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.

“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



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

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


Home, But Not Alone

The ATA’s Home Telehealth special interest group was launched 16 years ago – and the progress made in that field has been spectacular.

Telehealth was originally envisioned as a way for rural patients to get access to specialists, but now it’s widely used in many other ways:

 Remote patient monitoring has really come of age. For example, the University of Arizona health system uses telehealth technology to provide at-home monitoring of prospective heart transplant patients who are waiting for a donor match.

Remote medication management helps ensure that patients adhere to the appropriate dosages and schedules. Research shows that medication non-adherence is a factor in more than half of hospital readmissions – and nearly twenty-five percent of all nursing home admissions.

Telehealth for care transitions reduces errors as patients move to different care settings: hospital, skilled nursing facility, home care, etc.

The bottom line is that thousands of patients are getting expert care without having to physically visit a specialist or PCP. As they grow comfortable with the benefits of at-home monitoring, they’re much more receptive to acute care consultations when the need arises.

The laws governing home health vary widely from state to state, and that’s why there are efforts underway to create standards and protocols for remote home care.

Without telehealth, most communities will fall short of their population health management goals. Patients with multiple chronic conditions need ongoing education and observation where they matter most: in their own homes.



Mayo Growing Via Technology

Most health systems grow through mergers and acquisitions, which is a costly and complex process. Merging the existing operations and cultures of healthcare organizations can be an overwhelming task.

Mayo Clinic thinks there’s a smarter way: reaching millions of new patients through technology. In just four years, the Mayo Clinic Care Network (MCCN) has grown to include dozens of affiliated facilities in 18 states, Mexico and Puerto Rico. Bear in mind that Mayo doesn’t own any of these partner organizations. It’s a relationship that’s based primarily on information sharing – and telemedicine plays an important role.

A great example is the Altru Health System in Grand Forks, North Dakota. Neurologists there conduct frequent e-consultations with Mayo specialists. This allows many more patients to be treated close to home, without requiring a trip to Mayo’s headquarters in Rochester, Minnesota.

Last year, MCCN reached seven million patients, which means that Mayo’s clinical footprint has increased threefold to about 63 million people. Mayo CEO Dr. John Noseworthy has set an organizational goal for that number to reach 200 million people by 2020. That’s nearly two-thirds of the U.S. population.

Mayo isn’t alone when it comes to adopting this “growth through technology” approach. The new Memorial Sloan-Kettering Cancer Alliance has found a pioneering partner in the Hartford Healthcare system in central Connecticut. Just like the Mayo network, the Sloan-Kettering alliance will allow cancer patients to get expert care without having to go to New York City for weeks or months of treatment.

Mayo and Sloan-Kettering are two of the biggest “brands” in healthcare. By demonstrating telemedicine’s many clinical and financial benefits, they’re setting the stage for similar partnerships in the near future.


A Banner Announcement

The 42-hospital Mercy system based in the St. Louis area recently announced plans to build a $50 million virtual care center – a 120,000 ft. command post that HealthLeaders reports will offer 75 telemedicine programs to serve more than three million patients.

This is truly a Big Deal in capital letters – similar to a large medical center announcing a prestigious new cancer institute or cardiac hospital. It’s pretty obvious that telemedicine has arrived as a standard of care when a leading healthcare system makes an investment of this magnitude.

When completed next year, the virtual care center will house 300 physicians, nurses, specialists and IT staffers. Their task: to bring quality healthcare to the vast expanse (mostly rural) of Missouri, Kansas, Oklahoma and Arkansas. Mercy serves many communities that lack specialists of any kind – and are often short of primary care physicians, too.

Even though Mercy already offers a comprehensive range of telemedicine services, the system keeps piloting new initiatives (like its new pediatric behavioral health program that lets kids get top-quality local care and offers big-time savings on transportation).

When Mercy holds its formal ribbon-cutting ceremony next year, it will truly be a watershed event in telemedicine history. A major healthcare system in the “Show Me” State is about to show all of America that telemedicine has the power to transform healthcare delivery.




Innovation in Telemedicine – An Entrepreneur’s Perspective

Yulun Wang, Ph.D., Chairman & CEO of InTouch Health and President-Elect of the American Telemedicine Association

Yulun Wang, Ph.D., Chairman & CEO of InTouch Health and President-Elect of the American Telemedicine Association

By Yulun Wang, Ph.D., Chairman & CEO of InTouch Health

The need to provide high quality healthcare to everyone, while reducing costs, has reached a crisis level where it is a major focus at the highest government level.   More and more politicians and healthcare leaders are realizing that telemedicine is clearly a cornerstone of the solution.  This is tangibly seen by the increasing number of healthcare systems that are adopting telemedicine, by the growth of ATA, and by industry investing in telemedicine products and services.  I believe that telemedicine is now reaching an “inflection point” where the industry will grow at an exponential pace.  We are realizing that if one can bring the right clinical expertise, to the right place, at the right time, to make the right medical decision in a cost effective manner; quality can be improved while cost lowered.

Although the concept of telemedicine is simple and elegant, implementing telemedicine can be complex and messy.  This is not unexpected as fundamental change in any industry is never easy and without obstacles.  As one works to implement telemedicine in order to benefit from this enabling technology, one quickly uncovers the many challenges in actually building telemedicine programs.   Barriers created by existing payment structures, regulatory policies, IT architectures, corporate boundaries, resistance to change, and technology limitations, all need to be overcome.   It is these barriers or challenges, coupled with the significant potential value that can be created, which makes telemedicine ripe for innovators and entrepreneurs.   I believe that with persistent innovation, usually accompanied with the risk of capital, entrepreneurs can overcome these barriers and unleash the benefits of telemedicine into our healthcare delivery system.

To succeed in creating positive change I believe in the “divide and conquer” theory.  Trying to orchestrate a singular fundamental change to our healthcare delivery system to incorporate telemedicine systemically is too monumental a task, and will likely fail.  The pathway for entrepreneurs to innovate successfully is to find appropriately sized healthcare workflow challenges which can benefit from telemedicine solutions, and then work to gain adoption by healthcare providers.   With adoption, the entrepreneur can continue to build on that success and expand the vision and market opportunity.

As the telemedicine industry grows, applications are partitioned into two broad categories differentiated by the health status and location of the patient.   The first category we call “acute care telemedicine”, in which telemedicine is used to enable remote clinicians to immediately diagnose and treat sick patients.  These patients may be very sick and require immediate help from a specialist who is difficult to access.   The second category can be called “chronic disease management telemedicine”, where telemedicine is used to periodically and regularly monitor and manage a person’s chronic illness.

The needs of the telemedicine solution and the economic model vary greatly across these two categories.    Telemedicine solutions for acute care must enable a remote clinician to be interactively present in the patient environment and gather pertinent medical information through examination and data access to form a medical decision. Often, this decision can have significant (e.g. life or death) consequences.   If the remote clinician is the physician-in-charge, then the system must enable the physician to lead and establish dominion over the complete environment.  Conversely, telemedicine for chronic disease management generally does not require acute medical decision making, and the interactions are more coaching and mentoring in nature.    These solutions often connect healthcare providers into patient’s homes and therefore must scale cost effectively to a single patient/single system mode.

Telemedicine entrepreneurs should identify opportunities where they can innovate manageable-sized solutions that create significant value for the healthcare providers.  Still change is always difficult, particularly in the field of medicine where process and procedures are honed and perfected over decades to insure every patient receives consistently high quality care.   Therefore the solution must solve the problem in its entirety for adoption to occur.  For example, solutions should not be limited to technology alone, but rather need to be coupled with clinical protocols, business plans, training and implementation services, regulatory assistance, and even the ongoing monitoring and measuring of the solutions impact.  The level of multi-disciplinary depth and detail required to facilitate a change can tax even the most persistent entrepreneurs.

Healthcare is in a seismic state of transition that hasn’t been seen for many decades.  The fundamental goal of changing from “fee for service” to “fee for value”, and competitive pressures re-aligned to drive continued improvement of the quality/cost value curve, is enabling telemedicine to transition from a research topic to mainstream medicine.   Generational changes like these happen infrequently, and should be embraced by adventurous entrepreneurs.  We are at a time when the need for innovation and entrepreneurism in telemedicine is at a maximum!

WIRED And Inspired

The first-ever WIRED Health Conference in New York last week was an ideal forum for spreading the word about the latest innovations in telestroke and teleICU programs. ITH’s Charlie Huiner spoke at the conference, along with Yulun Wang (via RP-VITA) from Santa Barbara.

You may be sick of that overused phrase “thought leader,” but that’s exactly the type of person this conference draws. Most of the attendees could have easily worn badges saying “guru” or “visionary.” So there’s no better place to change the hearts and minds of the world’s healthcare elite.

Yulun and Charlie shared the stage with some notable names like genomics pioneer Craig Venter and Harvard’s Nicholas Christakis. But their mission there was not to bask in the limelight but to amplify the conference theme: using realtime data to drive healthcare decision-making.

InTouch Health’s RP-VITA

The InTouch presentation was something of a coming out party for RP-VITA, showcasing its environmental awareness capabilities. The ITH presenters noted that coordinated care at most hospitals remains elusive, and demonstrated how RP-VITA can help make it a reality.

Each year in the U.S., 100,000 lives are lost due to medical errors and miscommunication. By providing team-based care and easy documentation, RP-VITA can dramatically reduce those errors and missteps.

Conference attendees marveled at how RP-VITA can undock automatically and glide to a bedside on its own – all from a tap on an iPad. (Don’t forget that most of WIRED’s editors like Steven Levy are longtime fans of R2-D2.)

Thanks to the InTouch presentation, the WIRED world has a clearer understanding of how telestroke and teleICU programs can make healthcare decision-making faster, more accurate and less expensive. Click here to see the live stream of the InTouch presentation.