Posts

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

 

 

No Crystal Ball Needed

For far too long, telehealth has been touted as a future miracle that’s just out of reach. So it’s significant that the theme of a recent U.S. News Hospital of Tomorrow conference was “Telehealth Isn’t The Future – It’s Changing Care Now.”

From beginning to end, the conference highlighted what telehealth is doing in the present: improving care, lowering costs, reducing hospital readmissions and much more.

You don’t need to be H.G. Wells to realize that most Americans are perfectly comfortable getting technology-enabled remote medical treatment. But what is surprising is the scope of what’s already being done nationwide. For example, you don’t automatically think of ophthalmology as a prime candidate for telehealth. But conference speaker Dr. Julia Haller chronicled how Wills Eye Hospital in Philadelphia is using remote home monitoring for patients at the highest risk for the progression of blindness.

Another present-day achievement is how telehealth is transforming the rules of engagement. It’s knocking down the barriers that have long existed between doctor and patient. At the conference, University of Pittsburgh Medical Center telemedicine director Dr. Andrew Watson discussed how today’s patient portals are bringing new spontaneity to physician-patient communication – something not seen since the heyday of house calls.

The recent Disney movie Tomorrowland was only modestly successful at the box office. Maybe what we really need is a movie called Present World – one that celebrates what telehealth is achieving in the here-and-now.

 

Telehealth

Telehealth Today

 

 

 

 

 

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

 

 

 

 

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

Retooling Primary Care

For decades, the entry point in healthcare was the primary care physician’s office. That’s changing rapidly as retailers like Walgreens and Walmart ramp up their efforts. The first wave of retail medicine has been described as a “nurse practitioner in a closet.” But in 2015, we’ll be seeing many retail locations that offer everything a traditional PCP does…and often a whole lot more.

This trend is great news for telehealth providers. Most retail medicine operations are just barely beginning to make a profit. They can become more successful by partnering with telehealth companies that don’t have a comparable investment in brick-and-mortar offices and can leverage scalable, cloud-based technologies.

For example, if nurse practitioners at a retail site wants a quick second opinion, they can get one via telehealth without having to send the patient to a nearby primary care doctor. That keeps more money in the system, both for the retail provider and the telehealth partner.

The rapid growth in both retail medicine and telemedicine is fueled by patients’ desire for greater convenience and faster access to care. A recent Advisory Board story highlighted some of the reasons why Americans have so quickly warmed to retail medicine:

Easy online scheduling – The appointment portals at places like CVS and Walgreens are simple to use – and provide far greater convenience than what most urgent care clinics and EDs currently offer.

Extended hours – Unlike most PCPs, the caregivers at retail clinics work evenings and weekends.

Monitoring chronic conditions – Retail clinics are already adept at helping patients manage and monitor ongoing health problems like diabetes and hypertension.

Deep pockets for clinic upgrades – Retail giants have far more cash than your local PCP for things like the newest medical devices and EMR enhancements.

This will be the year when the synergy between retail medicine and telehealth becomes mutually profitable. The public has made it very clear: give us greater access and more convenience beyond the 9-to-5 limitations of traditional medicine.

images

Crisis In The Stroke Belt

Information provided by the U.S. Centers for Disease Control and Prevention.

We’re all aware that the number of strokes per year in the U.S. is about to cross the 800,000 threshold, but it’s shocking to see how much of that is concentrated in the Southeast region.

Just take a look at this map of the “Stroke Belt” to see how bad it’s gotten in Dixie. It makes you wonder what folks in Phoenix, Minneapolis, and Albany are doing right – and why that success can’t be repeated in the South.

When you take a closer look, you’ll see that many of the nation’s stroke “hot spots” are in underserved areas like northern Maine and in rural parts of the Pacific Northwest. But the South is where you see ample evidence of a double-whammy: a large number of rural communities that don’t have access to advanced stroke care, plus the nation’s highest rates of obesity and high blood pressure.

You’d think that most hospitals in the Southeast would be staffing up on stroke specialists left and right, but many simply can’t afford the high cost of on-site neurointensivists. That’s why telemedicine has such a huge role to play in turning the Stroke Belt into the Southern Success Zone.

Although some sections of the country are more stroke-prone, that doesn’t diminish the need for telestroke capabilities in every community. New Mexico may have enviable stroke statistics, but that doesn’t mean much to someone experiencing a possible stroke in a small town like Portales or Hobbs. Survival trumps statistics every time.

This map makes one thing crystal-clear: hospitals in the South must implement telestroke programs with an urgency akin to D-Day. This year, the number of stroke deaths will be enough to fill two NFL stadiums. That’s totally unacceptable. It’s time to declare war on stroke, with telestroke programs leading the charge.