Telehealth Gives New Hope For Small ERs

As small hospitals struggle to stay profitable, one of the first things they often jettison is a 24-hour emergency room. But some of these facilities are using telehealth to restore round-the-clock ER service.

Last year, the 30-bed Kings County Memorial Hospital in rural Montague on Canada’s Prince Edward Island was forced to reduce its ER hours from 8 a.m. to 10 p.m., but the town council recently approved a telehealth pilot in the ER.

Ray Brown, the local businessman who spearheaded this effort, argued that a sick astronaut on the space station can be treated immediately – and Montague residents deserve no less. 

When a small hospital curtails ER hours, it’s a red flag that they’re on the road to full closure. The University of North Carolina estimates that about 70 rural hospitals have closed their doors in the last six years. When they go under, the National Institutes of Health estimates that it reduces community per-capita income by about $700/year and increases the local unemployment rate by 1.6%.

The Kings County facility has about the same number of beds as a critical access hospital in the U.S. – and there are more than 1,300 of them across the country, mainly serving rural communities. Last year, researchers at the University of Mississippi Medical Center in Jackson conducted a study of the fifteen small hospitals that use its telehealth platform. They found that a typical spoke hospital could reduce its staffing costs by 25% and increase admissions 20% by retaining patients that otherwise would need to be transported to larger hospitals.

How Telehealth Can Help Hospitals Manage Post-Acute Care Costs

HHS estimates that 25 percent of all Americans – and 75 percent of those over age 65 – are dealing with multiple chronic conditions like diabetes and congestive heart failure (CHF).

Hospitals and providers now share the responsibility for the total medical expense (TME) of these patients, yet up to 40% of those costs come in the post-acute phase. One key way to lower costs and improve outcomes is to integrate telehealth into a variety of post-acute care settings.

This year’s InTouch Telehealth Innovation Forum offered several blueprints for how to achieve this, including a presentation by Sue Thompson, administrative director for integrated care management at PinnacleHealth System in Pennsylvania.

In a pilot project at Pinnacle’s Colonial Park Care Center, Thompson’s first move was to narrow the network from 40 skilled nursing facilities (SNFs) to just five preferred providers. Each of them received an InTouch telehealth device to aid in things like wound and ostomy evaluations. Colonial Park’s readmission rate quickly dropped from 20%-plus to 16%.

Thompson feels that telehealth technology fosters a “we’re in this together” mindset across the care continuum. “SNFs are now facing the same quality metrics and value-based purchasing requirements that hospitals do,” she said. “All stakeholders are looking for ways to improve post-acute care.”

Thompson’s enthusiasm for telehealth was shared by presenter Barry Bittman, MD, CEO of the Institute of Innovative Healthcare. He used the hypothetical case of 87-year-old “Jennie” – a woman with diabetes and CHF who does well in the hospital but has difficulties in the post-acute phase, whether it’s a SNF, home health provider or simply at home alone. Bittman notes that telehealth can provide the hospital-caliber oversight that the Jennies of the world so urgently need. In his view, telehealth is the most cost-effective way to improve care coordination and reduce the number of costly 911-driven hospital readmissions.

A Porsche dealer wouldn’t dream of letting you drive off the lot without a plan for ongoing maintenance, education and support. Hospitals must likewise have a plan for post-acute care – one that relies heavily on telehealth technology.

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

 

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

Five Encouraging Trends

In certain fields, things seem to continuously trend upwards. That’s true with smartphones, where device ownership increased 30% in just the last four years. It’s also true for the Golden State Warriors basketball team, which saw its win totals increase from 51 to 67 to a record-setting 73 over the past three seasons.

We can now add telehealth to that list, where usage has increased by an astonishing 50 percent since 2013. Nearly 15 million people used telehealth services last year.

The ATA recently identified five trends that are creating favorable tailwinds for our industry:

  • More telehealth legislation – To date, 29 states and the District of Columbia have passed laws requiring commercial payers to cover telehealth. Eight more states are considering legislation this year.
  • Employers jump on the bandwagon – Telehealth is rapidly gaining popularity with employers like Nissan and Google that offer onsite health clinics. By 2018, many of these companies will use telehealth.
  • Older adults see the value of telehealth – People approaching Medicare age are quite comfortable with web surfing and smartphone apps. More than half of older adults say that “health information” is one of their primary reasons for digital engagement.
  • App adoption has doubled in the last three years – In 2013, only 16 percent of Americans had a health app on their smartphone. Now that number has doubled to 32 percent.
  • Medicaid is loosening distance requirements – 86 percent of states now cover Medicaid telehealth services statewide rather than imposing distance restrictions.

Many industries are envious of these positive trends. Fax machine manufacturers are no doubt having a lousy year. But things are definitely looking upbeat for the telehealth sector.

Five Telehealth Trends

Five Trends

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

Telehealth Transforms India

Nipun Goyal is the co-founder of Curofy, which makes an app that connects more than 50,000 doctors across 300 cities in India. The Times of India recently hailed Curofy as “one of the 5 best Android apps for doctors.”

Goyal recently gave a shout-out to the InTouch Vita, citing it as a famous example of telehealth technology in action. Telehealth is already playing a key role in Indian healthcare, like in the aftermath of the 2014 Kashmir floods that interrupted medical services to more than 2,000 villages.

Here are Goyal’s thoughts on the five ways that new health technologies are improving patients’ lives across India:

  • Building online health repositories that are easily accessible. Goyal sees this as essential to reducing the information gap between India’s urban and rural providers.
  • Robot-assisted remote care. He sees this as particularly important for patient monitoring before, during and after medical procedures.
  • Health & fitness apps and wearables. Goyal feels that we’re in the early stages of this revolution. There are now apps that accurately assess hydration levels and calorie intake – with much more innovation on the way.
  • Greater real-time collaboration between physicians. In Goyal’s view, it’s getting much simpler for physicians to get second opinions and specialty expertise, helping improve outcomes and save lives.
  • Improving physician access and scheduling – Like in the U.S., patients in India can now go online to search for a doctor and schedule an appointment just as easily as they can arrange a cab ride or schedule a haircut.

Goyal’s comments show that Moore’s Law is true the world over: computing power is doubling every two years, allowing telehealth technology to do increasingly amazing things – from Bangalore to Boston.

Telehealth in India

Telehealth in India