The consensus among physician and healthcare IT leaders who met at the New York Health IT Summit to discuss the newly emerging telehealth paradigm was pretty clear—telehealth will change how physicians practice medicine, and healthcare organizations beginning to test the waters now will have a competitive advantage in the future.
The panel discussion, held at the Convene conference center in New York City's downtown financial district, was part of the New York Health IT Summit, sponsored by Healthcare Informatics, and included industry leaders familiar with telehealth platforms: Rahul Sharma, M.D., emergency physician-in-chief, division of emergency medicine, New York Presbyterian-Weill Cornell Medical Center; Mony Weschler, chief and senior director, applications and innovations strategy, Montefiore-Information Technology, Montefiore Health Systems and Todd Ellis, managing director at consulting firm KPMG. The panel discussion was moderated by Healthcare Informatics Editor-in-Chief Mark Hagland.
Framing the current telehealth landscape, Hagland said in contrast to 20 years ago when telemedicine was primarily considered a technology to connect rural physicians to urban specialists, today telehealth has not only matured but is becoming integral to care and wellness for managing population health across regions and the community.
“We have had this emerging population health concept, and, at the same time, we’re also seeing an explosion in the evolution of consumer-facing devices and we’re also moving inexorably from inpatient to outpatient care, even into the home, so now we have an interesting convergence of all these concepts and now we are no longer talking about telehealth just for rural physicians,” Hagland said. “How do you see this landscape evolving and all these different concepts coming together?”
“It’s interesting when you look at the healthcare landscape and you take a closer look at CVS, Walgreens and Walmart as they are getting into the healthcare business. The demand is there on all fronts, from the physician perspective, from a patient perspective and from payers,” Ellis said.
There is a lot of research indicating the benefits to telehealth and telemedicine, Ellis said, and he cautioned that “those organizations taking the ‘wait and see approach’ need to re-look at telehealth and see how it can help them.”
Sharma with New York Presbyterian-Weill Cornell Medical Center said despite the passage of the Affordable Care Act which has enabled more people to get insurance and has resulted in a greater demand for primary care services, there also continues to be tremendous demand for emergency care services as well.
“Last quarter, we had the highest number of visits ever to our ER,” he said. “One thing that has changed dramatically in healthcare is that the government now is really focused on the patient experience and what patients say about their healthcare, and then linking it to financial reimbursements for hospitals. It matters what experience patients have.”
In order to provide patients who visit the emergency room more options for how they receive care, New York-Presbyterian health system launched, just two months ago, a digital health platform, called NYP On Demand, providing virtual emergency room visits with the goal of reducing wait times in the emergency department and providing patients more convenient care options.
“We launched a pilot telehealth program so when a patient comes into the ER, they have the option of a virtual visit through real-time video interactions with a clinician after having an initial triage and medical screening exam. So they go to a private room and see a clinician via a telehealth monitor,” Sharma said.
He continued, “The analogy we use is that years ago there were banks going up on every single street corner, and then the banks all put in ATMs. And people said that’s crazy, why go to ATM when can go to the teller? It’s the same concept. We’re allowing patients a choice in how they get healthcare.”
To date, there have been 160 patients enrolled in the ER telehealth pilot with average wait times of 30 minutes, from the time patients come in to discharge, Sharma said.
“Patients love it and we’ve gotten great feedback. We’re responding to what patients want and we’ll soon have an app,” he said. “In order to be competitive, if you’re not doing it, the competitor down the block is doing it as consumers are driving how they are seeking healthcare.”
Health systems also are partnering with pharmacy retail companies, such as CVS and Walgreens, to provide virtual care with a health system clinician when the on-site pharmacist is not able to provide appropriate care, Ellis noted. “The leading healthcare organizations are talking about access to care, and how do you get a patient into an organization. There are unique things that healthcare systems are doing now with those access points to get that patient into their respective organization.”
Regarding the policy landscape, Sharma said there is work going on behind the scenes at the legislative level to provide reimbursement for telehealth visits. “Under fee-for-service, telehealth is only covered if it’s in a rural area, or it’s a participating Medicare facility, but I think that’s going to change in the next several years or even in the next several months as more people are embracing telehealth because it’s cost effective and also it’s really about quality of care. If a patient goes to the ER, the minute they get admitted they have an increased risk for hospital-acquired infection. Telehealth is a great way to help prevent these costly hospitalizations.”
IT and Data Challenges
At the Bronx, N.Y.-based Montefiore Health Systems, Weschler leads IT innovations and applications strategy for the health system and Montefiore has developed a telehealth program for its home care patients with congestive heart failure and diabetes.
Speaking to Montefiore’s population health efforts and its telehealth technology platform, Weschler says healthcare leaders have learned important lessons about using data and developing data analytics.
“It’s all about the data, so the more data you have on a patient, the more you can have a longitudinal view, the better you can treat that patient. If a patient stays in our system, then we have data and we do very well. But if the patient leaves our system, then we need to fill in the gaps as there are holes in the data, and we don’t do as well, so we learned from that,” he said.
He continued, “We also learned to be very good gatherers. The presentation layer was lacking and the decision support machine learning behind the data also is lacking. So, for providers who spend 15 minutes with patients, how much can they consume from all that data gathering? Very little of it is consumed. At this point, we’re not good at percolating to the top the data that says, 'this is what you need to do, this what is actionable for you with this visit,' and that’s where we need to do more work on how we present the data.”
“We’ve also learned that we need to make this easy and very seamless for the physician,” he said. While most of these technologies can interface with the electronic medical record, he called on EMR vendors to “step up to the plate and make it seamless.”
“This has to become a seamless operation for patient and provider, and there’s an ability to improve on that. If those things doesn’t fall into place, then there’s going to be a lack of adoption both from the patient side and provider side,” he said.
The Future Telehealth Landscape
Weschler sees the promising potential for telehealth to disrupt healthcare and improve how care is delivered.
“This is the future, to use sensors, wearables and implantables, and the technology is being developed right now to enable continuous monitoring of the patient and to be able to do vitals and get real data from the patient, as that’s one of the last obstructions to telehealth,” he said.
He noted current developments on a medical device that will enable imaging of a patient’s ear so physicians can virtually diagnosis an ear infection. “That device will provide the physician the same quality of imaging as in the office and the physician will feel comfortable legally prescribing antibiotics. It’s coming and it’s here and it’s already being used in other countries. That’s the potential and the future we’re starting to see.”
And, echoing Sharma’s comments, Weschler says, “Organizations like ours, if we don’t step up to the plate, others will. And I agree with the bank analogy. And, with future generations, they might be never be inside a hospital, only the sickest patients will be seen inside a hospital, others will not.”
When panelists were asked for predictions regarding telehealth, Ellis said healthcare organizations testing the waters now will be better prepared to expand their telehealth programs. “You need to start thinking about how to use telehealth and your organization will be more mature and have a competitive advantage.”
“Telehealth and telemedicine is the future and the present of medicine,” Weschler said. “The military performs robotic surgeries on aircraft carriers and that’s happening on a daily basis. Being able to have a telehealth consult with a physician, having the right devices, a clinically validated device, that’s happening, and it’s what medicine is turning into. It’s not a technology issue, the technology is right here, it’s a cultural challenge.”
Ellis recommended that hospital and health system leaders need to develop a strategy to evaluate the value of telehealth at their specific organizations. “When understanding and starting a telehealth program, you need to ask where you want to be five years or 10 years from now as telehealth is going to be a critical part of value-based payment,” he said.
