Posts Tagged ‘telemedicine’
In a previous blog post for Popper and Co, I discussed how telehealth can be a life-saving tool in rural and urban settings. As devices get more versatile and affordable, we will start seeing additional efficiencies in health care delivery. Moreover, patients will (if they aren’t already) start demanding it. But does telehealth work in every situation? And how should telehealth systems developers adapt to an individual practice’s needs?
The Center for Telehealth and Cybermedicine Research found that while enthusiasm for telehealth was high among patients and (some) caregivers, not every clinic could perceive a benefit. It is very easy, for example, to lose the advantages of this technology without first doing some preliminary research on your particular center and patients. Telehealth must be needs-driven, filling gaps in health services that are not effectively met.
In some cases, demand for telehealth may not be very high. If patients can find care at other facilities or may be reluctant to seek care for certain diseases, then telehealth may not be helpful. Similarly, if practitioners are reluctant to use telehealth tools, this reluctance may place such a system in jeopardy.
Electronic health record (EHR) integration can be one obstacle to telehealth (at least among practitioners). Aside from data security and confidentiality issues, practitioners perceive converting records to electronic format as a burden. However, conversion is becoming easier, and improvements in remote devices are allowing us to integrate many records and data of patient vital statistics into the system, including blood pressure, weight, oxygen saturation, etc. If developed correctly, EHR adoption, remote monitoring, and health information exchange (HIE) systems can be complementary to telehealth and improve efficiencies in provision of care, improve health outcomes, and reduce costs.
Reimbursement is another issue. A project conducted by our ophthalmology division screened patients with diabetes who were at risk for retinopathy. An eye specialist looked at retinal images with a camera that didn’t require eye drops (therefore, a highly skilled caregiver wasn’t needed at the patient’s location). Two hundred patients were scanned, and approximately 40 percent of them needed referrals. Of those referrals, 5 percent were in danger of going blind without immediate treatment. Here, telehealth provided better access, improved patient health, and reduced costs of care. Yet Medicare would not cover these types of diagnostic image interpretations (called “Store and Forward”) and related referral services, because it only covers that type of Store and Forward remote services in Alaska and Hawaii. On an optimistic note: Coverage requirements can change (in fact, Medicare has already changed coverage rules for some services)!
Other obstacles to telehealth success include:
- Not thinking about sustainability. Your program may have started out with a grant, but it needs to continue operating after the grant expires. Controlling technology costs is key, as is finding out which technology is most appropriate.
- What’s the best technology? It’s always changing, making it hard to know where to turn. And often, the latest tool isn’t the best solution for a specific practice or facility. At the Center, we are always helping end-users develop the right technology mix. Often, the right mix may have to be invented.
- Telehealth may not immediately fit into a practice’s workflow. If you only have one patient using your conferencing facility, that’s a problem. Reasonable volume is key to providing adequate return on investment, as is making telehealth systems scalable to incorporate other health services. You’ll need to develop a business operating plan stating how telehealth encounters will be scheduled, how to document each encounter, what you need to build and design, how many staff you need, and what your upfront and operating costs are.
- Lack of data. Make sure you document your encounters, and analyze whether your programs are successful. How many more patients did you see? What were the outcomes? What’s the impact on costs? This data also is crucial for systems developers to create the right solutions for telehealth.
Telehealth and information technologies are needed for healthcare reform in this country. It’s going to be an interesting time, getting people connected to care. But it’s the way we do it that’s going to make the biggest difference.
Do you work for a technology company that aims to make a difference in how telehealth is practiced? Are you a health care provider who believes telehealth can make a significant impact to your practice? What, if any, are its limitations? Please tell us what you think.
Tags: cybermedicine, health technology, medical technology, telehealth system developers, telehealth systems, teleheath, telemedicine
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In a recent Forbes article on the last FutureMed meeting in California, writer David Shaywitz expressed his concern that technology developers are more focused on their technology than with how it may be accepted by health care practitioners. But he also expressed hope that, soon, technology and the practice of health care might experience a meeting of minds (and possibly even hearts).
At Popper and Co., we make an effort to search for technology solutions that can truly make a difference in health care, and often we’ve been skeptical of the “latest shiny new thing.” While I believe that sometimes technology apps appear to be solutions in search of a problem, we are arriving at a point in time when a happy merger between health care and health technology may be feasible. Why?
- Because we (the scientific and technology community) now understand enough about biology to adapt technology to address real clinical problems. Our knowledge of genetics alone allows us to design targeted (i.e., “personalized”) therapeutic solutions.
- Because cost and resource constraints have led to patients being more engaged in the price and quality of their health care.
- Because consumer power has forced many practitioners (and technologists) to consider the “might” of this market.
- Because new technologies facilitate fundamental health service innovation for providers as well as patients.
In response to a related article by David Shaywitz, Popper and Co. strategic advisor Paul Sonnier had this to say:
While we need to be cautious about broad generalizations when it comes to digital health (which includes non-FDA-regulated consumer solutions) and the business sectors where it is having a direct impact, drug development – an area of focus in Mr. Shaywitz’s Forbes piece – is certainly seeing the integration of wireless technologies in a beneficial way. For example, new, “virtual clinical trials” enabled by smartphones and other apps allow patients to register and participate in drug trials without visiting a clinical site. Moreover, monitoring clinical trial participant compliance and relevant vital signs via wireless health devices can provide a greater level of detail and confidence in study data and conclusions, which is also of benefit in obtaining FDA clearance. DNA sequencing, too, which has been described as “bio-digital health,” allows for more targeted clinical trial participant selection and a movement away from population-based medicine. These examples alone illustrate digital health’s potential to improve biopharma’s bottom line and, ultimately, create better, more individualized health care.
Finally, here are some thoughts on the topic from Popper and Co. co-founder Ken Walz:
Many new emerging technologies have disruptive potential; including smart phones for clinical trials, remote diagnosis and data interpretation, for example. And there are some areas of health care in which patients and practitioners may be more amenable to adopting new technology. But not every part of medical practice is welcoming technology with open arms. It’s important to note that many of the areas that aren’t as accepting happen to be the more challenging areas of medicine. To assess the fate of all technology based on its current lack of proven utility in specific niches of health care may be setting the bar needlessly high.
In fact, targeting areas that are less “sexy,” but nonetheless important—e.g., process workflow improvement, better use of sensors, remote monitoring of patient compliance, and online appointment scheduling and lab result access—could deliver a great deal of value through new technology adoption.
Where do you see the most ideal matches between technology and health care? What challenging areas of medicine might be better postponing marriages with technology for another day? Do you have specific questions about the convergence of technology and health care that you’d like to pose to us? Share with us here.
Tags: bio-digital health, cyber health, digital health, digital technology and health, health technology, healthcare technology, telemedicine
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Wireless technology is evolving in positive ways. It’s now more affordable, more accessible (thanks to broadband capacity), and more portable (via devices such as tablets and smartphones). And it is no exaggeration to say that this technology has made a life-saving difference for many patients who otherwise would not get care.
At the Center for Telehealth and Cybermedicine Research at the University of New Mexico, we studied the ability of telehealth tools (e.g., video connections, conference calling, electronic record sharing) to improve access and outcomes of rural New Mexicans suffering from a variety of health problems. In that role, we have been the incubator for several applications of telehealth designed to integrate the technologies that address important healthcare needs and gaps in access. One example was hepatitis C. While this disease is curable, multiple treatments are required and patients must be monitored for adverse effects. Project ECHO (Extension for Community Healthcare Outcomes) was initially incubated in our Center under the leadership of Dr. Sanjeev Arora. That project was recently published in the New England Journal of Medicine demonstrating how the program provided community healthcare providers with the expertise and tools they needed to treat hundreds, if not thousands, of people who previously were receiving no care for hepatitis C. In addition, outcomes of these remote patients were as good as outcomes of patients who traveled (often hundreds of miles) to the University’s medical center in Albuquerque.
This model was successful enough that it is now being expanded into other treatment areas, such as cardiology, rheumatology, and even adolescent psychiatry. For example, adolescents on Indian reservations, who have very high rates of suicide, are benefitting from counseling. Once the patient and practitioner are familiar with the technology, online counseling sessions are very similar to face-to-face encounters.
In addition to improving patient outcomes and access to care, telehealth can reduce costs in the clinic. At the University of New Mexico, our head of neurosurgery worked with The Center to set up a system where surgeons could view patient CT scans through a secure web portal. Because of this system, 44 percent of risky patient transfers were avoided, simply by looking at the scans remotely before surgery.
In rural New Mexico, the access improvements of telehealth appear obvious (though telehealth doesn’t work in every situation, an issue I’ll discuss in a future post). But the technology can also work in urban areas, bypassing transportation and traffic congestion problems by bringing virtual care to the patient. This is health care where it’s needed, when it’s needed.
One effect of health care reform that isn’t making headlines is that increased demand for services will be placed on a limited resource: existing health care providers. But telehealth systems will help meet this new demand by providing services to nearly everyone. For example, Dr. Arora, one of the few liver specialists in New Mexico, stated as we helped start his project that he couldn’t personally treat the 30,000 New Mexicans with hepatitis C at that time. But with the help of specialists—such as Dr. Arora and his team—at the touch of a button or the click of a mouse, community practitioners can readily access experts.
What do you see as the limitations of telehealth? Is rural New Mexico a truly unique niche for this technology? In my next post, we’ll discuss the importance of setting up an operating plan, and more cost-cutting benefits of telehealth. In the mean time, if you have any questions about my telehealth study or work, please post them here.
Tags: cybermedicine, health technology, medical technology, teleheath, teleheath study in New Mexico, telemedicine
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There’s a definite romance developing between pharmacy outlets and medical organizations when it comes to consumer-driven opportunities in health care delivery. We’ve continued to watch Medco’s foray into genetic testing, which lingers on with all of the predictability of a clumsy first date. Then last May came the relationship between Johns Hopkins Medicine and Walgreens. And recently, we learn of Rite Aid’s Partnership with OptumHealth to provide straight-to-the-doctor online video consultations at its Detroit locations.
Of all of these relationships parading around the consumer dance floor, it may be the Rite Aid deal that makes a real impact, especially on how medical institutions compete in the marketplace. Rite Aid intends to use telemedicine—which is not a new concept but one whose technology has certainly come of age—to have consumers interact in real-time with physicians and nurses. This brings up a host of questions concerning how primary care physicians may need to re-examine future business models. And what about ERs and walk-in clinics? Will this be the final test whereby online services trump the hassle of a noisy waiting room?
It remains to be seen whether we’re witnessing a new era in primary care, but one thing is for sure: the front line of consumer-based medicine is playing out on the retail floor and change could come quickly. Rite Aid has more than 4,700 stores nationally and is one of our largest national chains. If this venture is successful and implemented in other markets, there will be an impact and frontline medical providers will need to be prepared.
What are your thoughts about the use of telemedicine and its impact on the future of patient care? Will our growing comfort with online social networking accelerate this trend? What are the potential drawbacks, or even serious consequences, of consumer reliance on on-demand video consultations? We’d welcome your input below.
Tags: on-demand video consultations, online medicine, online video consultations, Rite Aid, Rite Aid telemedicine, telemedicine
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I had the very fortunate opportunity to meet with Dale Alverson, M.D., Medical Director of the Center for Telehealth and Cybermedicine Research at the University of New Mexico and current President of the American Telemedicine Association (ATA). Dr. Alverson has been instrumental in bringing telemedicine to New Mexico for the last several years, and is now actively engaged in bringing telemedicine to the rest of the world.
Telemedicine, defined by the ATA, is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status. Closely associated with telemedicine is the term “telehealth,” which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health (including patient portals), remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth.
Dr. Alverson presented at the ATA’s Fourth Annual (2010) Mid-Year Meeting in Baltimore this past September. His presentation was entitled “The Perfect Storm.” He described significant changes occurring – and which will continue to occur – given the current conditions in the U.S. healthcare system and the convergence of some key elements within, including:
- Need for effective and affordable health care
- Need for access to care
- Integration of new and emerging technologies
Following are excerpts from my interview with Dr. Alverson:
Q: What is the significance of telemedicine?
A: Telemedicine is becoming a standard of care and is utilized in many healthcare programs including early detection and early intervention programs.
There is evidence that telemedicine/telehealth programs have favorable outcomes. One example is the success of a program in New Mexico called the ECHO (Extension for Community Healthcare Outcomes), which is led by Sanjeev Arora, M.D. This program has shown improved outcomes for patients with hepatitis C infection who may not otherwise be able to receive the care and treatment needed for their condition. Through the ECHO program specialists collaborate with healthcare providers in rural areas of New Mexico and provide quality healthcare to patients living in areas where access to care may otherwise be limited or nonexistent.
The ECHO telemedicine model has reached beyond the treatment of hepatitis C to address several other chronic illnesses. Additionally, the program provides rural practitioners access via videoconferencing to a much larger professional community enabling the rural practitioners to enhance and expand their skills.
One of the major funding sources for the ECHO was from AHRQ (Agency for Healthcare Research and Quality, Dept of Health and Human Services) under THQIT (Transforming Healthcare Quality through Information Technology).
There are many other projects developing across the U.S. and many new and innovative technologies in the market. During this time of urgency to create change in healthcare, there are also many unsolved issues that need to be addressed as telemedicine becomes a standard of care.
Q: What role does the ATA play?
A: The ATA is the leader in telemedicine. The organization began in 1993 with the purpose to create standards, guidelines, and policies and to serve as a resource to distill information to its members. The ATA works in collaboration with several federal agencies, such as the FDA, FCC, CMS, VA, DOD, as well as with international stakeholders, industry, and others involved in healthcare.
Q: What questions still need answers before the full potential of telemedicine can be achieved?
A: We need answers to questions such as:
- What are the best devices to use given there are so many and that the technology is changing and improving everyday?
- Who is reviewing the data coming through the device?
- How is the data acted upon?
- What will be done with the data?
I was fortunate to talk to Dr. Alverson, a thought leader in telemedicine, and I look forward to sharing additional insights from this rapidly evolving and important segment of the health care sector.
Do you feel there are other related questions that should be addressed? If so feel free to make suggestions here, and stay tuned for more information on this critical topic.
Tags: ATA, Dale Alverson, health innovation, healthcare, mHealth, patti doherty, public health, telemedicine
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