Telehealth isn’t a new concept. The technology for doctors to conduct virtual visits with patients via video conferencing equipment or over the Internet has been available for years. Yet, few health providers have applied this technology to their practices to date. There are several reasons why — the biggest inhibitor being the lack of reimbursement that has historically existed for medical consultations not conducted in person. However, with Medicare and Medicaid now beginning to cover virtual care, one of the biggest barriers to telehealth adoption is being removed.
Financial motivation isn’t the only factor poised to spark increased telehealth activity in 2015. Technological improvements, increased demands on physicians’ time, and patient demand are also driving adoption.
Why 2015 may be the year telehealth finally goes mainstream and what providers can expect once it does
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Telehealth isn’t a new concept. The technology for doctors to conduct virtual visits with patients via video conferencing equipment or over the Internet has been available for years. Yet, few health providers have applied this technology to their practices to date. There are several reasons why — the biggest inhibitor being the lack of reimbursement that has historically existed for medical consultations not conducted in person. However, with Medicare and Medicaid now beginning to cover virtual care, one of the biggest barriers to telehealth adoption is being removed.
Financial motivation isn’t the only factor poised to spark increased telehealth activity in 2015. Technological improvements, increased demands on physicians’ time, and patient demand are also driving adoption.
For example, faster Internet connections and improved software are facilitating smoother video conferencing than ever before. Furthermore, today’s mobile devices (e.g., smartphones, iPads, etc.) are enabling physicians and patients to conduct telehealth consultations from just about anywhere.
With more than 10 million newly insured patients entering the healthcare system as a result of ACA, physicians are under more pressure to make the most effective use of their time. Virtual consultations, secure messaging, and remote patient monitoring allow physicians to advise many patients on routine or chronic issues in a fraction of the time of an inperson visit. These tools also help physicians free up office time for more severe medical cases.
Finally, patients have become accustomed to the conveniences of the digital age that are prevalent in just about every other facet of their lives. They routinely go online or use mobile apps to do everything from purchasing airline tickets, to scheduling service appointments, to tracking and managing their finances. Patients expect this same type of flexibility and convenience in healthcare, but most cannot yet receive it through traditional providers.
The stage is set for a telehealth revolution. But what does that mean for providers? The implications are actually quite exciting. For example, telehealth has the potential to save health providers money and increase the value of a doctor’s time, but its impact goes much deeper than that. Specifically, telehealth has the potential to fundamentally and forever change the physician/patient paradigm that exists today. Remember, telehealth encompasses much more than just video chats between doctors and patients. It includes secure messaging, email, mobile apps, remote patient monitoring, and more. It has the potential to remove the barriers of time and space that currently exist in healthcare, increase access to care, and forever improve provider/ patient interactions. The ultimate result of this effort is increased patient satisfaction and improved outcomes. To gain a true appreciation of the positive change telehealth is bringing to the lives of providers and patients, let’s take a closer look at a few notable applications of the technology in play today.
Increasing Access To Specialized Expertise
One of the most common (and familiar) applications of telehealth today is leveraging the technology to make provider services more readily available to patients located in rural or underserved areas. For example, many community hospitals and clinics don’t have 24/7 access to the specialized medical expertise necessary to make accurate diagnoses and treatment plans at the point of care. By placing teleconferencing terminals in ERs and clinics, rural providers can quickly connect to specialists located in metropolitan areas. The teleconferencing technology allows a specialist to conduct a visual exam on a patient remotely while key vitals and other data help aid in diagnosis and treatment.
The University of Virginia Health System is one health provider that leverages telehealth in this manner. UVA Health System consists of a 604-bed hospital (located in Charlottesville, VA), a level I trauma center, numerous cancer and heart centers, and several specialty clinics located throughout Central VA. In the late 1990s, UVA Health System realized it was impossible to have the required medical expertise physically available in many of the rural locations it served. The provider deployed telehealth to augment what was not locally available in these communities. For example, in several of its community hospital settings, there is no pediatric cardiologist on staff. In these hospitals, UVA Health System offers 24/7 pediatric cardiac ultrasound support in its newborn intensive care units. The health system delivers this support using telemedicine and store-and-forward technologies.
UVA Health System offers numerous telehealth services throughout more than 94 sites in Virginia including teleophthalmology to support screening for diabetic retinopathy, telemental health services, and teledermatology. The provider also maintains a telestroke program that allows a suspected stroke patient in any of UVA Health’s locations to be visually evaluated by a neurologist via teleconference.
“When teleconference technology is coupled with CT scans, a neurologist can quickly and easily diagnose the type and severity of a stroke remotely,” says Dr. Karen Rheuban, Medical Director for the Office of Telemedicine at UVA Health System. “This specialist can then instruct local physicians on the proper treatment, which may include the administration of clot-dissolving agents. Having this type of expertise readily accessible in all of our locations can greatly reduce morbidity and other complications that may arise from stroke.”
Virtual Office Visits: The New House Call
Increasing access to specialized medical expertise throughout all locations in a health network via telehealth is definitely having a positive impact on patient care, but it just scratches the surface of what the technology is capable of. For example, many providers have started leveraging telehealth to bypass the healthcare facility altogether and allow patients to access medical services directly from their homes.
UNC Health Care is one provider that has been experimenting with at-home telehealth. The provider has introduced the technology (at least initially) as a way to better serve its elderly patients. For example, many older adults frequently visit doctors’ offices and ERs because they suffer from chronic illnesses and regularly worry about their overall health. They seek the peace of mind that comes along with regular checkups with their doctors. The problem is that many of these office visits are ultimately unnecessary. Unnecessary office visits place a drain on physicians’ time and add needless costs to the healthcare system. Traveling to these on-site appointments can also be burdensome for elderly patients and their families.
In an effort to address this issue, some physicians at UNC Health Care have begun leveraging a telehealth technology solution from TouchCare. TouchCare is a mobile app that can be downloaded on smartphone or tablet devices, enabling a secure and HIPAA-compliant video call between patient and provider. Physicians now regularly request that many patients (particularly elderly patients) download and use the app to schedule follow-up appointments after they visit one of the health system’s ERs.
“The ability to connect with me via video call for five minutes can mean the world to a patient who is not feeling well and is nervous about their health, but ultimately doesn’t need to be seen in the doctor’s office or ER,” says Dr. Kevin Biese, Emergency Medicine Residency Director and Associate Professor for the Division of Geriatrics at UNC Health Care. “Furthermore, the ability to conduct these routine visits remotely helps free up my time to focus on those patients that truly need to be examined on-site.”
According to Dr. Biese this approach also helps to reduce costs for both the patient and the health system. “Prior to TouchCare, fear led many of my patients to present in the ER, which is the most expensive place in the health system to receive care,” adds Dr. Biese. “Patients incurred unnecessary medical expenses and often had to suffer through long waits in the ER before they were seen by a doctor. The video call offers a much better use of resources in many instances.”
The School Nurse’s Office Of The Future
Back in my day, a trip to the school nurse involved little more than getting your temperature taken and lying down for a while before you were ultimately sent home or back to class. Telehealth is also poised to transform this fundamental healthcare interaction.
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For example, thanks to a grant from the Michigan Department of Community Health, the Community Health Center of Branch County (Coldwater, MI) recently embarked on an initiative that brings telehealth technology to three area school districts. Through this project, Telemed ED carts by AMD Global Telemedicine are installed in school nurses’ offices throughout the county. However, it’s really not accurate to call these rooms “nurses’ offices” because the rooms bear a closer resemblance to a doctor’s office or clinic than they do to the “sick rooms” that I recall visiting when I was in school.
The Telemed ED carts provide teleconferencing capabilities that allow school nurses and sick students to conduct virtual visits with on-call nurse practitioners or available physicians throughout the county. The carts also include inputs for special stethoscopes and otoscopes that allow remote clinicians to listen to the heart and lungs and view real-time images of a patient’s ear, nose, and throat. In essence, students are able to receive complete medical exams without ever leaving school.
According to Theresa Gillette, RN, program manager at the Community Health Center of Branch County, the school-based telehealth solution offers several benefits. “Telehealth technology has allowed us to make quicker and more accurate assessments of student health onsite, which really helps to protect the health of our student population overall,” says Gillette. “For example, we can quickly determine whether or not a student has a communicable illness such as influenza or chicken pox. With this information, we can isolate them from the rest of the student population as soon as possible, prescribe the appropriate treatment to get them well, and take the necessary precautions to limit the spread of the illness to other students throughout the school.”
According to Gillette, the telehealth solution also provides convenience to students and their parents. “With on-site telehealth, parents no longer have to take time off work to take their children to the doctor’s office,” she says. “We are able to expedite the process by conducting the exam on-site.”
Finally, Gillette says the school-based telehealth solution has also contributed to cost savings throughout the county. “With telehealth, we no longer need to have a licensed RN employed at every school,” she says. “We need someone who is trained on how to use the technology in every location to initiate the virtual consultation, but that doesn’t have to be an RN. This saves us money from a salary perspective.”
Remote Monitoring Adds Efficiency To Homecare
Telehealth technologies, particularly remote monitoring devices, are also being leveraged to improve the efficiency of homehealth services throughout the United States. One of the primary purposes of homecare is to help reduce hospital readmission rates for patients with chronic conditions such as diabetes, congestive heart failure, and COPD. However, keeping chronic conditions in check using traditional homecare methods often requires numerous in-person visits to a patient’s home on a monthly basis. In an effort to reduce the need for face-to-face visits, Aurora At Home, the homecare arm of Aurora Health Care (Milwaukee), has begun adding telemonitoring services from Philips to the mix.
Through this initiative, many Aurora At Home patients are provided with remote monitoring devices (e.g., wireless scales, glucometers, blood pressure monitors, etc.) that allow them to capture vitals related to their chronic conditions from their homes on a daily basis. This information is automatically transmitted to a Philips secure server where traveling nurses and other clinicians can view the data in real time. The system can be programmed to alert caregivers when specific patient vitals fall outside the norm and require some type of action to be taken (e.g., insulin therapy, medication adjustment, at-home or in-office visit, etc.).
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Aurora At Home is currently targeting “frequent fliers” with the program (i.e., patients who have a history of frequent ER visits and hospital admissions) and has seen dramatic reductions in these areas as a result. Furthermore, remote monitoring technology has also led to a significant reduction in the number of at-home visits traveling nurses need to conduct with patients. This outcome has helped Aurora At Home improve nurse efficiency and cut costs.
“Prior to remote monitoring, our traveling nurses would average about 16 visits to a patient per 60- day episode,” says Ray Darcey, President of Aurora At Home. “With telehealth, we’ve reduced the number of patient visits during this time period to 8 or 9. Even though we’re not currently reimbursed by Medicare for telehealth encounters, the money we’re saving by cutting our in-person visits in half provides powerful cost justification for the system. Moreover, we’re constantly monitoring patients’ conditions, keeping them out of the hospital, and ensuring Aurora Health Care isn’t penalized for preventable readmissions.”
Smartphones, Wearables, And Patient-Generated Data: The Next Wave Of Telehealth
Dr. Eric Topol, practicing cardiologist and chief academic officer at Scripps Health, is one of the foremost authorities on digital health in the world. He has written best-selling books on the topic including The Creative Destruction Of Medicine and The Patient Will See You Now. He also regularly speaks about telehealth at key industry events as well as on popular television programs such as “The Daily Show” and “The Colbert Report.” Dr. Topol’s vision of telehealth extends far beyond the examples outlined thus far in this article. Central to his vision is the belief that patients will usher in the next wave of telehealth adoption — not providers.
“I don’t think the next wave of telehealth is necessarily going to be embraced by doctors,” he says. “It’s the patients — the consumers — that are going to be the driving force behind this transformation. The patients themselves are going to want to generate and take control of their own health data, and they’re going to bring the physicians along for the ride. When this occurs, the role of the physician will shift somewhat away from diagnosis and monitoring to focus much more on treatment, guidance, and healing.”
Personal smartphones, wellness apps, and wearables are all central to Dr. Topol’s telehealth vision. For example, Dr. Topol asserts that the technology exists today for patients to diagnose an infection or pathogen themselves using medical smartphone accessories and applications. Wearable devices and smartphone apps are also available that allow patients to track everything from heart rate to blood pressure to glucose levels. In fact, many of Dr. Topol’s own patients have used apps and algorithms like these to monitor their heart health and even diagnose their own arrhythmias. Prevalence and use of these technologies is only expected to increase.
“The current practice of doctors and hospitals owning private patient data is unacceptable,” says Dr. Topol. “A fundamental shift is on the horizon. When patients start generating much of their own data, on their own devices, about their own bodies, they will be poised to take ownership.”
For example, thanks to a grant from the Michigan Department of Community Health, the Community Health Center of Branch County (Coldwater, MI) recently embarked on an initiative that brings telehealth technology to three area school districts. Through this project, Telemed ED carts by AMD Global Telemedicine are installed in school nurses’ offices throughout the county. However, it’s really not accurate to call these rooms “nurses’ offices” because the rooms bear a closer resemblance to a doctor’s office or clinic than they do to the “sick rooms” that I recall visiting when I was in school.
Aurora At Home is currently targeting “frequent fliers” with the program (i.e., patients who have a history of frequent ER visits and hospital admissions) and has seen dramatic reductions in these areas as a result. Furthermore, remote monitoring technology has also led to a significant reduction in the number of at-home visits traveling nurses need to conduct with patients. This outcome has helped Aurora At Home improve nurse efficiency and cut costs.
