Population Health Requires Telehealth

In recent years, there have been more articles written about population health management than about the entire Kardashian clan.

The first version of population health management had a lot of good intentions but few measurable results. Now comes the hard part: turning mission statements into successful programs. And it’s becoming increasingly obvious that telehealth is an essential ingredient for success.

In a recent article in Executive Insight, Dr. Yulun Wang noted that one of the six pillars in the AHA’s population health roadmap is “seamless care across all settings,” which is practically a Webster’s definition of telehealth. If the population you’re managing happens to be Bear River, Wyoming (population: 521), there are probably not enough locally based primary care physicians, much less specialists, to handle the job. An enterprise telehealth platform is the force multiplier that can solve the problem, while also improving quality and lowering costs.

Dr. Wang’s article also made it clear that many telehealth solutions fall far short of being enterprise platforms, which need to provide:

  •  Scope to accommodate sub-acute services (clinics, SNFs) in addition to high-acuity service lines like ICU, neurology, etc.
  • Scalability to make it easy and cost effective to add new service lines and organizations
  • Ease of use in capturing and viewing clinical data across a wide range of environments and applications
  • High quality and reliability because high-acuity cases often involve life-or-death decisions
  • Access controls to safeguard data integrity across multiple time zones
  • Superior analytics and reporting, both historical and real-time

Any organization that’s serious about population health management must also be willing to implement – or be affiliated with – an enterprise telehealth platform that meets these criteria.


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.


Fresh Start In Health IT

The legendary rock group The Who once had a song entitled, “We Won’t Get Fooled Again.” That should be the theme song of the thousands of healthcare organizations that paid too much and waited too long for EHR systems that haven’t produced the promised savings and interoperability.

In a recent Black Book Market Research report, 94% of hospitals that are struggling financially say that it’s due to botched or delayed IT projects. And 75% of the CFOs surveyed say that they can’t afford revenue cycle management tools because they overspent on EHRs.

This means that struggling hospitals are likely to fall further behind their well-off competitors who do have the funds to invest in a variety of new projects.

Bear in mind that this was a massive research project that polled more than 2,300 hospital CFOs and CIOs. The report provides ample evidence that the fastest way to become a “have not” hospital is to embark on a poorly executed EHR implementation.

Fortunately, hospital leaders don’t have to repeat the past. There’s now a golden opportunity to “get it right” when implementing telemedicine by avoiding all the potholes and problems that have plagued EHRs so far.

When hospitals and health systems make wise telemedicine decisions, they can achieve things that EHRs promised but didn’t deliver: interoperability, ease of use, and timely implementation.

The painful lessons learned from EHR projects will help more healthcare organizations choose the right telemedicine partner – and get things right from the very start.


The DIY Trap

Thanks to Turbo Tax and Home Depot, there are now millions of Americans who think they can do a better job than their local accountant and carpenter. Sometimes a healthcare system gets caught up in this do-it-yourself spirit, only to discover that implementing an acute care telemedicine (ACT) network is far more difficult than it first appears.

Our own Rob Fisher and Greg Brallier have an excellent article on “The Dangers of Do-It-Yourself Telemedicine” in the current issue of Executive Insight magazine. Step by step, they examine why acute care telemedicine is not for well-meaning novices. Here are some typical problems that DIYers run into:

Getting sidetracked by tech features – It’s easy to fixate on things like a camera’s zoom capabilities and ignore important success factors like clinical program development and physician engagement.

Difficulty getting fast answers – If a PACS imaging server goes down in the middle of the night, who do you call to get it back online fast? Who has the expertise to determine whether a problem involves the WiFi in a doctor’s home or the firewall at the spoke hospital?

Building a team from scratch – Prior to ACT, an IT team at a hub hospital seldom if ever contacted their counterparts at a spoke facility. Now they have to become part of one cohesive team.

Why do healthcare systems even contemplate cobbling together their own ACT network? It’s often an attempt to save money (which backfires), combined with technical overconfidence. In their article, Rob and Greg examine the comprehensive strategy needed to successfully operationalize an ACT system. Before your hospital goes down the do-it-yourself path, read what they have to say

Network Management Made Easy

As telemedicine networks grow larger and more complex, the task of managing them has become more challenging. That’s why we’ve introduced a new product called SureView™ that puts network utilization data right at your fingertips. It’s the first acute care telemedicine network management tool of its kind, and it’s already being hailed by both network managers and hospital IT staff. In addition to providing network stats and utilization data, SureView integrates clinical workflow solutions like StrokeRESPOND for continuous monitoring of key clinical outcomes.

Before SureView, you had to contact your ITH rep to get utilization data, which was sometimes a day or two old. Now it’s available to you instantly, in a graphics-rich, easy-to-understand dashboard that you can access from any computer, any time.

Example dashboard of SureView clinical software application.

The bigger your hub-and-spoke network, the more you’ll appreciate SureView. Network administrators can quickly identify which sites and physicians are using remote presence devices the most – and those that aren’t. SureView also presents information from the StrokeRESPOND database so you can see month-over-month trends and determine whether door-to-needle time is improving.

SureView simplifies IT troubleshooting by providing a precise picture of network conditions at any time. If a physician reports a problem from the previous night, an IT person can quickly investigate to see if there were bandwidth problems or connection issues.

With SureView, it’s easy to export utilization data to Excel for easier reporting and charting. And all SureView information is sortable and searchable. For instance, you can quickly sort by endpoint battery status or wifi status to determine which units need attention.

SureView 1.0 is available now, so contact your ITH rep for details or click here for more information.

The Do-It-Yourself Disaster

Some hospitals mistakenly think that you can create a telemedicine program as easily as someone can build a patio by going to Home Depot.

Good luck with that.

These healthcare do-it-yourselfers make two big mistakes from the get-go: they underestimate the complexity of the job and they overestimate what their IT departments can deliver.

For starters, any hospital that tries to jimmy-rig its own telemedicine system is automatically considered a manufacturer by the FDA. In its 2011 MDDS ruling, the FDA made it crystal-clear that devices that perform active patient monitoring are Class II devices requiring far greater regulatory scrutiny. It’s very costly and time-consuming to get FDA clearance – and why on earth would a hospital want to assume that kind of liability exposure?

Secondly, many hospital IT folks think that creating a telemedicine network is as simple as connecting two tin cans. They fail to realize that telemedicine technology is vastly different from videoconferencing. In telemedicine, a hospital must manage outside networks where there’s no on-call IT person. And the endpoints aren’t static, like in a boardroom-to-boardroom video conference.  But that doesn’t stop many overconfident hospital IT people from biting off more than they can chew.

Starting up a telemedicine program is far more complicated than most hospitals ever expect.

When hospitals try do-it-yourself telemedicine, their IT staff often gets so befuddled by technical issues that clinical workflow becomes an afterthought – and the end result is a system that clinicians hate to use.

We’ve all had neighbors who thought they could build a deck or patio worthy of Town & Country magazine – only to wind up with something that looks like a bomb site. That’s why we urge hospitals to avoid the temptation of do-it-yourself telemedicine. Let the pros do it.