Tips for giving your organization a telehealth checkup

March 30, 2017

Telehealth is fundamentally changing how healthcare leaders handle care delivery. In the ever-changing digital age, it’s important to stay current on telehealth as to not fall behind the competition and more importantly, to provide a higher level of care to patients and work toward improved interoperability within the healthcare system.  

With so many advances in telehealth technology, HMT asked a roundtable of relevant providers about their new technologies and costs as well as integration with EHRs and the billing process.

Increasing the availability of preventative and chronic care services outside the hospital

Manu Varma, Vice President and General Manager, Philips Wellcentive & Hospital to Home

New technologies
Philips is continuing to expand its solutions in population health management. By offering enterprise telehealth, home monitoring, personal emergency response systems, and personal health services that address multiple groups within a population, from intensive ambulatory care for high-risk patients, to prevention and personal health programs for the general population. Through its acquisition of Wellcentive in the third quarter of 2016, Philips seeks to increase the availability of preventative and chronic care services outside the hospital. These innovations complement our portfolio with cloud-based IT solutions to aggregate and analyze clinical claims and financial data across hospital and health systems to help providers potentially improve care delivery.

Additionally, with telehealth solutions for the hospital as well as the home, Philips is enhancing its tele-ICU solution, eCareManager, a 510(k) class II medical device, with a new form of graphic visualization of an acute population. This development is designed to enhance operational efficiencies for remote care teams, allowing one clinician to monitor care delivery for many patients at a time.

The cost
Working with a strong partner who has experience rolling out this technology and has a proven method of clinical process for telehealth program implementations can make a big difference. Philips partners with health systems to support them in improving their clinical and operational efficiencies, which ultimately can help to drive health systems’ return on investment. This is made possible through programs such as tailored ambulatory care, which feature technology-enabled, clinically transformative solutions targeted by population acuity.
Philips offers various models of payment including monthly subscription, financing, or capital models to flexibly support customer adoption of telehealth. Ongoing support for the telehealth program is complimented by Philips’ clinical program managers who work with each customer for the lifetime of the program.

Integration with EHRs and the billing process
Philips leverages the industry standard HL7 to support bidirectional interoperability with the nation’s leading EHRs. Philips recognizes the need for universal data access and aggregation and supports this approach with additional technologies that provide an agnostic aggregation of ambulatory data. Through a process of data normalization, Philips is able to drive toward connected health with the Philips HealthSuite, which supports any kind of connected device or mobile app and is backed by more than 10 years of experience.

Our primary goal is to help return value to the health system and improve quality of care. Philips recognizes an increasingly favorable climate for telehealth reimbursement as the efficiency of its use in chronic disease management continues to grow. Value-based organizations are developing continuum-based models of population health, wherein telehealth is becoming a standard of care to improve operational efficiency and reduce patient care costs.

Expansion of VCMnexus Developer Program

Dave Skibinski, President & CEO, SnapMD

New technologies
SnapMD recently announced the expansion of its VCMnexus Developer Program with the availability of new open-source Software Development Kits (SDK). Our SDKs make it easy for developers to quickly build new applications using SnapMD’s source code.

Through the VCMnexus program, we offer a set of API and SDK libraries for integration with third-party systems or development of complementary applications, providing access to more than 90% of our system functionality. SnapMD’s VCM system consumes its own APIs in order to efficiently interact with the core system, ensuring that these APIs are fully functional at all times. The unique advantage this offers to customers is that when they want to integrate SnapMD with their systems, the existing APIs are ready to be utilized, eliminating the need to develop new ones.

SnapMD will also be rolling out expanded financial modeling tools that will allow providers to set up various services models such as plans for employer-based health contracts, concierge medicine, and other subscription-based modeling.

SnapMD VCM

The cost
SnapMD offers seat-based pricing models and enterprise-level models for larger deployments. Our flexible pricing plans offer reasonable flat-rate models that are easy to budget and control. Prices vary depending on the size of the health system using the platform and the number of physicians and nonclinical staff utilizing the technology.
Integration with EHRs and the billing process

SnapMD’s Virtual Care Management private-label, cloud-based telemedicine platform was built for integration via APIs. Our HIPAA- and HITECH-compliant platform includes a set of API and SDK libraries to enable full integration with existing EHRs and other external systems such as insurance verification and e-Rx. SnapMD is also available on the athenahealth Marketplace and integrates with athenaClinicals. SnapMD is partnered with Redox to offer additional integration options to all of the top EMR/EHR platforms in the market as well.

Data integration issues, if any, always come down the client requirements and the two systems in question “talking” properly to each other. It’s always a two-way street. In many cases we see little to no issues, and in other cases we see more challenges. From SnapMD’s perspective, since our system is designed on a self-consuming API construct, our end-points are fully available systemwide. The costs associated with any integration vary based on the EMR provider and the integration solution our client desires. For example, there are no additional costs for athenahealth customers.

SnapMD recently announced the rollout of new service-type pricing management, which allows providers to create configurable pricing structures for patient care services, enabling them to define and bill different rates for different services offered through the VCM platform. This also empowers them to assign specific insurance codes and target appointment lengths to services for improved insurance verification. Clients wishing to handle billing with payors can pull all the necessary data out of our system to process in their respective practice management system. This can be done manually through our reporting engine, or a direct integration can be done via our API. There are no additional costs associated with utilizing our reporting engine. Direct system integration would involve some additional costs largely dependent upon the third-party system.

DOT Telemedicine Backpack enables better video quality, even over low bandwidth

Evie Jennes, Chief Commercial Officer, swyMed

New technologies
Regulations, reimbursement, and consumer acceptance have been just some of the barriers over the years to the wide scale adoption of video telemedicine. Fortunately, with time, many of those barriers are fading away, but one very challenging one remains—bandwidth to reliably conduct video encounters for live telemedicine outside the hard-wired four walls of a hospital or clinic.

swyMed is tackling this problem with its recently announced DOT Telemedicine Backpack that carries with it patent-pending technology enables exceptional video quality—even over low bandwidths. The lightweight, mobile telemedicine solution enables field care providers to conduct high quality, reliable, real-time video consults with physicians to treat patients in even the most remote areas or on the go. It includes antennas, redundant dual-modem connection, 15-hour battery, integrated speaker/microphone, two digital scopes, and a ruggedized sunlight-readable tablet with full HD camera. The company’s technology has been used in home health, EMS/critical transport, telestroke, and mobile integrated healthcare programs.

DOT Telemedicine Backpack from swyMed

The cost
By allowing providers to assess and monitor patients in an ambulance, facilitate paramedicine programs, and prevent expensive and unnecessary emergency transports through the use of the DOT Telemedicine Backpack, swyMed is enabling care delivery models that improve outcomes and reduce costs.

We have a subscription model with new hardware if the contract is renewed and a straight buyout option should our customers have capital they need to raise. With the buyout option, the monthly fee is one third less than the subscription-only rate.

Integration with EHRs and the billing process
swyMed’s DOT Telemedicine Backpack is fully secure and provides interoperability with existing EHRs as well as EMRs, PACS, and certified third-party diagnostic equipment. We use HL7 protocol to communicate with EHRs and can also do a deep integration. The HL7 is a recurring monthly fee, where the deep integration is a one-time fee. Price depends on what is needed, but within the $10,000 range. swyMed is a provider of the Backpack, so we do not directly provide/bill for medical services.

Editor’s Note: Shortly after publication Evie Jennes was promoted to President and Chief Commercial Officer of swyMed.

Continuous, real-time workflow management

Gian Cavallini, Vice President of Strategy and Development, Advanced ICU Care

New technologies
To provide our specialized critical care services, Advanced ICU Care developed and operates a proprietary orchestration engine which handles connectivity, message processing, and workflow management across all partner hospitals as well as our eight worldwide care centers. The platform enables continuous and real-time inputs from a variety of hospital systems, including EHRs, bedside physiologic monitors, diagnostics, medication, and telemetry. It incorporates eCareManager from Philips to process some of the data and adds proprietary workflow management, per-hospital protocol customization, and clinical and management reporting.

The company recently announced its launch of a new telemetry service, which capitalizes on its capability to maintain and process continuous information flows to monitor patients at cardiac risk anywhere in the hospital.

The cost
The cost of tele-ICU care is typically borne by the hospital as a per-patient charge for each admission to the ICU. There is usually an initial system set-up fee as well as installation costs for equipment specific to the tele-ICU, such as the two-way in-room audio/video arrangement. Inclusive of all capital and operating costs, our experience is that tele-ICU care consistently delivers an ROI in the range of 200% to 600%.

Training on the tele-ICU relationship, its implementation, and its specific protocols and workflows is conducted as part of the initial implementation process as well as on a periodic, recurring basis.

Integration with EHRs and the billing process
It is critical for our tele-ICU platform to acquire data from the hospital’s EHR on a continuous basis. To that end, we have already interfaced with all of the major EHRs. Interfaces are developed and tested upon the initial launch of a hospital partner. As needed, EHR interfaces are updated and retested when a client upgrades to a new version of the EHR.

Our tele-ICU relationship with a hospital does not affect how a hospital’s physicians bill for their services. The cost of tele-ICU care is charged to the hospital on a contract basis. The hospital retains the primary patient relationship, including billing, and also is entitled to any associated insurance reimbursement. Advanced ICU Care does not get involved in patient billing or insurance reimbursement.

ProNet expands use of patient data in telehealth

Chrystal Adams, Associate Vice President, XIFIN

New technologies
XIFIN has developed an integrated platform called ProNet that expands the use of patient data in a telehealth environment to improve clinical decision making and support cost-effective, patient-centered care. ProNet allows hospitals and health systems to integrate and exchange diagnostic images from different modalities (e.g., X-rays, digital pathology slides) along with other clinical and patient encounter information into a live, shared clinical workflow. Clinicians use the telehealth capabilities to collaborate on complex cases, expedite treatment decisions, and increase efficiency in geographically disperse environments.

XIFIN ProNet also includes a universal image management system that can be fully integrated into a Laboratory Information System (LIS) workflow environment to provide telepathology and consultation capabilities locally and globally using digital pathology technology in a cloud-based platform. The integration goes beyond currently available interfaces to address use cases such as consultations, multidisciplinary team meetings, and integrated reporting seamlessly. The integrated LIS/universal image management system provides functionality for managing data, both DICOM and non-DICOM, across all case types complete with contextual information and a proprietary communications layer to enable clinical workflows.

The cost
Costs vary based on specific statements of work. Platform fees, specific module fees, and implementation fees may apply. There is no charge for integration within the product family.

Integration with EHRs and the billing process
XIFIN enables integration with EHRs via web services and HL7 interfaces. Where XIFIN is integrating with third-party systems, vendor cooperation is often required to ensure a bidirectional data exchange between HIT systems. In cross-vendor integrations, integration and implementation fees may apply for each vendor involved.

There is a monthly service fee for the integrated software platform that delivers universal image management integrated with the LIS for all data in the database, including upload, viewing, archival and retrieval, and security. Once a facility has the platform, they pay a monthly platform service fee and can add additional application modules as desired. In addition, one of XIFIN’s core competencies is lab billing and reimbursement. As such, the XIFIN platform can send telehealth billing codes along with quality measures to the EHR.

Expanding patients’ access to care with telehealth suite

Saurabh Singh, Director of R&D, eClinicalWorks

New technologies
eClinicalWorks is developing its telehealth suite to fully support healthcare delivery across care modalities to expand the patients’ access to care. With telehealth, care is delivered during real-time interactions to patients who are unable to travel to the office for a visit and allows staff to communicate with employer-health clinics and home health environments. Physicians can remotely deliver quality of care with the same clinical tools that are vital in traditional office encounters. Fully integrated into the workflow and schedule, the telehealth information is directly imported into the EHR, becoming part of the patient’s complete medical record.

The cost
Currently, each telemedicine encounter is $2.00 for clients who have already purchased the eClinicalWorks EHR. To assist with setup and integration, all clients are assigned a dedicated implementation account manager.

eClinicalWorks EHR

Integration with EHRs and the billing process
In 2015, eClinicalWorks launched a new cloud services platform, eClinicalWorks 10e, which integrates EHR, population health, and patient engagement in one single platform. Specifically, the platform integrates telehealth visits from within the EHR itself. Telemedicine enables providers to maintain a continuous medical record for a patient, consisting of in-office and telemedicine encounters. Additionally, health and wellness data from wearable devices can be fed directly into the platform, allowing physicians easy access to patients’ wearable device data eClinicalWorks offers an end-to-end solution for billing and collecting payments electronically. Patients can pay for telemedicine services through the convenience of the Patient Portal.

Cloud-based, cloud-architected solution

Alan Roga, President, Provider Market, Teladoc

New technologies
Teladoc has made significant investments in its telehealth solution for the provider market. Our solution is not only cloud-based, but cloud-architected, allowing healthcare organizations to implement and configure the platform to meet their business imperatives. Many of our clients see Teladoc as a strategic weapon that meets their clinical and operational needs.

As we continue to innovate the software, our enhancements center around two key areas; quality of care and patient engagement. One example is our multi-party video capability that we co-developed with hospital partners to infuse best practices. This allows multiple people—physicians, patients, families, and caregivers—to participate in the visit so that nonregistered users can join at the request of the patient and provider to create the best possible care experience. Innovations like our integration with the Kinsa thermometer help drive utilization, by using a ubiquitous device that brings clinical value. And lastly, our technologies enable health systems to integrate their advertising and branding into our virtual waiting room and message patients about particular health topics or services.

The cost
We offer a simple and transparent pricing structure. There are a flat annual license fee (not paid by seat or use case) and professional services fees that cover training and implementation, configuration, branding, and more. The value in what we provide goes beyond cost, as Teladoc remains committed to a quality experience, and that means offering physician training to ensure they are well-versed in the nuances of delivering telehealth services.

Integration with EHRs and the billing process
Teladoc’s integration ranges from CCD to bilateral HL7 integration and beyond. We have a dedicated integration team that is experienced with all major EHR vendors.  As with most anything in the health IT space, cost will depend on scope, what other systems are in place, and many other factors.

Our platform and technology are very adept and experienced with a range of billing processes. Teladoc has the infrastructure and experience to address multiple reimbursement models, and we have strong relationships with payers. We work across plan-sponsor, self-pay, and commercial billing processes and work to help our providers no matter the reimbursement. Teladoc also actively legislates on behalf of the telehealth industry to make progress in this regard.

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