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

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

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

Next Generation For Real

For decades, TV ads have been promoting the “next generation” of products, whether it’s a soft drink or smartphone or laundry detergent. The phrase has been so overused that we’re wary of it.

But now there’s a “next generation” announcement that’s the real deal: the Next Generation ACOs (Accountable Care Organization) unveiled last month by CMS (Centers for Medicare and Medicaid Services). There’s much to applaud about this announcement because it offers many things that are indeed “new and improved” – especially when it comes to telehealth.

A Next Generation ACO must have at least 10,000 aligned members – or 7,500 if it’s in a rural area. To qualify for next-gen status, an organization must provide access to both telehealth services and home visits. The new model also has more sensible financial metrics and goals than the preceding Pioneer ACO model.

Next Generation ACOs are now allowed to cover and reimburse for telehealth services just like Medicare Advantage plans do today. The new model lifts the longstanding requirement that beneficiaries must live in a rural community. That’s great news for the 80 percent of Medicare beneficiaries who live in large metropolitan areas.

It didn’t take long for telehealth advocacy groups to sing the praises of the new ACO structure. “This is an important change in CMS policy and attitude,” said Jonathan Linkous, chairman of the American Telemedicine Association. “We hope it will encourage CMS and Congress to further open up all value-based payment plans to telehealth.”

His comments were echoed by leaders of the Alliance for Connected Care. “This policy is a critical step forward in expanding the use of telehealth services in Medicare, which will allow for greater care coordination and improved quality of care,” said Alliance chairman Joe Peterson, M.D. “It represents a major victory for patients and the broader telehealth community, which has been gathering evidence of telehealth’s benefits for decades.”

For years, many telehealth proponents have been patiently waiting for the CMS to take this long overdue step. Now it’s time to pinch ourselves because it’s not a dream any more. The Next Generation ACO model will help bring telehealth services to nearly 40 million Americans who previously didn’t qualify. It’s a bold innovation that truly lives up to its name.



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.


Lawsuit Sends Signals

Last year, a Montana hospital filed a lawsuit against its EHR vendor for failing to meet Meaningful Use deadlines. It’s believed to be the first lawsuit of its kind – and Modern Healthcare recently noted that this may be the first of many such cases.

In this litigation, the company being sued happens to be one of the most experienced EHR vendors in the country – an organization that focuses solely on healthcare. So just think how many lawsuits are waiting to happen when hospitals partner with healthcare novices.

Billions of dollars are still pouring into health IT projects, and that’s enough to attract companies that have little or no healthcare expertise. Let’s take the example of videoconferencing companies. If something goes wrong with a normal videoconference (such as a quarterly call to investment analysts), no one is likely to sue. But when people’s lives are in the balance, it’s another story.

Attorneys are also likely to pounce if a hospital has unforeseen problems treating patients using freeware like Skype. The question becomes: Could they have done more to safeguard the well-being of their patients?

At this year’s annual HIMSS conference, you’ll hear endless talk about mobile health technologies, many of which are not FDA cleared and have been developed by healthcare newcomers. For acute care applications, that’s an open invitation to costly lawsuits.

Most patients have two basic expectations when it comes to telemedicine. First, they expect to be treated by an expert, not an intern. Secondly, they assume that the technology connecting doctor to patient is also the work of acute care experts. When those expectations aren’t met, it’s just a matter of time until lawyers get involved.

Mobile App Clarity

Mobile apps in healthcare have become so ubiquitous that there are now several magazines that cover nothing else. They contain little or no news about hospitals and providers – just info on the latest healthcare apps for your smartphone. It leaves people with the impression that tomorrow’s healthcare will be delivered entirely on the run, with doctors making clinical decisions on the golf course or at a rock concert.

Fortunately, the FDA recently took steps to mute some of the exuberance about healthcare mobile apps. The organization has ruled that these apps fall into two broad categories: passive ones (used mainly for education and information-sharing) and active ones that require FDA Class II medical device clearance.

In the FDA’s view, apps that are designed for things like surgery training or patient education don’t have anything to do with real-time patient care. The same is obviously true for the vast array of business and administrative apps that perform things like billing or physician scheduling.

Even in the active category, most mobile apps are pretty limited tools compared to the Class II devices used in telemedicine. Most of these apps are designed for doctors who are already physically en route to the hospital. For example, there are now smartphone apps that let obstetricians view a baby’s fetal heart rate in real-time as they head for the delivery room. Likewise, a cardiologist can get a real-time look at a patient’s ECG transmitted from an ambulance. But that’s a far cry from the peri-operative and post-surgical precision that telemedicine brings to high-acuity environments.

The FDA has made it crystal clear that most healthcare apps are not – and never will be – worthy of medical device clearance. And those that do meet the criteria fall far short of delivering what’s needed for active patient monitoring in high-acuity settings. There’s no danger of tablets replacing telemedicine networks anytime soon.


FDA Gets It Right

There are many healthcare pundits who feel that the Food and Drug Administration should relax its rules on Medical Device Data Systems (MDDS). But we applaud the FDA for living up to its century-old mission: putting patient safety first.

There are already plenty of smartphone apps that can monitor things like a diabetic’s blood sugar readings. The FDA classifies those products as MDDS because they simply collect data. But there’s a growing number of mobile apps that let physicians view things like sonograms and EKGs in realtime. As the FDA sees it, when a product crosses the line from mere documentation to active patient monitoring, the app is no longer an MDDS but a Class II medical device.

Not surprisingly, the makers of these mobile apps are complaining that the FDA is stifling innovation. The process of getting the FDA’s 510(k) clearance as a Class II medical device is expensive and time-consuming – and many mobile app vendors feel that it’s creating an unnecessary barrier to market entry.

But in our view, the FDA is simply weighing the risks and making patient safety the top priority. FDA guidance makes a clearcut distinction between a mobile app that lets a doctor view a X-ray on an iPhone and one that lets the physician consult with colleagues and make clinical decisions.

MDDS products don’t go through a rigorous vetting process. In contrast, our remote presence devices already have 510(k) clearance for a wide array of assessments, including pre-operative, peri-operative, post-surgical, cardiovascular, neurological, pre-natal, psychological and critical care examinations.

We have nothing against today’s glut of iPhone apps with groovy graphics. But we agree with the FDA that these products must be held to a higher Class II standard.

Remote presence devices used for active patient monitoring require a Class II clearance.
Photo courtesy of Saint Alphonsus Regional Medical Center.