that about 80 percent of mental health or psych patients present at EDs and primary care offices, where providers often lack the training to effectively treat them. And a study by the IAHSS Foundation revealed that many Emergency Departments board mental health patients for 24 hours or more. Some rural hospitals have wait times as high as 18 days.

At the InTouch Telehealth Innovation Forum, three providers outlined their solutions to this growing problem:

  • The 25-bed Illini Community Hospital in Illinois showed how telemental health technology is linking its community with a tertiary center 50 miles away – and with mental health practitioners as far away as Kansas City. Illini has already achieved a Press Ganey patient satisfaction score of 99 percent.
  • At the other end of the scale, HCA annually conducts 17,000 telemental health or behavioral care consultations across its vast network. The hospital giant has already dramatically reduced the ED backlogs of mental health patients.
  • The PeaceHealth system in Oregon now provides telemental health care to four hospitals – bringing pediatric services to one facility that had never offered them. PeaceHealth plans to widen its program to provide behavioral telecrisis consultations for two other Oregon hospitals.

Studies show that outcomes improve significantly when a behavioral care patient is seen within four hours. These three programs are providing much-needed guidance to other hospitals that are currently overloaded with mental health ED patients and are looking for both clinical and financial solutions.

TeleBehavioral Session

TeleBehavioral Session

Thumbs-Up for TeleICUs

The American Association of Critical Care Nurses (AACN) is an influential organization with just under half a million members. Its teleICU nursing practice guidelines provide a very thorough blueprint for how health systems can join the ranks of the 45 teleICUs currently connecting more than 200 hospitals.

In the American Journal of Critical Care, the AACN recently published the results of a survey that affirmed the teleICU’s effectiveness to date. Here are some of the highlights from that study:

  • Nearly 80 percent of the nurses who took part in the survey indicated that teleICU systems improve patient care
  • About 75 percent of respondents felt that teleICU technology improves their job performance
  • 63 percent found that the teleICU enables faster work performance
  • 66 percent saw improvement in clinical collaboration
  • Nearly 50 percent of the respondents felt that telehealth allows more time for patient care

Survey respondents felt that telehealth’s three top benefits were the ability to monitor vital signs, provide medical management and improve patient safety.

The study also revealed some obstacles to teleICU adoption, including the lingering belief among some clinicians that telehealth interferes with care. The overall findings were quite positive – and reflect the prevailing views of America’s largest specialty nursing association.

It’s estimated that up to 1,000 nurses work in American teleICUs, and an additional 16,000 nurses interface with them every day. It’s clearly a nursing career path that has just begun to blossom.

TeleICU

TeleICU

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

Embracing The Network

There have been dozens of books published on how to “fix” healthcare, but probably one of the best is “Where Does It Hurt?: An Entrepreneur’s Guide To Fixing Healthcare” by Jonathan Bush (who also happens to be CEO and co-founder of healthcare software giant athenahealth).

In a recent article, Bush proclaimed that the “future of the hospital is the network.” He praised Mt. Sinai Hospital in New York for its marketing campaign headlined “If Our Beds Are Filled, It Means We’ve Failed.” Those ads show that Mt. Sinai is serious about moving away from isolated, intermittent care to continuous, coordinated care – a shift that Bush feels all hospitals should make.

Bush believes that successful hospitals are rapidly moving from the EHR-centric model, to the patient-centric world of cross-continuum connectedness, a/k/a the network. Telehealth is an integral part of that brave new world.

Telehealth is the arterial system that can connect acute care specialists, home health providers, Ambulatory Surgery Centers, imaging centers, and all points between. Bush foresees a day (coming soon) when a patient can get an immunization at a retail clinic, an outpatient surgery at an ASC, and a telehealth consultation at home all in a single week.

That’s the “right care, right time” mantra that has long been the guiding principle of telehealth.

Bush sees a bright future for telehealth because relying on a robust network is the only way to “unbreak” our healthcare system.

 

Telehealth Network

Telehealth Network

 

 

Oasis In The Desert

In a recent MarketWatch report, Phil Miller, from the physician search firm Merritt Hawkins, said that 65 million people in the U.S. live in what’s “essentially a primary care desert.” According to the latest Kaiser Family Foundation research, it’s not just a rural phenomenon. Rhode Island and Connecticut are struggling to find primary care physicians just as much as North Dakota and Nebraska.

 Telehealth technology and osteopathy may soon be providing an oasis in that desert. Telehealth can help improve primary care access in struggling states like Missouri, by leveraging the expertise of first-line physicians in states like Delaware, which are amply supplied. Meanwhile, osteopathic schools are starting to create long-distance alliances to solve the primary care shortage.

The educational requirements for an osteopath are nearly identical to an M.D. program – and more than half of young osteopaths go into primary care. That’s one of the reasons why the New York Institute of Technology recently created an osteopathic medical campus at Arkansas State University in Jonesboro. The first group of 115 students will begin classes this fall.

Innovative programs like these can go a long way toward reducing the projected primary care shortfall. The Association of American Medical Colleges estimates this could be as high as 31,000 physicians by 2025.

Telehealth technology is already helping to improve access to specialty care nationwide, which may encourage more medical students to consider a career in primary care. There’s still significant pressure on medical students to forsake primary care for the higher paying specialties in order to pay back six-figure college loans.

Until there are more incentives to enter primary care (perhaps government funded), telehealth can bring “water to the desert” by connecting patients with physician assistants, nurse practitioners and osteopaths who are ready to help.

 

Telehealth

Oasis in the Desert

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

 

Telehealth Serves The Neediest

Yenagoa, Nigeria, is about a 7-hour drive from Nigeria’s largest city, Lagos – and many of its residents weren’t able to get high-quality specialty care close to home. That is until the InTouch 7 (previously, RP-7) arrived.

Thanks to a grant from the Sonoma West Medical Center Foundation (SWMC), the Sebastopol, Calif., Sunrise Rotary Club and InTouch Health, who donated the robot and connectivity services, there’s now an InTouch 7 on-site at Federal Medical Center in Yenagoa. The Sonoma West grant also paid for six Nigerian doctors to travel to SWMC in Sebastopol for eight days of intensive InTouch 7 training.

The Federal Medical trainees can now consult easily with colleagues in California (and vice versa). SWMC Medical Director, Dr. James Gude, also taught the visiting group how to set up grand rounds training sessions so the students can return the favor and train others in Nigeria.

This type of transcontinental collaboration, though not yet common, is helping to save lives in some unlikely settings. Fast Company reports that Dr. Rogy Masri recently used telehealth technology to make a difficult diagnosis at a Syrian refugee camp in northern Lebanon.

The Syrian patient presented with an incredibly red lesion on one hand. The patient was suffering no pain or itching, yet the condition never improved. So Dr. Masri posted a photo on a telehealth app called Figure1 – and within hours, internal medicine resident Yusuf Dimas at St. Paul’s Hospital in Vancouver offered a diagnosis of Leishmaniasis, which soon proved correct.

The World Health Organization estimates that at least 400 million people worldwide lack access to basic healthcare – and some organizations feel that the actual number might be as high as 1.3 billion people.

By delivering expert care to underserved communities around the world, telehealth is making access more timely and affordable – especially for those most desperate for that care.

 

Refugee telehealth

Refugee Telehealth

 

 

The DigiPsych Revolution

The term “telepsychiatry” makes you think of those days when a movie star filming in New York would call a Beverly Hills shrink for a long-distance session.

Today, a land-line telephone is seldom used in remote mental health, so perhaps we should start using the expression “DigiPsychiatric” treatment. That term encompasses not just the traditional provider/patient session, but the enormous amount of data that can be collected (both actively and passively) to aid in diagnoses.

Here are some of the pressing problems that DigiPsych is helping to address:

  • Mental health is the third costliest health condition in America
  • Nearly 60 million Americans have a behavioral health condition, far more than can be treated in conventional brick-and-mortar locations
  • Patients who have a behavioral condition in tandem with a chronic disease cost the U.S. healthcare system 75 percent more than those with physical illnesses alone

There’s a lot of innovative work being done at the crossroads of telehealth and mobile mental health apps. For instance, Centerstone Research in Nashville gave smartphones and the Ginger.io app to patients in a recent pilot. The app was used to gather both active (patient-provided) and passive data gathered on sleep patterns, activity levels and communication trends (e.g., a patient who normally sends 20 texts per day is now sending none). The Centerstone program reduced the participants’ ER days by 23 percent and hospital days by 51 percent.

And we’re just beginning to tap the full potential of wearables like FitBit. In a recent study, a specially designed wearable was able to remotely detect patients’ use of opioids and cocaine in real-time.

In the past, a behavioral care provider had to guess whether a patient was abusing drugs or not sticking to treatment protocol. Now it’s possible to gather meaningful data 24/7 to eliminate the guesswork and greatly improve the quality of care. The DigiPsych revolution has just begun.

TeleBehavioral Session

TeleBehavioral Session

RPM Is A Proven Winner

How well does Remote Patient Monitoring (RPM) perform when it comes to increasing access, lowering costs and improving quality of care? Extremely well, according to last year’s joint research project conducted by the University of Michigan and University of Kentucky.

Lead researcher at the University of Michigan, Rashid Bashshur, Ph.D., and his associates narrowed the focus of the study to three chronic diseases: congestive heart failure, COPD, and stroke. The team sifted through more than 175 studies that looked at RPM from many vantage points: age, level of patient participation and whether the program was led by a physician or nurse.

The findings: remote patient monitoring and related telehealth services increased both access and quality of care while reducing costs.

This confirms the results of a study called CONNECT, which found that wireless remote monitoring of cardiac patients enabled clinicians to make informed treatment decisions 17 days sooner than with in-person visits alone.

Telehealth has come a long way since the Holter (cardiac event) monitor was introduced in the early 1960s. That device wasn’t portable and required the patient to remain in the hospital for monitoring.

As practiced today, RPM is a continuous two-way process, not just a periodic check-in. One recent RPM study found that diabetes patients showed improvements just by receiving and sending text messages to clinicians.

The word “remote” implies a cold and distant relationship. But with RPM, doctor/patient communication is now continuous and caring and it’s helping to significantly lower healthcare costs. RPM has proven ROI.

Remote Presence Monitoring

Female doctor using remote presence monitoring

“Discharge” Is An Illusion

Health systems and regulatory agencies compile mountains of hospital discharge data – and too often they consider a discharge to be a one-and-done event worthy of a marching band. But some health systems have realized that many patients are never fully discharged. They often move quickly – and invisibly – between inpatient, outpatient and post-acute settings.

Telehealth technology is proving to be a game-changer in this new world where hospital discharge is just a recovery phase, not a grand finale.

According to Modern Healthcare, the Hospital for Special Surgery in New York has developed a telehealth app that allows the staff to easily monitor patients after discharge. For example, clinicians can see how well patients are walking – and that visual confirmation is much more effective than a phone-based check-in.

Telehealth is also the ideal technology for connecting the dots. There are a lot of simple reasons why many patients boomerang back into acute care: not having a primary care physician, not sticking to a medication regimen, etc. A 30-year-old might be able to get away with that, but for seniors it can be a one-way ticket to readmission.

Telehealth technology ensures that physicians, case managers. pharmacists and patients are on the same page (or home page as the case may be).

For a patient recuperating from a stroke, pneumonia or heart attack, discharge isn’t a red-letter day like a college graduation. In the days and weeks following discharge, the care team has to share information every bit as effectively as a coaching staff in the Super Bowl. Every coach wears a headset – and every care coordination team should be using telehealth.

 

Hospital Discharge

Hospital Discharge