AcuteCare Telemedicine Blog


Study Reveals Application of Telemedicine Delivers Positive Outcomes

A recent study by The Agency for Healthcare Research and Quality (AHRQ) entitled Telehealth: Mapping the Evidence for Patient Outcomes from Systematic Reviews, indicates that that the application of telehealth delivers the most positive outcomes when used for remote patient monitoring, the treatment of several chronic health conditions and for psychotherapy as part of overall behavioral health. The leading chronic conditions, for telehealth success was cardiovascular and respiratory disease, according to the AHRQ study. The study’s authors also said that “research into practice-level implementation should be the next step, particularly since the vast majority of research conducted to date has been conducted within old and possibly soon-to-be-outdated care delivery models.”

The purpose of the study was to provide an overview of the large body of data about telehealth for use by healthcare decision makers. The approach used was to create an evidence map of systematic reviews published to date that assess the impact of telehealth on clinical outcomes. According to the report, the focus of future systematic reviews could include telehealth for consultation, uses in intensive care units and applications in maternal and child health. In addition, telemedicine for triage in urgent or primary care, management of serious pediatric conditions, patient outcomes for TeleDermatology, and the integration of behavioral and physical health were earmarked by AHRQ as ripe for analysis.

Healthcare remains a system where service is delivered primarily through in-person interactions, but many hospitals, physician groups and clinics as well as tech-savvy patient/consumers are turning to telemedicine to effectively and efficiently deliver and receive healthcare services regardless of their geographical location. The rise of utilization of telemedicine is one of the largest and most disruptive shifts in healthcare delivery over the last decade. With recent advances in telemedicine technology, an impending evolution in legislation governing the use of telehealth and falling regulatory barriers predicate that 2016 may be a turning point for the increased adoption of telemedical technology in the delivery of healthcare across a full spectrum of healthcare disciplines.



Continuity of Care in Telemedicine

Continuity of care is a fundamental factor in the delivery of quality healthcare and a bedrock principle of the patient-doctor relationship. It is understood to be a critical element in all health care systems and has shown to be responsible for reducing hospitalizations and lowering costs, particularly among chronically ill patients.

Traditionally, continuity of care is the delivery of a “seamless service through integration, coordination and the sharing of information between different providers.” The increasing complexity of healthcare delivery is complicating the assurance of continuity of care. Virtual interactions between patient and caregiver and a plethora of health related monitors, devises and mobile apps, has some believing the increasing complexity in healthcare delivery might impede the achievement of continuity of care. Even in a traditional face-to-face care relationship, it is common to have more than one care provider across the process of diagnosis and treatment. Add options like retail clinics, e-visit websites, smartphone apps, freestanding urgent care centers and kiosks and continuity of care could be compromised by all the disruptive innovation.

For this reason much debate about telemedicine and the effect it is imposing on healthcare delivery has been centered on the doctor/patient relationship and the adherence to maintaining a high standard of care, regardless of the method of interaction. While the importance of the patient and physician in the new electronic relationship is well understood, there is a third component essential to the successful integration of telemedicine. The ability to access patient’s medical information is critical to extending continuity of care for patients as well as improving transparency between telemedicine providers and healthcare organizations.

AcuteCare Telemedicine (ACT), the leading practice-based provider of telemedicine services for healthcare organizations for stroke and other neurological care, is providing technology enabled services to healthcare providers for the delivery of high-quality clinical care virtually anywhere, anytime. ACT has been on the forefront of the use of this technology for years, remotely delivering live and interactive Telestroke and other Teleneurology assessments to patients at hospitals and emergency medical centers throughout the nation. At Bon Secours Neuroscience Institute in Richmond, Virginia, Patricia Lane comments on their collaboration with ACT, “I just love the technology and clinical solutions platform. It allows for continuity in communications from doctor to doctor and permits the real-time sharing of information between care-givers. Our ultimate goal is to provide a better treatment plan for each patient.”

Integrating telemedicine connections into a secure electronic medical record system designed with familiar digital formats, functions and cutting edge security measures in order to ensure the highest level of patient confidentiality will be essential to insuring quality and continuity of care and answer much of the concern over the new disruptive healthcare delivery model.



Telemedicine Achieves Its Potential for Parkinson’s Patients

Ask any patient suffering from chronic disease and they often will tell a story of isolation, uncertainty and frustration over the debilitating effects of their disease. Many times the focus of their complaints is not being afforded easy access to specialized care and consultation with caregivers. While significant inroads have been made in the treatment options for chronic maladies like Diabetes and Parkinson’s disease, gaining routine, daily access to those ground breaking discoveries is out of the reach of many sufferers.

Researchers are looking at how modern communication technology, coupled with the latest techniques in treating Parkinson disease, can revolutionize the quality of care for sufferers of the chronic neurological disorder. “We are looking at quality of life, quality of care and reducing the burden on healthcare providers”, says Dr. Ray Dorsey, co-director of the Center for Human Experimental Therapeutics at the University of Rochester (N.Y.) Medical Center. “Imagine if you thought there was a possibility you had Parkinson’s disease, but you lived 100 miles or more from the nearest medical center with a qualified neurologist. You’re faced with at least a couple of hours of driving, of navigating an unfamiliar urban environment, of parking and walking—and that’s assuming you’re able to find a neurologist within driving distance to begin with. Now think about how easy it is to buy a book or a pair of shoes online. The two should not be so different.”

Preliminary results of the Connect.Parkinson project, the nation’s first randomized clinical trial of remote treatment of Parkinson’s disease, indicate the benefits of virtual treatment for patients and caregivers alike. A recent report on the initial results of the 18-state, Connect.Parkinson project reported that 95 percent of Parkinson’s patients completing telehealth visits have experienced an increased proportion of the time with a healthcare professional of 89 percent; up from 25 percent for those opting for traditional in-person encounters.

The National Parkinson Foundation is committed to supporting efforts to demonstrate how telemedicine can enhance the delivery of care to people with Parkinson’s. Studies are indicating that telemedicine care, often delivered in the patients home, is just as good as care received at a brick and motor medical center. The fact that diagnosing and monitoring the progression of Parkinson’s disease and other movement disorders is based almost entirely on visual observation makes Parkinson uniquely suited for virtual care technologies. Christopher Goetz, MD, a leading expert on movement disorders and director of the Parkinson’s Disease and Movement Disorders Center at Rush University Medical Center says, “Ninety-five percent of the information I gather is visual. Thus, with telemedicine visits where I can see and hear my patient right in front of me on the computer screen, there is no decline in the quality of information I gather.”

Rush is located in the state of Illinois which is among those states not yet mandating payers to provide payments for telemedical services. But according to Dr. Brian Patty, Rush’s chief medical information office and chairman of Rush’s Telemedicine Steering Committee, the Medical Center has several telemedicine pilot projects underway that can likely have significant impact on Parkinson patients.

In New York, researchers at The Rochester Center for Human Experimental Therapeutics, are developing and testing mobile apps that will help Parkinson’s patients track metrics such as dexterity, balance, gait, voice patterns and cognition, then send readings to researchers.

After decades of promises, telemedicine is delivering on its promise to increase access to quality, specialty care to improve patient outcomes.



Paying for the Promises of Telemedicine

Telemedicine is living up to its hype on revolutionizing the healthcare delivery model. With many of the most formidable barriers to increased expansion being overcome, virtual technology is quickly becoming a preferred method for patients when connecting with their care provider. New advances in hardware and software coupled with faster digital info structure, is driving more and more healthcare professionals to electronic communications. Patients are warming-up to using new devices to relay their blood pressure, heart rate and other vital signs to their doctors so they can manage chronic conditions in the comfort of their home.

Healthcare providers, payers and governmen supported healthcare programs are recognizing the potential cost savings of telemedicine technologies. However, payment policies for telehealth services, while expanding quickly, continue to be inconsistent and are discouraging the progress towards realizing the full potential of virtual healthcare. Providers are eager to embrace telehealth. A survey of more than 1,500 family physicians conducted for Anthem and the American Academy of Family Physicians (AAFP) found that “almost 90% of respondents would use telehealth to help treat their patients—if they were compensated for that care.” Richard Bakalar, MD, managing director at KPMG and a member of the firm’s Global Healthcare Center of Excellence says, “Healthcare providers need to figure out how to become more efficient and the technology behind telemedicine allows caregivers to connect with patients remotely, efficiently and effectively.”

Currently payments for telehealth services are as far flung as the 50 states landscape. New rules for Medicaid managed care and MACRA are becoming telehealth-friendly, but Medicare and Medicaid reimbursements are spotty, with Medicaid payment varying greatly from state to state. Today, 48 states and the District of Columbia provide some form of Medicaid payment for telehealth services, according to the National Conference of State Legislatures. Commercial insurers seem to be embracing telehealth but consistency of payment policy remains elusive. In just over half of the states and the District of Columbia, private insurers are answering the call of parity laws that require them to pay for telehealth services. Payment parity is important for providers because it protects them against arbitrary cuts in reimbursement for telehealth services as compared to services provided in-person.

While expansion of virtual technology continues to progress at a steady pace, solutions to resolving remaining barriers like payment for services, multistate licensing, credentialing, and regulation are evolving at a deliberate pace.



The Marriage Between Technology and Telehealth Providers

Telemedicine is fast becoming the most promising break-through in the delivery of healthcare in the last century. While the promise has many championing the cause for expanded and universal use, some challenging hurdles remain in the way. Legislatures and medical boards are busy modifying regulations, payment structures, licensing and credentialing at various pace but one particular road block could derail the telehealth train if a workable connection is not soon found.

The video connection with the doctor is meeting the patient’s expectation for quick healthcare, but the process can often be overwhelming to providers who must sync the new service to their existing EHR platform. The key to a solution lies in creating a new virtual care environment within the providers existing EHR. James T. McElligott, MD, medical director for telehealth at the Medical University of South Carolina, is among a handful of health systems around the country that are pioneering virtual visits on a sustainable and scalable platform. “If you try to do something outside of that platform, there are downstream effects that end up making things very difficult” for the provider.

While some of the industry’s largest providers of EHR platforms have been slow to answer the call for a solution, smaller companies are making the connection happen for an increasingly larger number of provider clients. “We see time and again that workflow integration and ease of use are crucial factors to physician adoption of telehealth technologies,” Eran Westman, Vidyo CEO.

In a recent article by Eric Wicklund and published in mHealth Intelligence, titled “Virtual Care Within the EHR May Be a ‘Game-Changer”, the author reports on how some innovative companies are integrating creative solutions to the challenges presented when attempting to marry telemedicine services and existing electronic health records (EHR).

The idea of an electronic medical recording system was imposed upon an unprepared and often reluctant provider market several years ago. Many of the early glitches’ and bugs, that traditionally come with the roll-out of any new software system have been addressed, but the memory of the “fixing” process is fresh in the minds of many early users, leaving them less than enthusiastic about integrating still newer technologies into their daily routine.

It is becoming very clear to many in the healthcare industry that the once casual attitude towards telemedicine is changing as more and more applications for telecommunication technology in the delivery of healthcare become a reality. The disruption will continue. Telemedicine and EHR’s are not going to go away. Negotiating a workable union may indeed be the all-important game-changer for expanding telehealth.



The Era of Resisting Telemedicine is Fleeing

Despite the promise of significant consumer benefits of access and costs and the overall growth of Telemedicine, many patients and physicians are slow to adopt new communication technologies in the delivery of healthcare. A recent article in Medical Economics News reported that “A HealthMine Survey of 500 consumers who use mobile/Internet-connected health applications finds that 39% still have not heard of telemedicine, and only one-third of respondents say their health plan offers telehealth as an option.” And while many patients have not yet signed on to telehealth services, nearly three quarters of patients are interested in using it in place of in-person medical appointments. Could it be that the slow progression of patient participation may be due to resistance and lack of participation from care providers?

One of the most prolific reasons many providers resist the technology is the concern that patients would be unwilling to replace traditional face-to-face physician encounters with a virtual relationship and that many consumers would be fearful of the technology, particularly those among the growing number of “Baby Boomer” patients. But in a recent Georgetown University study, the results indicated that more than half of the aging generation preferred to use this technology. And among those 34 years of age and under, 60 percent desired a virtual interaction with their physician.

Some of the complaints from cautious physicians revolve around the complexity and cost of technology hardware and software and the difficulties in merging new platforms into existing operations, particularly syncing virtual experiences with current EHR systems. Ongoing design improvements in the technology and simpler user interfaces are driving down cost and simplifying required functions. The reality today is that telemedicine improves the bottom line for most medical practices while reducing appointment management and patient flow issues.

As legislatures across the country continue to make progress on modifying existing regulatory barriers and concerns involving payment parity, payer participation and individual state licensing and credentialing, many early telemedicine supporters are beginning to see the light at the end of the increased adoption tunnel. For those providers who continue to resist the trends of virtual medical technology, the time is nearing to overcome the natural tendency to resist and fear change. The simple truth is patients prefer and want telehealth choices and the technology is here to stay.



What’s In Your Digital Health Tool Box?

The early implementers of telemedicine faced resistance, skepticism, and predicted peril from an industry that has followed a standard of care, governed by regulations. Those initial trailblazers have prevailed in their efforts to improve access to specialized care for patients living afar from major medical centers, enhancing patient’s healthcare experiences and reducing the unnecessary cost of specialized treatment and ongoing chronic care. Their persistent efforts to merge the latest digital technologies in communication with modern medical care has spawned new terms to languages all around the world; Telepsychiatry, Telestroke, Telemedicine, TeleICU and Telehealth, just to name a few.

Technology is having a wider impact on how healthcare providers connect with their patients and dispense treatment. This connected health revolution is making everyone active participant’s in their healthcare through an ever expanding network of devices and platforms. But as is often the case, development of new technology can outpace the ability of an industry and their consumers to accept and engage the new methods.

Consumers have demonstrated an impressive demand and utilization of digital healthcare tools like activity trackers, smart watches and their accompanying health apps, but nearly half of the users complain that their caregiver is failing to integrate the data into a personalized healthcare plan. A survey, conducted by HealthMine, called “The State and Impact of Digital Health Tools,” found that “a significant amount of digital health data is not reaching doctors or health plans and that there appears to be a disconnect between where consumers would like their self-collected health data to go and how easy it is to share it.”

Many physicians articulate an understandable concern about the accuracy of many of these devices and the process of collecting and transferring the data. In a recent article Vaughn Kauffman, a global practice leader in PwC’s Health Industries Advisory, indicated that physicians have some apprehension around taking in data from mHealth devices and wearables. “Some providers are further down the road than others around utilizing these kinds of data for engagement. There’s the potential to extend the doctor-patient relationship to beyond the direct doctor visit interaction. And obviously, this would involve individuals opting in, as opposed to kind of a Big Brother phenomenon.”

While wearables continue to be popular, many once avid users are discontinuing their engagement with the technology. Some indicate their waning interest is due to not understanding how the data collection will benefit them or enhance their digital health plan. Education and better understanding of the technology and how it can benefit both providers and patients in improving the delivery of healthcare will solidify the acceptance and use of the technology. The early pioneers of telemedicine have opened the trail to a much larger spectrum of services but wider engagement is still dependent on the ability of technology to deliver on its promises.




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