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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

 

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

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

 

 

“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

 

 

Top 5 Reasons to Start a Telehealth Program in 2016

As we look forward to 2016, here are the top 5 reasons to start a telehealth program next year:

  1. Lower readmission ratesTelehealth is already playing a vital role in hospitals’ efforts to reduce unnecessary (and costly) readmissions.
  2. It’s a financial winner for health systems of all sizes. It’s easy to find fiscal rationales for just about any type of telehealth program. Here’s a detailed analysis of the financial advantages of an acute care telehealth program.
  3. Telehealth offers a competitive advantage. The market intelligence firm Open Minds recently published a report showing how health systems that offer telehealth services can gain a competitive edge over rivals that don’t.
  4. Tax advantages – Some not-for-profit health systems are already using Community Health Needs Assessments to redefine “community” to include remote care, thus protecting their tax-exempt status. It’s completely in line with the interoperable health IT ecosystem envisioned by the Office of the National Coordinator for Health Information Technology.
  5. Telehealth has unstoppable momentum. One by one, the barriers to telehealth are being lifted. Just before Thanksgiving, the National Association of Insurance Commissioners adopted model state legislation allowing telehealth to be used to meet adequacy standards for health plans’ provider networks. Next year, many states will enact the model legislation – and it paves the way for more states to join the 29 that have already passed telehealth parity laws.

Every health system has competing demands on its financial and clinical resources. But it’s hard to ignore these five compelling reasons to start a telehealth program without delay.

InTouchLite_Consultation_LowResolution

Time For FAST Action

Washington DC

Capital Building

In the run-up to an election year, a lot of praiseworthy legislation gets stalled in committee. That’s exactly what’s happened to Senate bill S1465 dubbed the “FAST Act”, which stands for “Furthering Access To Stroke Telemedicine” – a bill introduced by Sen. Mark Kirk (R-Illinois). There’s a similar bill in the House that’s also bottled up in committee.

The FAST Act would require Medicare to expand access to telestroke services regardless of the originating site. Medicare currently only reimburses for telestroke evaluations if the patient presents at a rural hospital, yet an estimated 94 percent of stroke patients present at either urban or surburban hospitals.

In a letter endorsing the bill, American Heart/Stroke Association president Mark Creager estimates that the FAST Act could result in net savings of $1.2 billion over ten years.

Nearly 800,000 Americans experience a stroke each year, and you’d think that Congress would expedite any legislation intended to help them. But that costs money – and lawmakers would prefer to kick the can as long as possible.

In recent years, Congress has gotten clogged with downright silly bills (creating a national jaywalking database for example). It’s a shame that something like the FAST Act – which can save countless lives and $100 million per year – remains in limbo when the Boys Town Commemorative Coin Act sails through.

Sen. John Thune (R-South Dakota) has signed on as a FAST Act co-sponsor, and we encourage lawmakers from both parties to join him. This is no time for business as usual. The FAST Act doesn’t deserve to die a slow death in committee.

 

 

 

 

Consumers Have Spoken

To say that healthcare consumers want convenience is like saying that Californians want rain. But a new Advisory Board survey shows that they don’t just want convenience – they crave it.

The survey found that 56 percent of healthcare consumers would gladly visit a retail clinic for episodic care (flu, cold, etc.) – and 42 percent would welcome an e-visit. In fact, access and convenience blew away every other category in the survey, which explains why the telehealth message is falling on fertile ground these days.

And here’s a big surprise: when it comes to service location, consumers liked the idea of an e-visit even better than going to a retail clinic near their home or workplace.

The survey calls into question many of the branding principles that have guided healthcare for half a century. For some would-be patients, convenience may trump a lofty reputation.

Survey respondents ranked cost as another key attribute. More of them said they’d switch PCPs if the annual cost rose $250, than if the doctor made a medical mistake. That’s likely to send the “patient experience” pundits back to the drawing board.

Here’s another takeaway that’s relevant to telehealth: consumers value convenience over continuity – the ability to see the same doctor on every visit. Seeing the same friendly face is much less important to them than seeing someone with the necessary expertise.

The survey concludes that on-demand care is now the front door to the health system. Fortunately, telehealth is poised and ready for the doorbell to ring.

Doctor using a digital tablet. Technology and medicine concept

Doctor using a digital tablet for telehealth consultation

 

 

 

Impressive Quality Metrics

The Dignity Health Telemedicine Network is one of the nation’s pacesetters in establishing – and continuously improving – quality and outcomes benchmarks. The network is based in Sacramento, California and now has 39 partner sites across the state (plus one in Hawaii).

In surveying the network’s recent achievements, you can almost hear the voice of quality guru William Edwards Deming saying, “Well done.” Here’s a quick look at some of those accomplishments, as reported at ATA 2015 by Dignity’s program director Jim Roxburgh, RN, MPA:

  • 15 specialties and growing, ranging from teleICU, teleneurology and telecardiology to telepediatric critical care, telemental health and remote wound care
  • Twice-a-day remote ICU rounding that provides greater continuity across shifts and gives families greater access to specialty providers
  • Response time of 5 minutes or less for critical care physicians
  • Teleneurologist response time of 2 minutes or less – and ability to screen all patients for tPA and ERT within 30 minutes, which enables Dignity to administer tPA about four times more often than most health systems
  • Target response of 30 minutes or less for initial telepsychiatric consultation – and under one hour for psych team evaluation by LCSW and registered nurse

While some health systems may view these quality benchmarks as unreachable as running a mile in 3 minutes and 43 seconds (the current world record), Dignity sees them as measurements that can be continuously improved.

The Dignity Health Telemedicine Network is a bit like Morocco’s Hicham El Guerrouj, the runner who holds the current record for the mile run. Dignity’s successes encourage other networks to push quality and outcomes beyond what they ever thought was possible.

 

Dignity Health TeleStroke

Telehealth and Telestroke

Telehealth Goes Mainstream

The pundits at leading tech publications like Wired and Information Week are now confirming what industry insiders have long known: telehealth is going mainstream.

Two recent stories in Wired prove that telehealth has indeed crossed the Rubicon. The magazine noted that UnitedHealthcare’s decision to cover virtual doctor visits is an undeniable tipping point. This year, the virtual coverage extends only to the insurer’s self-funded clients, but it’s slated to roll out to all members by 2016.

Wired also gave some love to the pediatric telemedicine innovations at Oregon Health & Science University (OHSU). Viewers of the TV comedy Portlandia might mistakenly think that most of Oregon is trendy and urban, but there are plenty of rural communities that don’t have a wide variety of service lines. In fact, there are only three pediatric intensive care units in the entire state – and all of them are in Portland.

The Wired story recounts how OHSU pediatrician (and telehealth medical director) Miles Ellenby was able to help guide the resuscitation of a newborn baby in a rural hospital from the OHSU network hub in Portland. It’s not a simple procedure, but now it’s becoming almost commonplace because specialists can walk local caregivers through the entire process.

This type of guidance is also essential in stroke treatment. The Wired piece notes that most rural providers don’t have the expertise to determine whether tPA administration will help or hurt the patient. But via telehealth, they can let a stroke specialist decide – and that’s why successful tPA administration rates are increasing dramatically throughout the U.S.

In recent decades, strokes have claimed the lives of many famous people (like Richard Nixon and Cary Grant), plus thousands of non-celebrities worldwide. Now telestroke networks are greatly improving outcomes by enabling timely, informed tPA administration. The fact that it’s becoming “commonplace” is extraordinary.

Wired Magazine Telemedicine