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Want To Cut Your Hospital’s Door-To-Needle Time By 13 Minutes?

There are times when 13 minutes can seem like an eternity, like when you’re sitting through movie previews in a theater. But in the world of stroke treatment, shaving 13 minutes off door-to-needle time is more like a heart-pounding Olympic event where every second matters.

Overlook Medical Center and Atlantic Health System in suburban New Jersey recently published a study in the journal, Stroke, which found that patients evaluated for stroke through the use of telehealth while in the ambulance en route to the hospital could be treated with the brain-saving drug alteplase 13 minutes faster than patients who were not evaluated in transit.

“Each passing minute of lost blood supply translates to more brain damage,” said John J. Halperin, lead study investigator and chair of the neurosciences department at Overlook. “Our observations suggest that in-transit telestroke services may provide a scalable, inexpensive way to expedite stroke treatment.”

In New Jersey, in-transit telestroke evaluations require close coordination between Basic Life Support (BLS) ambulances and Advanced Life Support (ALS) units. In Overlook’s service area, four ALS units were equipped with an InTouch Xpress telehealth device, which could be clamped onto BLS ambulance stretchers, allowing images to be transmitted by 4G wireless during patient transport. The stroke neurologist was able to instantly perform an evaluation in collaboration with the attending paramedics.

13 minutes may not sound like much, unless you ask a professional athlete or a stroke patient. For Great Britain’s Mo Farah, 13 well-planned minutes produced a gold medal in the men’s 5000-meter run in Rio. And 15 of the stroke patients in the Overlook/Atlantic study were also winners. They avoided possible death or disability by getting alteplase treatment 13 minutes faster than usual.

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

 

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

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

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

 

 

RPM Is A Proven Winner

How well does Remote Patient Monitoring (RPM) perform when it comes to increasing access, lowering costs and improving quality of care? Extremely well, according to last year’s joint research project conducted by the University of Michigan and University of Kentucky.

Lead researcher at the University of Michigan, Rashid Bashshur, Ph.D., and his associates narrowed the focus of the study to three chronic diseases: congestive heart failure, COPD, and stroke. The team sifted through more than 175 studies that looked at RPM from many vantage points: age, level of patient participation and whether the program was led by a physician or nurse.

The findings: remote patient monitoring and related telehealth services increased both access and quality of care while reducing costs.

This confirms the results of a study called CONNECT, which found that wireless remote monitoring of cardiac patients enabled clinicians to make informed treatment decisions 17 days sooner than with in-person visits alone.

Telehealth has come a long way since the Holter (cardiac event) monitor was introduced in the early 1960s. That device wasn’t portable and required the patient to remain in the hospital for monitoring.

As practiced today, RPM is a continuous two-way process, not just a periodic check-in. One recent RPM study found that diabetes patients showed improvements just by receiving and sending text messages to clinicians.

The word “remote” implies a cold and distant relationship. But with RPM, doctor/patient communication is now continuous and caring and it’s helping to significantly lower healthcare costs. RPM has proven ROI.

Remote Presence Monitoring

Female doctor using remote presence monitoring

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

2016 Telehealth Predictions

While some industries (like the petroleum business) are likely to have a dismal year ahead, the future has never been brighter for telehealth.

Here are some bold predictions from telehealth expert René Quashie, senior counsel in the healthcare practice at law firm Epstein Becker Green:

Strong momentum for licensure compacts – The Federation of State Medical Boards (FSMB) recently introduced an interstate physician licensure compact that 12 states have already enacted. And the National Council of State Boards of Nursing now has a draft compact that allows nurse practitioners to practice in any participating state with just a single license. Look for similar compacts to emerge in 2016.

Big Business buys in – According to the National Business Group on Health, 74 percent of large employers are expected to offer telehealth services in 2016 – up from 48 percent last year.

Telehealth accreditation takes off – Based on the groundbreaking accreditation programs from ATA and the Utilization Review Accreditation Commission (URAC), Quashie anticipates that health systems, health plans and telemedicine companies will develop additional telehealth accreditation programs in the year ahead.

Wearables market gains traction – Quashie notes that Soreon Research projects that the healthcare wearables market will hit the $41 billion mark by 2020. That will make it easier for telehealth clinicians to monitor conditions like diabetes, sleep disorders and cardiovascular disease.

Legislative progress continues – In 2015, more than 200 telehealth bills were introduced in 42 states. Look for more landmark legislation in the year ahead.

When you read Quashie’s full 2016 outlook, one thing is clear: telehealth is ringing in the New Year with industry-wide optimism.

Telehealth

Patient Access

 

 

How Telemedicine is Transforming Senior Health Care

How Telemedicine is Transforming Senior Health Care  

 

By Julie Potyraj – Guest Blogger

Polly, age 78, and suffering from obesity-related health issues, is sitting on her sofa on a snowy afternoon. At 3 p.m., it’s time for her wellness appointment. Polly turns on her iPad (supplied by her doctor’s office), and sees her physician’s face smiling back at her. The doctor has already received information on Polly’s blood sugar levels, heart rate, and blood pressure via a remote monitoring system that sends the data directly to his office. After chatting for a bit, Polly shows the doctor a mild rash on her arm. Upon evaluating the condition—made possible by high-definition video conferencing equipment—her physician recommends a round of antibiotics and transmits a prescription to the local pharmacy. Thirty minutes later, the appointment is over, and Polly hasn’t left the warmth and comfort of her home.

This scenario is not from some futuristic film—it’s telemedicine, and it’s gaining momentum in health care settings across the world. Also referred to as telehealth, telemedicine is defined by the industry as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” This is more than just a trend; 52 percent of hospitals already use remote technologies to deliver clinical services.[1]

The Impact for Seniors and Health Care as a Whole

For aging adults with mobility and transportation problems, telemedicine can offer a welcome respite from in-person office visits. Frequent doctor’s appointments become less of a strain for seniors as well as their caregivers, who often must take time off work to accompany their loved one.

The early intervention afforded by telehealth also helps prevent unnecessary emergency room visits and hospital readmissions. While this is good news for patients themselves, it also helps ease the burden on America’s health care system by improving efficiency and reducing costs. Consider the following real-world examples:

  • An Illinois-based skilled nursing home chain is using telemedicine to minimize readmissions and eliminate unneeded ER visits, saving the health system hundreds of thousands of dollars annually. Through this program, which involves using video teleconferencing to enable bedside evaluation by board-certified physicians, approximately 81 percent of patients using the technology can be treated on-site.
  • In North Carolina, telemedicine is helping seniors diagnosed with diabetes, COPD, and heart failure remain in their homes and out of the hospital for longer periods. This is accomplished by monitoring these patients remotely in between skilled nursing visits using specialized telehealth technologies.

Medicare is Warming to Telehealth

In 2015, the Centers for Medicare & Medicaid Services (CMS) delighted telemedicine advocates by adding seven new payment codes covering additional telehealth services, such as annual wellness visits and psychotherapy. However, there is still work to be done. In an effort to help all Medicare recipients enjoy the benefits of telemedicine, organizations such as the American Telemedicine Association continue to actively encourage CMS and Congress to eliminate the arbitrary restrictions that limit coverage.
Would you like to be on the cutting edge of telemedicine and other health care issues? Learn more about MHA@GW, the online master of health administration from the Milken Institute School of Public Health at The George Washington University.

 

[1] American Hospital Association. The Promise of Telehealth For Hospitals, Health Systems and Their Communities. Trendwatch. January 2015.

 

Telehealth for Seniors

Skilled Nursing Facility using telehealth