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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

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

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

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

 

 

“Discharge” Is An Illusion

Health systems and regulatory agencies compile mountains of hospital discharge data – and too often they consider a discharge to be a one-and-done event worthy of a marching band. But some health systems have realized that many patients are never fully discharged. They often move quickly – and invisibly – between inpatient, outpatient and post-acute settings.

Telehealth technology is proving to be a game-changer in this new world where hospital discharge is just a recovery phase, not a grand finale.

According to Modern Healthcare, the Hospital for Special Surgery in New York has developed a telehealth app that allows the staff to easily monitor patients after discharge. For example, clinicians can see how well patients are walking – and that visual confirmation is much more effective than a phone-based check-in.

Telehealth is also the ideal technology for connecting the dots. There are a lot of simple reasons why many patients boomerang back into acute care: not having a primary care physician, not sticking to a medication regimen, etc. A 30-year-old might be able to get away with that, but for seniors it can be a one-way ticket to readmission.

Telehealth technology ensures that physicians, case managers. pharmacists and patients are on the same page (or home page as the case may be).

For a patient recuperating from a stroke, pneumonia or heart attack, discharge isn’t a red-letter day like a college graduation. In the days and weeks following discharge, the care team has to share information every bit as effectively as a coaching staff in the Super Bowl. Every coach wears a headset – and every care coordination team should be using telehealth.

 

Hospital Discharge

Hospital Discharge

 

 

Behavioral Telehealth Is Booming

Thanks in part to the pioneering efforts of the Veterans Health Administration’s National Telemental Health Center, the number of remote behavioral care consultations is rising rapidly.

Behavioral care is a natural fit for telehealth because a psychiatric visit doesn’t require any physical examination, just face time. And many U.S. communities simply don’t have enough psychiatrists to meet the growing need. In fact, more than half the counties in America don’t have a single psychiatrist, psychologist or social worker. Here’s the scope of the problem:

  • About 25% of Americans (60 million people) experience mental illness each year
  • An estimated 80% of behavioral health patients present in EDs and primary care clinics, where providers often lack the training to diagnose and treat their conditions
  • 70% of EDs have a boarding time of up to 24 hours for patients waiting for an in-person behavioral health evaluation
  • Patients who have a mental illness in tandem with chronic physical conditions have healthcare costs up to 75 % higher than those dealing with physical ailments alone

Telehealth is a viable way to stem the crisis – and there are a host of new technologies and apps that are making a real difference. For example, behavioral care providers are now monitoring “passive data.” That’s where the patient uses a smartphone or FitBit-type device that captures a wealth of information on sleep patterns, movement (patient is isolating at home) and communication (patient is ignoring clinician emails). Armed with this data, behavioral care providers can often spot worrisome trends before they turn into full-blown depression or other disorders.

The public would be outraged if an ED patient had to wait 20 hours for a cardiac consultation. They should be equally outraged at the behavioral care bottleneck. Fortunately, telehealth technology is dramatically reducing that wait time while improving the quality of behavioral care across America.

TeleMental Health

TeleMental Health is Booming

CCM’s Huge Potential

Last year, CMS began reimbursing providers about $42/month per patient for spending at least 20 minutes in non-face-to-face Chronic Care Management (CCM) consultations. Yet surprisingly, many providers – including telehealth clinicians – have been slow to take advantage of this supplemental source of revenue.

If a provider offers CCM-defined services to, say, 400 eligible Medicare patients per month, that’s bonus income of more than $200,000 per year. And in most cases, that revenue doesn’t affect reimbursement from Evaluation & Management (E&M) and other services. It’s additional income, pure and simple.

According to the National Chronic Care Survey, there were two major problems with last year’s rollout: many clinicians were spending up to 35 minutes per consultation (when only 20 is required) and about half the participating providers used registered nurses for the checkups (when less expensive clinicians could do the job).

As providers become more efficient in CCM care delivery, it’s likely to gain popularity rapidly this year. That means that CMS auditors will be paying close attention to ensure compliance – and that’s where telehealth has a key advantage: thorough documentation.

Telehealth software makes it easy to identify and document the clinician, patient and length of consultation for each CCM encounter. That’s more than enough to satisfy any Medicare auditor.

The chronically ill Medicare population is the fastest growing patient demographic – and CCM participants appreciate what telehealth delivers: high-caliber, interactive care that’s also very convenient. That gives telehealth a competitive edge because CCM enrollees get to choose their own providers.

It’s time to familiarize yourself with CPT code 99490. It’s the Chronic Care Management billing code that holds enormous promise for telehealth providers in 2016.

Chronic Care and Telehealth

Chronic Care Management