Telehealth impacts ROI, patient safety

Feb. 27, 2018
Lou Silverman, Chairman & CEO, Advanced ICU Care

Company overview
Advanced ICU Care is a provider of 24 x 7 x 365 tele-ICU clinical services in the U.S. With over 12 years of experience in high-acuity telemedicine, we help deliver the new standard of patient care in more than 65 hospitals and 25 states nationally. Our team of U.S. board certified intensivists, advanced practice providers, and critical-care-registered nurses use a secure, constant stream of patient data and two-way audio/visual technology to provide care from one of our nine integrated care centers.

Security concerns
Understandably, security is on the minds of all constituencies in healthcare. At a very basic level, we are sensitive to eliminating any concerns that patients or providers might have that we are “big brother.” While our service is “always on,” our utilization of in-room cameras is guided by well-established protocols. Patients, their families, and bedside providers always know in advance when we are enabling our in-room cameras, and none of our camera interactions are recorded.

In terms of data security, we have earned and maintained continuous SOC2 and Joint Commission certifications. We have made significant and continually increasing investments in our technology infrastructure and related security systems and procedures. We employ state-of-the-art technologies internally, and top-rated third party partnerships in furtherance of our data security goals and objectives.

We believe constant vigilance and proactively scaling investments in this area to be integral to our strategy and approach.

Interoperability challenges
For the duration of our 12-year history, we’ve addressed interoperability and overcome the associated challenges. We integrate with, and concurrently operate on, all of the major inpatient EMRs, and over our growing client base, must manage a rapidly expanding array of technology platforms, policies, and environments, as well as a wide range of data security, passwords, authorization, and authentication protocols. We view the interoperability expertise we have developed as both an important operational necessity and a significant competitive advantage.

Rakhee Langer, Business Lead, Patient Engagement, eClinicalWorks

Company overview
eClinicalWorks is a cloud-based EHR, with more than 130,000 doctors and nurse practitioners, and 850,000 medical professionals using its solutions worldwide. With the evolution of medicine, access to care is expanding with healow TeleVisits, providing patients with live video visits. Leveraging the power of the eClinicalWorks EHR, TeleVisits is fully integrated offering all information submitted or shared by patients using this solution can be imported into the EHR.

New technologies
eClinicalWorks V11 will be paving the way for the evolution of EHRs. V11 will transform healthcare, delivering cutting-edge technology while continuing to reimagine the EHR. The version upgrade enhancements will include the creation of a truly connected office, one in which providers, staff and resources function as a single, coordinated team focused on delivering quality care, including healow TeleVisits, designed to help providers improve their workflows. V11 will also feature eClinicalWorks Virtual Assistant (EVA) which helps providers and staff organize their schedules, make sense of the growing volumes of data, and use their time and resources more efficiently.

Interoperability challenges
With direct access to patient records, TeleVisits provides the same level of care as a typical office visit. Direct integration with the EHR, provides access to all available patient information, including lab results, discharge summaries from hospitals, and access to previous visit notes. eClinicalWorks customers can seamlessly integrate with both CommonWell Health Alliance and Carequality Interoperability Framework with a self-service option to ensure they have more complete and accurate patient information at the point of care.

Mike Baird, CEO, Avizia

Company overview
Avizia partners with providers to deploy and power systemwide telehealth. To do this, Avizia combines a collaborative approach with a telehealth solutions suite that scales across the continuum of care.

Since 2013, our mission has been to make telehealth more efficient and accessible. We do this by helping healthcare organizations and patients reap the most important benefits of telehealth, including greater efficiencies, lower costs, and high-quality care.

Avizia’s telehealth platform offers an end-to-end solution designed to enable comprehensive, integrated and effective telehealth across all clinical-use cases and points of care. Our platform includes software, mobile applications, virtual care devices, and a provider network. It is compatible with major EHRs, connects industry-leading video devices with software and mobile apps to streamline care coordination, while encouraging provider collaboration and patient engagement.

Cost and billing challenges
We see some uncertainty on the part of healthcare providers in terms of how to bill for telehealth, amid the larger shift from volume- to value-based care. Providers want to know: Do they bill per telehealth episode, at the same rate of a visit? What types of telehealth visits will a payer reimburse? Is it better to think of telehealth as a value-added service, complimentary to patients? As our 2017 Closing the Telehealth Gap survey noted, providers are unsure about the finances: 41% said reimbursement was a barrier to implementation, the top obstacle they cited among provider organizations surveyed. Providers also said program cost (40%) and clinician resistance (22%) were major factors. Only 11% of providers cited patient resistance as a major barrier.

The good news is that we’re seeing new regulations that suggest that payer coverage of telehealth will expand. Bills introduced in 2017 to expand telehealth access include the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, and the Creating Opportunities Now for Necessary and Effective Care Technologies (Connect) for Health Act Of 2017. We expect to see more legislative action in 2018.

As virtual interactions between providers and patients become more mainstream, some of these questions will have clearer answers.

Meanwhile, payer reimbursement is constantly evolving too, as Medicare and private insurers evaluate potential cost savings of telehealth, versus traditional care modalities.

Cost and billing challenges have always existed, with or without telehealth. Payers are always changing their policies in efforts to save on costs, and patients are taking on increasing responsibility for their own care.

The future of telehealth
We feel extremely positive about the future of telehealth, in terms of its ability to make a profound impact on patient care. When we think about the greater historical context, it’s a bit mind-boggling, too. As recently as 10 or 15 years ago, a patient who lived in a small and rural community would have to drive hundreds of miles to receive any kind of specialist care. So many patients with life-threatening emergencies waited hours to be seen in emergency rooms. And by the time they would be seen, their condition often deteriorated considerably. That’s the opposite of today’s approach, which is centered on patient engagement, quality, and efficiency. As value-based care continues to grow, telehealth will grow in tandem, as it continues to prove itself as an essential component of patient care—especially in rural or underserved communities.

In five years, we believe that every telehealth and IT vendor in the marketplace will be focused on interoperability in order to meet provider demand for a ubiquitous health experience, and the industry’s demands for efficiency and better care coordination. Telehealth will be perceived as less of a supplementary, or add-on, service, and more of a tool that supports best practices in healthcare.

In 10 years from now, we believe that nearly all healthcare facilities will have either leveraged some kind of systemwide telehealth platform, or will be actively seeking ways to leverage the technology—either as an on-demand service, or in the ER setting, or some other way.

In 20 years, as costs continue to rise, a greater number of healthcare providers (not just physicians and NPs or PAs, but health aides and medical assistants, too) will be seeking new applications for telehealth—ways to use it more tangibly to examine, diagnose, and treat patients. For some patients, telehealth may replace many of the in-person primary-care services they receive.

Roy Schoenberg, MD, MPH, President & CEO, American Well

Company overview
American Well provides both technology and clinical services to healthcare institutions around the nation (payers, delivery systems, employers, and government) allowing them to extend the healthcare they do in-person onto online channels. Powering over 200 familiar brands of telehealth services, American Well technology reaches over 135 million Americans, serving them in their homes, workplaces, retail locations, physician offices, and the full spectrum of acute and post-acute care facilities. Our goal is to extend the best of healthcare via technology.

New technologies
Our focus has always been, and will continue to be, on the telehealth experience and its value to the different stakeholders we serve—patients, providers, and insurers. As such, we carefully vet, and bring into the fold those competencies that we believe expand what telehealth can do. On the consumer level, this means seamless integration with their phones (e.g. Samsung, Apple), wearables (e.g. Apple Watch) and dedicated home healthcare devices (e.g. Medtronic, Philips). It means massive expansion on how we allow providers to be available to patients by opening up telehealth inside their EHRs, building our telehealth into other systems (i.e in the form of software development kits), and opening up the door to private practice specialists to begin offering their services on our telehealth eco-system. Above all, we invest in connecting it all so telehealth can deliver on its promise of expanding the reach of quality healthcare. Our exchange infrastructure allows anyone using American Well technology, in their phone, home, workplace, medical practice, or hospital to connect with one another for the delivery of live healthcare services. If you stop and think about this for a second, it closely resembles what online retail has done, but in healthcare. The technologies we build or incorporate today serve this transformative vision of tomorrow.

Joel Friedman, Ph.D., Director of Outpatient Services, Center for Family Guidance

Company overview
InSight is a telepsychiatry service provider organization with a mission to transform access to behavioral health care through innovative applications of technology. The InSight team has been providing telepsychiatry services in a variety of settings since 1999. InSight designs and runs scalable telepsychiatry programs to help our partners meet immediate needs, anticipate future hurdles, and track quality services over time.

The InSight team is rapidly growing and proudly serves hundreds of organizations of all sizes across the country. Our team currently employs several hundred psychiatric prescribers with specialties across the spectrum of behavioral healthcare. InSight’s telepsychiatry providers are overseen by a team of clinical leaders and supported by administrative, technological, educational, and provider engagement teams to help ensure that our clinical team does not feel as though they are working in isolation from the rest of our team.

Inpathy is the name of both our direct-to-consumer division and the platform that is used to deliver telepsychiatry and telebehavioral health directly to individuals in their homes or other private spaces. The Inpathy model allows individuals to receive therapy or medication management services without having to leave their homes. Inpathy was developed in partnership with WeCounsel several years ago, and has continued to roll out features and improvements to enhance the experience of users who are accessing care in non clinically supervised settings.

Overall benefits
There are many important benefits of telehealth. First and foremost, telehealth provides increased access to care. In areas and states where there are limited health resources and a shortage of providers, accessing the appropriate care in a timely manner is difficult. Improving access to care through telehealth can be particularly powerful in the field of mental health, where there are many shortages, especially for certain specialists. For instance, 96%1 of US counties have unmet needs for psychiatric prescribers and all 50 states2 have a high or severe shortage of child and adolescent psychiatrists. With telehealth, the small number of health care providers and specialists who are available can offer care to anyone regardless of their location. It allows people, often in great need of immediate assistance, to receive the help they need when they need it most.

Convenience and flexibility are other benefits of telehealth that you will hear about, especially when it comes to direct-to-consumer care. Consumers are often able to schedule direct-to-consumer telehealth appointments at a time that is convenient for them, and they are able to access the appointment from the comfort of their home, workplace, school or any other private space. This flexibility also means no travel time to get to an appointment, no waiting rooms, and no need to arrange for child-care or time off work or school. An often overlooked barrier to behavioral healthcare is the reluctance of some consumers to endure—what is for some people—the anxiety-provoking experiences of being in a waiting room. Due to their particular conditions, some behavioral health consumers may find the waiting room to be either overwhelming or a place that can exacerbate some of their symptoms. Some individuals may also want to preserve the confidentiality of their treatment and may find sitting in a waiting room to be a challenge to maintaining the privacy of the fact that they are seeking treatment.

There are also benefits from the provider perspective. Telehealth enables providers to expand their reach beyond their offices and to serve populations of consumers with whom they may not otherwise be able to work. Many telehealth providers enjoy an improved work/life balance by being able to work from home. We have found that this benefit can help keep providers in the workforce longer. For example, many providers will continue to work via telehealth as they raise young children or continue to see patients even after they have semiretired and moved to a different state. Keeping these providers in the workforce longer is helping to ease the behavioral healthcare workforce shortages.

From a systemwide view, telehealth has been shown to reduce the cost of healthcare, increase efficiencies and improve outcomes. In the world of telepsychiatry, one commonly cited study3 was conducted by the VA. That study evaluated the outcomes of approximately 100,000 veterans who used telebehavioral health services. The study found a 25% decrease in psychiatric admissions among veterans who utilized telebehavioral health services.

Evie Jennes, President & Chief Commercial Officer, swyMed

Company overview
At our core, swyMed is a real-time video software company. Our “special sauce” is our unique ability to transport, manage, and present a high-quality, secure data stream using whatever bandwidth is available whether it’s 60kbps or 4Mbps.

Telemedicine consults require simple, fast and highly reliable connections. However, many solutions fail even when hard-wired in a hospital. swyMed’s solutions expand the reach of telemedicine to places where it was previously unavailable. We do this by leveraging our patented data transport protocol, which overcomes traditional connectivity issues (such as latency or packet loss) to deliver real-time video telemedicine encounters in even the most difficult environments.

swyMed’s DOT Telemedicine Backpack is a truly mobile telemedicine solution for Mobile Integrated Healthcare (MIH). It is a mobile, enterprise-grade communications hub, which gives care providers in remote clinics, or even patient homes, the ability to connect to doctors for real-time video telemedicine, anywhere, any time. It changes the outcomes and economics of healthcare by giving providers the ability to assess and monitor patients in an ambulance (for mobile telestroke or critical transports), facilitate community paramedicine programs, prevent unnecessary and expensive emergency transports, and much more. The DOT Telemedicine Backpack leverages multiple carriers, allowing us to greatly extend the reach of telemedicine.

swyMed’s newest product, the DOT Mini, has the same connectivity capabilities as the DOT Telemedicine Backpack but does not have the portability of a backpack. The DOT Mini has a smaller form factor that can be built into an emergency vehicle, cart or building and hidden out of sight. The DOT Mini is also ideal for schools, rural clinics or any facility lacking the connectivity infrastructure to conduct telemedicine visits.

Overall benefits
In the U.S. alone, 1.1 billion face-to-face medical encounters are conducted per year. With a growing physician shortage, significant doctor time is wasted driving between clinics or to outlying areas or filling downtime when a patient misses an appointment. Separately, patients often face long wait times, take time off work, drive long distances, or simply forego care until there is a crisis because of the challenges of time and distance. Telemedicine programs address these challenges by increasing the availability of healthcare services where and when they are needed. The programs are given names like MIH, community paramedicine, mobile telestroke, home health visits, and more, but the basic idea is to get the best-trained eyes to where they are needed in the most convenient care setting for the patient.

Telestroke is a prime example that illustrates the benefits of telehealth. The Centers for Disease Control and Prevention (CDC) states that stroke is the nation’s number five killer and a leading cause of serious long-term disability. For these patients, every minute matters, and a delay in care greatly increases the risk of brain damage and long-term disability. In rural areas, many hospitals don’t have a 24-hour neurologist on hand to make real-time assessments, and a third of patients live more than an hour from a Level I or Level II trauma center with stroke specialists, so moving the patient to the treatment they need in the timeframe necessary is a logistical challenge.

Telestroke has become increasingly popular to address this problem because it gives neurologists the ability to remotely evaluate patients in real-time, leveraging advanced video telemedicine technology to provide diagnosis, direct emergency care teams to the best available facility and in some cases even begin treatment. Mobile telestroke takes that idea one-step further and beams the specialist into the back of the ambulance, enabling high-quality, real-time interactions between doctors and patients while en route to a hospital.

Tom Zajac, Strategic Executive Advisor, Population Health Management,Philips

Company overview
Philips is focused on transforming and empowering healthcare—our global solutions and services span the health continuum—across diagnostic imaging, patient monitoring, consumer health, and health informatics. A critical piece of this strategy is population health management. Combining data-driven population management solutions, hospital and home-based telehealth solutions, and a spectrum of data, analytic, and consultative services, we empower truly connected care to enable healthcare systems and clinicians meet the clinical, financial and human demands of the evolving, pay-for-value landscape.

Philips telehealth solutions are essential capabilities within our population health management strategy, connecting care and enabling collaboration between all stakeholders that touch a patient’s health—the clinician, care team, care givers, and the patient. Health organizations will continue to face mounting pressure to improve quality of care while reducing costs. As a valuable component of this overall population health management solution, our integrated telehealth solutions bridge the gap between hospital and home, drive better care at lower costs, and keep patients engaged in their recovery. That creates a continuous care path—improving monitoring and compliance of health needs, identifying and proactively addressing the causes of re-admissions, and focusing not just on sick care, but true healthcare.

Telehealth limitations
One of the greatest challenges in population health is getting patients to be actively involved in their own health. Providers can create an ideal care plan, supply connected devices and support teams—but if patients and their families are unable or unwilling to actively participate in that care, the plan will have little value. An organization’s strategy must include evaluation of both social determinants and patient motivation—not only identifying impactful patients, such as pre-diabetics, but also motivatable patients who are willing to activate, coupled with supportive living environments.

Telehealth doesn’t replace a clinician and their expertise. Its role is to leverage, augment, and coordinate the care team and their ability to provide an optimal health journey.

Cost and billing challenges
A major current limiting issue within telehealth is determining the economics. The potential economic and quality benefits to empowering patients with telehealth solutions, and the economic and performance leverage created within the care team can be monumental. However, as always, determining who pays—whether it is the patient, provider, health system or payer—is a complex issue. Recent federal reimbursement changes for in-home monitoring is a start, but the entire continuum of community-based and telehealth services must be vetted, measured, and incented through the value-based care construct to move such approaches from the pilot stage.

Dave Skibinski, CEO, SnapMD

Company overview
SnapMD is a full-service Virtual Care Management (VCM) telehealth enterprise-software company, enabling healthcare providers to engage their patients via a comprehensive, secure, HIPAA/HITECH/COPPA compliant, and cloud-based telemedicine platform with powerful back-end systems to manage the digital healthcare continuum. SnapMD offers the software and services that healthcare providers need to improve access to convenient and effective care.

SnapMD’s private-label VCM platform includes all the features and functions needed to manage the digital exam room and reach across multiple service lines. The VCM’s architecture can be integrated to work seamlessly with existing—and future—systems. SnapMD offers 360° telehealth professional services including consulting, omni-channel marketing, analytics, equipment, and information technology across the continuum of care, helping providers to lead in the age of remote care.

Security concerns
As health systems continue to transition to digital records and care options, cybersecurity, especially when addressing HIPAA and HITECH compliance, is critical to protecting sensitive patient data. SnapMD understands the importance of cybersecurity and utilizes Microsoft Azure Cloud Services, which delivers next-level security and second-to-none healthcare regulatory compliance. Azure’s security protects against online threats via Microsoft Anti-malware for cloud services and virtual machines. The service’s Operational Security Assurance (OSA) builds on SDL knowledge and processes to provide a framework that helps ensure secure operations throughout the lifecycle of cloud-based services. Furthermore, Azure Security Center makes Azure the only cloud platform to offer continuous security-health monitoring.

Lee Horner, CEO, Synzi

Company overview
Synzi is a virtual care company, dedicated to providing better ways for you to engage colleagues, patients, and members—simply and efficiently. Over the past 18 months, our company has evolved amid a dynamic, ever changing healthcare industry. During that time, we have developed an integrated communication platform that goes beyond traditional telehealth applications to help healthcare organizations effectively engage patients across the continuum of care.

For healthcare organizations seeking to improve the timing and quality of care, Synzi helps providers conduct efficient and effective virtual consults and virtual visits with colleagues and patients/members. Our platform is equipped with a variety of communication modalities (including video, audio, email, and secure messaging) to optimize engagement, improve health outcomes and reduce costs. Providers can also use our platform to access specialists on-demand to provide diagnoses and decisions in emergent care situations. Moreover, the patient-centric platform offers all stakeholders the ability to add an interpreter to any conversation; text and email communications can also be translated in the patient’s preferred/primary language, as needed.

Interoperability challenges
The rural population has critical gaps related to healthcare. There are 2,157 Health Professional Shortage Areas in rural areas compared to 910 in urban areas. Almost a third of America’s hospitals are Critical Access Hospitals. According to the Rural Health Information Hub, 19.5% of rural adults describe their health status as fair/poor vs. 15.6% of their urban counterparts. Rural residents have more frequent occurrences of diabetes and coronary heart disease than non-rural areas. Given their remote location, rural populations may experience difficulties in securing reliable transportation and traveling considerable distances in order to reach a provider or a hospital.

Given these challenges, rural communities can benefit from widespread deployment and usage of virtual care. Traditional healthcare settings (such as hospitals and medical offices) are insufficient to meet the increasing needs to provide rural residents with access to better and more convenient care. Healthcare organizations can use virtual visits to augment and accelerate their current methods of delivering follow-up care to rural populations.

While the broadband infrastructure continues to be built throughout the U.S., healthcare organizations can help rural populations leverage telehealth across mobile connections using Synzi’s cutting-edge platform. Designed to run on commodity devices and connections, our platform enables providers to deliver high quality virtual care within the context of existing devices and infrastructure.

In order to provide all populations better access to care, healthcare organizations should not be stymied by the limitations of today’s broadband situation. Mobile connectivity, as in the case of Synzi, can be reliable for timely, quality video visits. Providing timely and quality care via a cellular connection can be critical for rural patients who may experience geographic isolation when trying to obtain convenient care. It is expected that continued investments in adoption of broadband infrastructure will eventually help bring more care to at-home patients, such as those in rural communities.

Further thoughts
Technology is advancing, impacting the way we live, and presenting new opportunities to improve the delivery of healthcare. Virtual care provides additional options in terms of how, when and where care can be delivered. These solutions will continue to enhance the overall timing, quality and comprehensiveness of healthcare delivered, improving both patient satisfaction and health outcomes. At some point, the “tele” of telehealth will not be necessary and the use of virtual care will be inherent in our healthcare system.

Alan Roga, MD, President, Health Systems Market, Teladoc

Company overview
Teladoc is a provider of virtual healthcare delivery services, transforming access to care around the globe and tackling the biggest cost drivers in healthcare.

For the health system market, we provide a fully configurable, private, labeled solution that is backed by comprehensive operational support. As the health system industry continues to realize the value of telehealth for their organization, we tailor our solutions to align with their strategic goals, having partnered with more than 200 hospitals and health systems around the country to help build their business and brand.

Telehealth limitations
Too often organizations think of telehealth only in terms of technology and not as a strategic delivery platform for care. As my colleague Dr. Hollander, associate dean for strategic health initiatives, Sidney Kimmel Medical College at Thomas Jefferson University, has stated, “telemedicine is not a stand-alone intervention.4” At Teladoc, we’re focused on improving the healthcare experience by redefining what care can be provided in a virtual environment. That means going beyond single-part telehealth, to provide a comprehensive virtual healthcare delivery platform that addresses the full continuum of care. By providing quality care that combines data analytics, AI and EHR integration, we’re solving health systems’ and businesses’ largest organizational objectives.

While telehealth can’t currently fix broken bones or suture stiches, we envision a world in the not-too-distance future where you can get answers to an array of healthcare needs from cold and flu, to behavioral health, to cancer and heart failure, even surgical consults—all from one single access point.

The future of telehealth
In some ways, the future of telehealth is the present. We expect every hospital in the country to have at least one application of telehealth in place, and our data suggest that 76% of health systems will be having or implementing telehealth by the end of this year. With health systems treating a wider variety of conditions, expect telehealth to help hospitals to attract and retain patients through new service offerings, going beyond the point solutions like tele-stroke and tele-rehabilitation to wide-scale use. We also expect hospitals to expand the use of telehealth to their own employees and outpatient care. The promise of further interoperability and data analytics will also aid clinical decision-making, as physicians are able to get a complete picture of their patients’ healthcare history. As virtual care delivery is embraced at scale, we’re removing “tele.” This is healthcare.

References

  1. https://www.semanticscholar.org/paper/County-level-estimates-of-mental-health-profession-Thomas-Ellis/a0fa07523183680555bfb661fae62966a6d52843
  2. https://www.aacap.org/aacap/Resources_for_Primary_Care/Workforce_Issues.aspx
  3. https://www.ncbi.nlm.nih.gov/pubmed/22476305
  4. http://www.telemedmag.com/article/bring-telemedicine-researchers/

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