AcuteCare Telemedicine Blog

Crossing the Point of No Return in the Delivery of Healthcare

For a number of years now, the prediction that telemedicine technology was on the verge of unabridged expansion has been as common as snow fall in the Rockies in January. But in reality expansion has always fallen short of the predictions.  At the beginning of each year loyal proponents touted that telemedicine would revolutionize the healthcare delivery model and change the way patients interface with their healthcare providers, only to encounter a number of stubborn road blocks that managed to slow the process of full utilization and implementation of the technology. This year, due to the convergence of more affordable technology and changing patient expectations, many industry leaders are once again claiming 2015 to be the long-awaited year of the break-out.

Telemedicine has been making significant progress in making specialized care, such as stroke and other neurological care, more accessible to patients who live in remote outlying areas not served by major urban medical centers. According to the American Telemedicine Association, more than half of all U.S. hospitals now use some form of telemedicine. But the full utilization and benefits of telemedical technology has been allusive.  Now there are several market and technological factors that could make 2015 the year that significant progress is achieved in the application of telehealth across all healthcare sectors.

With the predicted significant financial benefits and efficiencies for healthcare providers, insurance companies and ultimately the consumer, the global telehealth market is predicted to approach $27 billion by 2016. By 2018, it is expected that 65 percent of interactions with healthcare providers and organizations will be performed via virtual communication devises which will eventually be interconnected with an ever expanding array of mobile and wearable monitoring gadgets. Major healthcare players from pharmacy to health insurance companies and technology companies like Google are taking notice and making significant investments in telemedicine technology. Four factors that will insure expanded adoption in the coming year are beginning to come into focus:

Payment for telemedicine services. Government payers like Medicare and Medicaid as well as private healthcare insurers have broadened reimbursements for telemedical services. As payment barriers continue to be resolved utilization of telemedicine across the healthcare spectrum will advance more rapidly.

Market introduction of communication technology improvements. Advances in wearable technology will provide opportunities to interlink the monitoring devices with a comprehensive telemedicine communication system which will enhance remote diagnosis and virtual treatment in many cases. Long awaited improvements and increased adoption of electronic medical records (EMRs) will eventually benefit overall healthcare. By making patient medical history records easily and immediately available to virtual caregiver’s telemedicine services will have a greater opportunity to expand beyond the current limitations.

The consumerization of health care. Patient push-back over faceless physician encounters was once promoted as a formidable barrier to the implementation of telehealth. As patients became responsible for a larger share of their healthcare costs, tech user consumers began to embrace the convenience and lower cost provided by virtual remote care. From retail health insurance stores to health care kiosks in retail outlets, pharmacies and shopping malls, patients are embracing the concept of consumerization. The free market concepts that are already an established staple of other industry markets is turning the traditional delivery of healthcare into a business to consumer (B2C) model. Today’s healthcare consumers are increasingly setting the terms of service and expecting high-quality, personalized and convenient experiences from their healthcare encounters.

The state by state licensing of physicians has been a formidable barrier to multi-state expansion of telemedicine for years. “The morass of regulations and paperwork required by each state licensing board is a mountainous obstacle to efficient medical care throughout these United States. The recognition of multistate licensure would ease this restriction and improve access to experts for patients of all 50 states. I foresee the easing of these restrictions in the coming year,” says Dr. Matthews Gwynn, Director and Founder of the Stroke Center of Northside Hospital in Atlanta and AcuteCare Telemedicine CEO.

The long anticipated year of telemedicines break-out may finally be upon us. While many may find the new reality of healthcare delivery unsettling and disruptive, telemedicine may have finally crossed over the point of no return.

Preparing for the New Reality of Telehealth

A little more than a decade ago, telestroke and teleneurology were words that where not even part of our language but today are synonymous with the delivery of remote life-saving treatment for stroke and other neurological maladies. Telemedicine has provided vast improvements in medical care for our nation’s troops and veterans who are deployed in remote areas across the country and around the world, and is now poised to expand to a much larger telehealth initiative which promises to bring virtual, routine medical care to the home, workplace and public facilities of millions of patients throughout the country. With this expansion, telehealth will not only change the method of delivery of healthcare but proposes to alter the dynamics of the traditional caregiver/patient relationship. Yesterday’s patients are today and tomorrows consumers.

A new study from consulting company Oliver Wyman titled “The Patient to Consumer Revolution,” is revealing how empowered-consumers and outside industry innovators are influencing important changes to a centuries-old healthcare delivery model. “Empowering the consumer is what’s toppled many markets,” says Tom Main, partner at Oliver Wyman and co-author of the report. Companies like Walgreen’s, CVS, Google and Apple are beginning to enter what was traditionally an industry driven market. These new influencers are consumer experienced and able to successfully initiate telemedical products and services to a more aware and influential consumer.

In order to adjust to the new reality of virtual care delivery; hospitals, physicians and healthcare professionals across the care giving spectrum will need to alter not only their hard technology skills but learn new methods of personal interaction with their patients. Practitioners accustomed to performing good bedside manners will need to add “laptop manners” to their set of skills.

Relating to patients in person requires a much different approach than interacting with them virtually. Randy Parker, CEO of MDLIVE, a Florida-based telehealth provider says, “There’s a whole comfort level and professionalism involved (in telehealth) that many doctors don’t get, there’s even a dress code, and a way you present yourself” in a video encounter.” The new skills are not yet taught in medical school and few practitioners have yet had the opportunity to develop and fine-tune them in practice.

Peter Antall, medical director of the Online Care Group, says “Online doctors face two unique challenges that they don’t encounter in the exam room. First, they should have a familiarization with the technology they’re using, in case the patient on the other end of the encounter isn’t tech-savvy and needs help. Second, they have to learn “how to evaluate patients without the ability to examine by touch. Developing these skills requires a physician to be open minded and willing to learn and grow.”

It could be safe to say that very few healthcare professionals envisioned the disruptive effects the arrival of the internet, social media, wearable devices and mobile technology would have on the delivery of healthcare in the 21st century.

This Could be the Year the Predictions are Realized

Telemedicine has been around for nearly a generation but its universal adoption remains restrained and its best promises to revolutionize the delivery of healthcare unrealized. With each approaching year a prediction that “it’s time has come” echoes throughout the industry and each year the gap to full realization closes only incrementally.

For more than one generation now sweeping improvements in treatment and changes in how healthcare providers deliver their product and service has been a benchmark example of an industry experiencing continuous improvement. Even concerns over how telemedicine will handle the lack of a direct in-person physical examination, the management and maintenance of patients medical records and the assurance of follow-up patient care have been widely debated and in large part addressed by medical professionals with the implementation of standards, protocols and guidelines for the practice of telemedical care.

Private insurers are recognizing the potential benefits of telehealth to controlling rising costs and improving access to improved medical care. Federally funded Medicare and other state payers are deliberately moving to approve payments for telehealth services for many of their constituents and the Veterans Administration (VA) has shown leadership in advancing new communication technologies to improve access to specialized care for their veterans.

But the regulatory groups responsible for multi-state licensing continue to adversely influence the rate of expansion of telemedical care nationwide. Recent offers from state medical licensing boards to streamline the licensing process has left many to doubt the effectiveness these changes will have in removing the barrier to meaningful progress. Advocates of the traditional licensing procedures are quick to point out the importance of these procedures to patient safety and assurance of care quality. Opponents see their limited effort in changing the process as an attempt to preserve a regulatory function that is out of date with the reality of today’s global economic environment.

In an era where geographic lines and narrowly defined market distribution models have all but disappeared from nearly every other industry, the healthcare industry continues to struggle with outdated regulatory processes which impede the full implementation of the benefits of telemedicine.

If the shared goal of both proponents and opponents of change is to improve the quality and efficiency of medical care for all consumers, then why does a more dynamic solution to removing the licensing barrier appear to be so difficult?

The Building Momentum of Telehealth

Some proponents of telehealth are predicting that 2015 will be the year consumers will discover the convenience and cost benefits of accessing common health care through a virtual encounter. Telehealth has been reported to be on the precipice of rapid expansion for several years now, only to have the predictions fall short of expectations, mainly due to an established industry infrastructure that seemed to be well behind the present day technology curve. As service reimbursement, licensing and technical issues continue to fall-away many predict the time for a break-out in telehealth is upon the industry.

Entrepreneurs are taking the lead in providing opportunities for consumers to access common medical care services through virtual technology. More than 200 entities have entered the “doctor on call” market, connecting patients with a doctor for remedies for common every day ailments. In some parts of the country the service is becoming routine.This year more than 300,000 users will connect with a medical care provider over the internet, with that number predicted to grow to more than 7 million by 2018 as consumers discover the ease of use, convenience and lower costs. The initial concern that consumers would resist abandoning the traditional face-to-face office visit with their doctor has quickly dissipated as savvy; tech accepting consumers embraced the convenience of the new experience. The momentum continues to build, but is the other side of the doctor patient equation as prepared and eager to accept and embrace the new technological aspect of healthcare delivery?

For decades medical care has become increasingly industrialized and structured, primarily out of a need to control costs and manage available resources effectively and efficiently. The personal relationship between care giver and patient suffered as time was allocated to attending to increased numbers of patients. As primary care physicians integrate virtual encounters into their practice of care, the technology promises to provide new opportunities to once again place the relationship at the center of the care delivery. The addition of virtual encounters to the doctor/patient relationship promises many challenges to the largest and arguably the most important segment of the medical care industry, the general practitioner (GP), however, delegating the majority of follow-up or less critical visits to telecommunication may leave more time for developing the quality of the personal relationship through the face to face visit.

The clamor from the consumer is loud and clear but the growth rate of telehealth may be more dependent upon the medical professional’s willingness and preparedness to lead the way to the advancement of the new healthcare delivery model.

Your patients appear to be ready, are you?

Has The VA Been Telehealth’s Most Effective Proving Ground?

Every new product, marketing campaign, movie or television series has something in common. Each go through a period of trial and error to work out the specific details of the product or production where problems, glitches, barriers or creative faux pas are tweaked and corrected before making a debut to the greater community. Each new plane has its test flights; each new television series has its pilot episode; and every new product has its test market before being premiered to the whole of the world.

The Veterans Administration (VA) has long been out in front of the medical industry when it comes to providing remote monitoring and the delivery of virtual healthcare to it patients. Charged with healing a significant patient population afflicted with chronic illness, most living long distances from VA care centers, the VA may be the ideal proving ground for a new and revolutionary healthcare delivery model.

A new study published by Adam Darkins, Chief Consultant for Telehealth Services, and published in EHR Intelligence, highlights some of the results of the virtual healthcare programs first piloted by the VA. The study reveals that 11 percent of veterans received some portion of their care remotely in 2013, a growth rate of some 22% over the previous year. The VA’s telehealth programs include video interactions between caregivers and patients, remote monitoring of chronic disease, and teleradiology. A new program, currently under evaluation, allows veterans to access treatment for mental disorders like post-traumatic stress disorder (PTSD) from remote locations through a secure video connection. The challenge of connecting to patients residing away from regional care centers mirrors that of the greater healthcare community, where patients living in rural areas often have limited access to specialized chronic care treatment and facilities.

The confined organizational environment of the VA has allowed it to effectively navigate around several barriers that continue to frustrate the wider expansion of telemedicine in the private sector: Payment for telemedical services, limited or inadequate technology info structure, and the individual state licensing requirements of telehealth practitioners.

It appears that the VA has been a respectable micro test environment to develop, design, engineer and ultimately introduce virtual healthcare services. Dr. Darkins says, “Telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the health care system will dramatically change with the full realization of the ‘connected patient.’ The high levels of patient satisfaction with telehealth, and positive clinical outcomes, attest to this direction being the right one.”

Telehealth Takes Important Care To Veterans Through The VA

Even before the recent revelations of the administrative follies at the Veterans Administration (VA), it was common for each of us to know of a veteran seeking medical attention from a VA Hospital. Usually the discussion centered on the time it took the patient to travel to the nearest VA Medical Center, particularly for those patients living in more rural communities many miles from the urban centers where most VA facilities are located. It was even more difficult for those veterans who needed specialized care from a consolidated, regional VA Center located many more miles from their home, often one or more states away.

Despite today’s plethora of negative information coming from the embattled Veterans Administration, it appears that someone at the organization was doing something right in order to bring better and more accessible healthcare to our nation’s military veterans via telecommunication technology. The VA System seemed the perfect proving ground for implementing telemedicine on a larger scale. With patients scattered far and wide, doctors and caregivers were able to connect virtually with VA patients no matter how far they were from the hospital.

A recent review of the telehealth services initiatives at the VA indicates that more than 600,000 veteran patients received some element of their health care via telehealth in 2013. The patients represented 11 percent of the veterans in the VA health care system who participated in 1.7 million telehealth episodes of care. According to Dr. Adam Darkins, “telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the healthcare system will dramatically change with the full realization of the ‘connected patient’. The high levels of patient satisfaction with telehealth and positive clinical outcome, attest to this direction being the right one.”

Forty-five percent of the patients live in rural areas, limiting their access to VA healthcare. The number of veterans receiving care via VA telehealth services is growing approximately 22 percent a year. Telemental Health is one of the leading specialties provided through telecommunication. The VA has delivered 1.1 million patient encounters through 729 community based outpatient clinics since 2003 and in 2013 the VA delivered 278,000 Telemental Health encounters to 91,000 patients.

The use of TeleDermatology is up by 279 percent from its inception, treating more than 45,000 veterans. New programs under development include TelePathology, TeleWound care, TeleSpirometry and TeleCardiology. Dr. Darkins says, “Telehealth is often described as helping provide the right care in the right place at the right time, which translates into many veterans receiving care in their own home and local community. In doing so, telehealth often avoids the need to travel, but can also alert the VA that a patient needs to be rapidly seen in the clinic or hospital.

Based on this report, the agency’s telehealth initiatives are positively impacting veterans by providing quality and accessible care.

Diligently Working To Formulate An Interstate Licensing Solution

Representatives of the country’s State Medical Boards are persistently working on drafting new legislation to revamp the process of the state by state licensing of physicians. Currently physicians are required to be licensed in each individual state in order to practice across state boundaries. The individual state licensing requirement is widely thought to be a major barrier to the expansion of telemedicine.

The proposed plan is thought to offer the most dramatic changes in medical licensing offered to date and, if enacted, could increase access to doctors and specialists for patients located in rural areas and permit people with complex illnesses or rare diseases to more easily consult experts. The proposed interstate compact would speed-up the process of licensing doctors in multiple states while preserving each state’s authority to regulate the practice of medicine within their respective borders.

Under the proposed compact, doctors who meet certain standards could avoid the longstanding requirement that they apply for licenses state by state. The compact would be administered and enforced by an interstate commission consisting of representatives from each participating state.

Mari E. Robinson, executive director of the Texas Medical Board said, “The compact would make it easier for physicians to get a license to practice in multiple states and would strengthen public protection because it would help states share disciplinary information that they cannot share now.”

While the compact proposal is the most aggressive model for change to interstate licensing to date, some feel as though the effort stops short of resolving all the issues. Jonathan Linkous, CEO of the American Telemedicine Association, believes the Federation’s proposition does not go far enough. “Their model is not a reciprocity model,” Linkous recently told MobiHealthNews. “The physician would still have to pay a fee to every state, probably (also) a processing fee, and have a third party handle the paperwork, which may or may not be a good thing. And we don’t know if all the states will adopt it.” The ATA estimates that doctors currently spend $200 million to $300 million a year for multiple state licensing, an expense that contributes to the rising cost of medical care nationwide.

Participation in the compact would be voluntary for both physicians and state medical boards and would only become effective and binding upon legislative enactment of the compact by at least seven states. If adopted by enough states it would be a first step in removing a formidable barrier to rapidly expanding the use of telemedicine nationwide.