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Telehealth Safeguards Newborns

Some precious lives start out in jeopardy, like the 10% of newborns with an Apgar respiration score of one (irregular breathing) or zero (no breathing at all). Most of these babies can be resuscitated easily, even in a small community hospital, but about one case in a thousand requires advanced intervention that only a highly trained neonatologist can provide.

Telehealth is helping deliver that expertise, as documented recently in Mayo Clinic Proceedings. For twenty months, Mayo’s division of neonatal medicine worked with six health systems to provide 84 newborn consultations using telehealth technology.

Dr. Jennifer Fang, a fellow in Mayo’s neonatal program, said, “Following a complicated delivery, a newborn’s outcome is associated with the quality of care provided during the first minutes of life. In Mayo’s telehealth study, the enhanced access to neonatologists – who could guide the local care team through the resuscitation – allowed one-third of the babies to stay with their families in the local hospital.”

Providers at the community hospitals gave the telehealth consultations high scores for clinical teamwork and quality of care. “These results speak to the acceptability and clinical impact of this type of telehealth project in community hospitals,” added Fang.

We’ll never know how many of these small town, one-in-a-thousand babies will grow up to become adults who change our world. But now newborns around the globe – in both rural and underserved urban locations – can get a better start thanks to telehealth. And their parents can breathe a little easier, too.

Telehealth Enters The Mainstream

We’ve all heard the term “mainstream media,” which differentiates network TV and the New York Times from, say, blogs intended for a niche audience. We often view healthcare in the same way, where primary care and acute care are the “mainstream,” leaving things like concierge medicine and palliative care on the margins.

For too long, telehealth has been relegated to the margins. Now it’s time to quit viewing telehealth as a boutique service for sophisticated consumers. In other words, it’s time to treat telehealth as just “health” – no different from any other form of medicine.

InTouch Health founder, Dr. Yulun Wang, has long emphasized that telehealth plays a critical role at every point in the care continuum. Just look at the continuum diagram above and you’ll see that telehealth is involved at every “mainstream” point possible – from intensive care to ambulatory surgery centers to rehab facilities, long-term care, pharmacies, and even the patient’s home.

That’s why it’s strange that some people still see telehealth as a niche service, useful only for someone who has a stroke while fly-fishing in some rural stretch of Montana. But the truth is that telehealth is becoming commonplace and ubiquitous, improving outcomes in inner-city clinics, urgent care offices, operating rooms, skilled nursing facilities, and a host of other places.

That’s about as mainstream as you can get. So maybe some day we’ll drop the “tele” entirely and start simply calling it “health” – safeguarded at every step by seamless technology.

Assessing Telehealth’s Value

A typical value-based care contract (VBC) is extremely complicated, but gauging the overall value something brings is much easier – and telehealth delivers amazing value.

Recently, at the American Association of Nurse Practitioners’ Specialty & Leadership Conference, family nurse practitioner Thanh Nguyen from Providence Health Express in Oregon noted that “we don’t know” what telehealth’s return on investment will be in the new value-based care model. Only about 40% of providers are even using VBC contracts, which means that six out of 10 providers are still using the fee-for-service approach.

But Nguyen is certain about one thing: telehealth is providing undeniable value every day. In her view, it’s saving lives and improving access to care while offering growth opportunities for nurse practitioners.

Nguyen feels that it’s now time for legislators and regulators to bring more telehealth value to clinicians – namely, getting paid for every hour worked.

In a recent speech, the American Medical Association’s immediate past president, Dr. Steven Stack, spoke about the need for a “quadruple aim”: adding “clinician satisfaction” to the current trio of improved access, better care and lower costs. “We need to restore joy to the practice of medicine,” he said – one way to do that is fair compensation for the long hours worked.

Current reimbursement policies don’t allow telehealth providers, like Nguyen, to get paid a penny for the time it takes to respond to patients’ emails. She’s licensed to practice only in Oregon and Washington, and she recently got burned by a Nevada patient who claimed to be visiting friends in Oregon. Ultimately, Nguyen had to waive her fee for the 20-minute session.

The healthcare industry’s journey to value-based care is a worthy effort, but it will only succeed when it brings real value to the clinicians who make it happen – and when it fairly compensates them for the care they provide via telehealth technology.

Survey Reveals Positive Views For Telehealth, Part II

From Ross Perot to the fictional J.R. Ewing from Dallas, business people rule the roost in Texas. And their powerful voices are providing strong tailwinds for telehealth in the Lone Star state.

The Texas Association of Business (TAB) recently published a report called “Telemedicine: The 21st Century Answer To The Call For Better Healthcare.” In our previous blog, we discussed why patients across Texas are pumped about the prospects for telehealth. Now let’s take a look at what influential business leaders are saying:

  • A Texas-size 77% favor using telehealth to diagnose common medical conditions.
  • 70% feel that access to providers has gotten more difficult in recent years.
  • 18% of Texas companies surveyed already offer telehealth as part of their health benefit programs.
  • Of that 18%, a unanimous 100% of the companies plan to continue offering telehealth benefits – and 24% plan to expand their current programs.
  • 66% received positive feedback on telehealth from their employees – and not a single employer received negative feedback.

States like Texas, California and New York are early adopters who greatly influence initiatives in the other 47 states. It’s not surprising that those three states have already passed telehealth parity laws, encouraging holdout states like Utah and Wisconsin to join their ranks.

When the Texas business community wants something, they get it – usually without delay and they’re demanding a wider use of telehealth technology. Why would J.R. Ewing drive from Dallas to Ft. Worth to see a specialist when telehealth is available?

Survey Reveals Positive Views For Telehealth, Part I

Texas has long been a bellwether state, just like California and New York. All three of those states have large cities plus sizable rural stretches. Think Houston/Amarillo, L.A./Modesto, New York City/Syracuse.

That’s why the new Texas Association of Business (TAB) report on telemedicine is so encouraging. Entitled “Telemedicine: The 21st Century Answer To The Call For Better Healthcare,” it provides ample proof that states with both megacities and wide open spaces are fertile ground for telehealth.

The report contains so much good news that we’re devoting two blogs to what it highlights: first from the patient perspective, then from the employer angle.

The report begins with a sobering overview of the current state of Texas healthcare, where physician shortages, rising healthcare costs and poor patient outcomes have become the norm. The report estimates that one-third of medical issues now resolved in doctors’ offices, urgent care clinics or EDs could be handled effectively via telehealth.

TAB surveyed 600 registered Texas voters to get their opinions on telehealth, and their answers may surprise you:

  • 70% of those surveyed favor the use of telehealth to diagnose common medical conditions.
  • 51% of those Texans feel that access to providers has grown more difficult in recent years.
  • 24% of rural Texans surveyed have to drive 30 minutes or more to visit a doctor’s office.
  • 23% of those surveyed have to wait 14 days or more to see their doctor.

The TAB survey shows that Texas patients are clamoring for fresh solutions like telehealth. To use a popular expression in the Lone Star state, they’re “chompin’ at the bit” for change.

In the next blog, we’ll discuss why Texas employers are equally excited about what telehealth can deliver.

How Telehealth Can Help Hospitals Manage Post-Acute Care Costs

HHS estimates that 25 percent of all Americans – and 75 percent of those over age 65 – are dealing with multiple chronic conditions like diabetes and congestive heart failure (CHF).

Hospitals and providers now share the responsibility for the total medical expense (TME) of these patients, yet up to 40% of those costs come in the post-acute phase. One key way to lower costs and improve outcomes is to integrate telehealth into a variety of post-acute care settings.

This year’s InTouch Telehealth Innovation Forum offered several blueprints for how to achieve this, including a presentation by Sue Thompson, administrative director for integrated care management at PinnacleHealth System in Pennsylvania.

In a pilot project at Pinnacle’s Colonial Park Care Center, Thompson’s first move was to narrow the network from 40 skilled nursing facilities (SNFs) to just five preferred providers. Each of them received an InTouch telehealth device to aid in things like wound and ostomy evaluations. Colonial Park’s readmission rate quickly dropped from 20%-plus to 16%.

Thompson feels that telehealth technology fosters a “we’re in this together” mindset across the care continuum. “SNFs are now facing the same quality metrics and value-based purchasing requirements that hospitals do,” she said. “All stakeholders are looking for ways to improve post-acute care.”

Thompson’s enthusiasm for telehealth was shared by presenter Barry Bittman, MD, CEO of the Institute of Innovative Healthcare. He used the hypothetical case of 87-year-old “Jennie” – a woman with diabetes and CHF who does well in the hospital but has difficulties in the post-acute phase, whether it’s a SNF, home health provider or simply at home alone. Bittman notes that telehealth can provide the hospital-caliber oversight that the Jennies of the world so urgently need. In his view, telehealth is the most cost-effective way to improve care coordination and reduce the number of costly 911-driven hospital readmissions.

A Porsche dealer wouldn’t dream of letting you drive off the lot without a plan for ongoing maintenance, education and support. Hospitals must likewise have a plan for post-acute care – one that relies heavily on telehealth technology.

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

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