More Schools Using Telehealth

A recent article in the Washington Post shows that telehealth is gaining popularity in American schools, but state laws are slowing its implementation. Consider that:

  • More than 30 states still don’t authorize Medicaid reimbursement for telehealth services provided in schools.
  • Some state Medicaid programs only cover telehealth if a doctor or nurse practitioner is at the school – and most schools are staffed by registered nurses, not NPs.
  • School telehealth is largely limited to primary care/pediatric cases, although New York and South Carolina are using it for mental health, and Michigan uses it for speech pathology.

Yet there are many success stories to share. Missouri state legislator Kip Kendrick helped pass a law allowing Medicaid payments for K-12 telehealth. “School telehealth will be a game-changer in children’s health, keeping them in school and improving educational outcomes,” he says.

The benefits of K-12 telehealth to date fall into three main buckets:

Quelling flu outbreaks – Before telehealth, Sevier County, Tennessee schools experienced annual school closings due to flu. Since the arrival of telehealth, there have been five straight years with no flu-related school closings.

Improving individual attendance – With telehealth, a child who leaves an asthma inhaler at home can be seen promptly by a doctor and given medication at school rather than having to go to an ER.

Reducing missed work time – When a student sees a doctor via telehealth, parents don’t have to leave work for office visits.

So let’s applaud states like Maryland, Missouri and South Carolina that are tapping the full potential of school telehealth. And here’s our message for the lag-behind states: you’re missing some great opportunities.

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

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

 

 

Global Trends In Telehealth

If you think that telehealth in America is a crazy quilt of conflicting state regulations, then you should take a look at the international picture.

Telehealth adoption and regulations vary dramatically from one nation to the next. In Africa, the pacesetters seem to be South Africa, Nigeria, and Uganda. The latter just announced plans for a cutting-edge telemedicine center, a joint venture of the Ministry of Health and Apollo Hospitals.

There are also telehealth initiatives underway in India, but India lags far behind the U.S. in telehealth law and privacy safeguards.

Last year, the National Health and Family Planning Commission (NHFPC) of the People’s Republic of China outlined a far-reaching plan for a national telehealth network. But that program is still a work in progress.

Fortunately, there’s a new report from GBI Research that sheds light on global telehealth trends and the fast-changing regulatory landscape. The study examines not just the current telehealth regulations and guidelines in North America, Europe, and Japan, but in China, India and South Africa as well.

The report concludes that countries around the world are launching telehealth initiatives to reach common goals: reducing readmissions due to chronic conditions, eliminating unnecessary Emergency Department visits, etc. The study also takes a closer look at obstacles to global telehealth adoption, including inadequate data security and lack of IT expertise in many developing economies.

It’s been nearly 15 years since the pioneering Lindbergh Operation allowed doctors in France and the U.S. to collaborate on a surgery in real-time. Telehealth technology continues to outpace international consensus on how best to regulate those innovations. But as this report makes clear, there are serious efforts underway to standardize and simplify global guidelines.

Telehealth

Global Healthcare

 

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

 

 

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.

listening

InTouch Health is listening

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

 

 

 

 

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