Telehealth Solution

Telehealth – A Dementia Care Solution?

Kudos to Linda Kaufman, RN, for a thought-provoking article in Executive Insight about how telehealth can improve care and lower costs for patients with dementia.

Kaufman cites some shocking numbers from the Alzheimer’s Association: the cost of care for Alzheimer’s patients this year is expected to top $226 billion – and that number could go even higher when you include those who suffer from Alzheimer’s plus chronic conditions like diabetes.

In Kaufman’s view, telehealth can play a pivotal role in lowering the staggering cost of care for dementia patients by reducing unnecessary hospital visits and improving communication between skilled nursing facilities and home health providers.

She even outlines how a fledgling telehealth program might be structured. Registered nurses could be available 24/7 for calls and video chats with family members providing dementia care. The nurse would use a series of algorithms and protocols to make recommendations to the caregiver. This early intervention could go a long way toward eliminating unnecessary ambulance transport and ED visits. It can also provide ongoing emotional support for stressed-out caregivers.

The Alzheimer’s Association estimates that there will be more than seven million Medicare-age dementia patients by 2025. Meanwhile, there are only about 1.6 million nursing home beds in the U.S., and Baby Boomers are retiring at the rate of 10,000 per day. It soon may be necessary to provide home-based care for huge numbers of dementia patients – and telehealth may be the only viable solution.


Telehealth Solution

Telehealth Solution


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 Today







Listening Drives Innovation

We listen closely to telehealth analysts and observers because they help us – and the industry in general – meet expectations and remain forward-looking.

Almost a year ago, Chirag Patel from New York-based incubator Highnote Foundry cited three things that need to happen for telehealth use to expand:

  • Combining virtual diagnosis and on-the-spot treatment
  • Providing scalable models capable of integrating data from a variety of devices
  • Supporting post-treatment care and compliance

Here’s how InTouch measures up in these three categories:

Using remote diagnostic devices for immediate treatment – We’ve long been a catalyst in this category. Our Patient Access products provide medical device connections that support all FDA requirements for active patient monitoring.

Scalable technology for integrating data from multiple devices – The InTouch Telehealth Network is a secure, scalable platform that reliably manages network performance to share patient data and clinical documentation from a variety of devices.

Post-treatment care coordination and compliance – You’ll find InTouch technology at every point in the care continuum, not just the ICU or physician office. Our solutions help coordinate post-treatment care in rehab centers, skilled nursing facilities, outpatient imaging, home health and many other locations.

At InTouch, we don’t develop products and services in a vacuum. We listen to the input of telehealth visionaries so that our solutions meet changing clinical needs and help move the telehealth field forward.


InTouch Health is listening

Veterans Affairs

Care Coordination, VA-Style

The Department of Veterans Affairs has taken a lot of heat lately, but one thing they’ve done right is to be an early and enthusiastic advocate for telehealth.

Veterans with traumatic brain injuries require care coordination that goes above and beyond. The VA starting using telehealth technology in 2003 to foster greater communication between the veteran’s family members, clinicians and rehab providers.

Here are some lessons we’ve learned from the VA’s head start in telehealth:

  • Be decisive – There’s nothing wishy-washy about the military. Once the VA saw the potential in telehealth, the organization jumped in with gusto. That’s the polar opposite of how Accountable Care Organizations (ACOs) have implemented telehealth. The eHealth Initiative found that just 23 percent of ACOs surveyed were actively using telehealth technology. That’s partly because Medicare’s Pioneer ACO model didn’t initially contain enough telehealth incentives. CMS is trying to remedy that in its soon-to-launch Next Generation ACO model. But so far, ACOs haven’t come roaring out of the telehealth gate like the VA did.
  • Have a vision – When the VA began using telehealth twelve years ago, its stated aim was to “improve the health of designated individuals and populations with the intent of providing the right care in the right place at the right time.”

That last phrase has since become the mantra of telehealth: right care, right place, right time. The VA had a vision for what telehealth could provide – and now it’s a reality around the world.

The VA is the poster child for what it means to be an “early adopter” of telehealth technology for care coordination. Now it’s time for CMS and other influential healthcare organizations to likewise have a dream for what telehealth can accomplish — and to move confidently in that direction.

Veterans Affairs

Telehealth Veterans Affairs





Hospital Readmissions

Telehealth Combats Readmissions

In fiscal year 2016, 2,665 hospitals will receive lower Medicare reimbursements due to excessive readmissions within 30 days. But here’s the good news: 799 of those hospitals won’t be penalized at all – and your facility can join that elite club by skillfully using telehealth technology.

The number of penalized hospitals has been steadily increasing because CMS has added two new conditions – COPD and total hip/knee replacements – to the original trio of monitored conditions: heart attack, heart failure and pneumonia. The maximum Medicare withholding has risen to 3 percent – and only 38 hospitals reached that level in the last monitoring period. But even a 1 percent decline in Medicare reimbursement is a serious blow to any health system, large or small.

According to The Advisory Board, there are four key stages of care that determine whether a provider will incur or escape these penalties – and telehealth plays a vital role in two of them: post-acute care coordination and transitional care support.

At the recent Telehealth Innovation Forum, there were numerous presentations about how telehealth is improving post-acute care coordination across skilled nursing facilities, outpatient rehab, long-term care, home health and imaging centers.


Here’s how it worked before telehealth:

A patient would get discharged from the hospital, and the primary care physician often didn’t know about it for weeks, if ever. The skilled nursing facility had questions about the plan of care, but found it difficult to track down specialists. When patients finally went home, they were confused about when to make follow-up appointments – and with whom.

With telehealth technology, patients are better informed and clinicians know exactly who’s accountable every step of the way. The result: patient outcomes improve, hospital readmissions decline, and providers can provide follow-up care within Medicare’s 7- and 14-day timeframe in order to qualify for transitional care incentives. By CMS’s own estimates, timely transitional care can increase physicians’ revenue up to 4 percent.

The key to avoiding readmission penalties is to improve care across the continuum, not just talk about it. Telehealth is by far the best tool for accomplishing that.


Hospital Readmissions

Hospital Readmissions

Doctor with notebook

Skype Is Still Scary

It’s hard to believe that some health systems are still relying on Skype for remote consultations. This Microsoft-owned technology is great for chatting for free with a friend in Sweden, but it’s not even close to being HIPAA compliant.

Hoala Greevy, CEO of an encryption company called Paubox, recently concluded that “Skype is not HIPAA compliant, and if you’re a covered entity (hospital system or payer), stay away from it.”

The HIPAA Omnibus Rule requires all healthcare providers and their associates that transmit Protected Health Information to have Business Associate Agreements (BAAs) in place. But Microsoft doesn’t have any BAAs for Skype. In fact, one Oklahoma doctor was recently sanctioned for using Skype, mainly because there wasn’t a BAA covering its usage.

Then there’s the issue of data security. Skype was hacked last year by a group calling itself the Syrian Electronic Army. Despite that ominous name, the hack wasn’t exactly sophisticated. CNN reported that it was a simple “phishing” scam, where Skype users clicked on an email link and revealed their names and passwords.

Bear in mind that the average cost of a data breach is now roughly $3.8 million. The cost per compromised record is highest in healthcare: about $363 per record. So even a relatively small breach of 500 patient records would cost over $180,000 (not counting possible lawsuits), and the hospital’s name would get listed on Health and Human Service’s infamous “Wall of Shame.”

In an era when there are superb, HIPAA compliant telehealth networks, it’s hard to fathom why any health system would take the huge financial risk of using Skype.

Communication software isn’t “free” if it leaves an organization vulnerable to multi-million dollar data breaches and regulatory penalties. Don’t give your CFO and legal staff an unnecessary headache. Steer clear of Skype.

Doctor with notebook

FDA Cleared Devices Only

Telehealth Investment

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




Doctor using a digital tablet for a telehealth consultation.

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




Growing Appetite M

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

Impressive Quality Metrics

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