Is telehealth – or telemedicine – finally about to break free of the return-on-investment concerns that hobbled its use? After all, many hospitals have been participating in a telestroke program either as a hub or a spoke member of a network for some time. Grant-funded services to improve rural health care have been operating for years, and remote services provided to the incarcerated is another well-developed program. At the same time, information software and hardware developments have spawned remarkable advances in monitoring technologies. This includes the use of wearable sensors, which gives both the telehealth and wearable sensor markets the potential for huge growth. Most telehealth services, however, have been developed in isolation from each other, often at the request of an individual clinician and with little strategic analysis. Is telehealth now an imperative service rather than a niche application?
Wearable Sensors Fuel Telehealth Growth
“Wearable sensors” previously referred to large, bulky devices that recorded vital signs as a patient lay in a hospital bed. Now, wearable sensor technologies for health care use are significantly smaller and allow both healthy individuals and sick patients to monitor vital signs from home and other locations. These sensors come in different forms, from wristlet devices to skin patches to head domes designed to track vital signs from the head. The market for health care sensors is expected to grow tenfold, from $3 billion to at least $30 billion, in the next five years. This anticipated growth can be attributed to a focus by companies on remote monitoring of specific diseases (e.g., diabetes, heart failure) to enable just-in-time health care management – if the data are actively monitored clinically so that timely action can be taken.
Getting a Grip on Telehealth Guiding Principles
While hardware, software, and individual niche uses are down in the weeds of telehealth, one question remains: Who is looking at the overall aims of telehealth in clinical care? With all the activities driving the explosive use of telemedicine, the American Medical Association (AMA) decided at its June 2014 annual meeting to approve a list of guiding principles. These principles are intended to help foster innovation in telemedicine use, protect the patient-physician relationship, and promote improved care coordination and communication with medical homes. The American Telemedicine Association, in partnership with another 12 organizations, is spearheading the development of telehealth coverage. It specifically calls for authorization of the following:
• The use of telehealth for all Accountable Care Organizations (ACOs) and bundled payment programs
• Telehealth payments for population health management to include all critical access hospitals and all federally qualified health centers (FQHCs)
• Remote patient monitoring for chronic obstructive pulmonary disease and congestive heart failure, and at FQHCs, remote monitoring for patients with diabetes
• The facilitation of care by allowing video visits and remote monitoring for Medicare patients such as those undergoing home-based kidney dialysis
Additionally, the Alliance for Connected Care is pushing lawmakers to allow telehealth services to be substituted for in-person care and that current Medicare restrictions on telehealth services be waived for ACOs. (The Alliance is composed of leading companies across the health care and technology spectrum, representing insurers, retail pharmacies, technology and telecommunications companies, and health care entrepreneurs.)
The future of telehealth programs looks rosy and may mimic successfully operated telestroke programs that have been in use for some time. Telestroke is the delivery of neurologic care via remote video conferencing from a neurologist at the base – or hub – site to patients in outlying hospitals – the spokes – who may be having a stroke. Telestroke is often viewed as the poster child for telehealth success by providers, payers and patients. Telestroke solved a particular need – coverage by an expert neurologist for hospitals that could not provide coverage 24/7. Regional programs using hospitals or a neurology physician group as the hubs have strived to improve stroke care.
Now, in addition to calls for payment reform from industry groups, more momentum has been shown by the Veterans Administration Health System (VAHS). It reports that in fiscal year 2014, it delivered more than 2 million telehealth visits to more than 690,000 veterans. Also, the annual cost of treating veterans via telehealth fell 4 percent between 2009 and 2012. VAHS has achieved scalability, and it is looking for more use of telehealth as it expands from fixed-based telehealth access sites to mobile programs using cellphones.
Google also announced it is conducting a trial of live-video medical advice. Google has partnered with several telehealth companies to provide the service to those online searching for medical information and to ensure that the participating clinicians are appropriately credentialed and licensed. While it does not offer live advice on every medical search, this basic telehealth application might break down barriers even further among the patient population.
So while telehealth barriers remain (e.g., reimbursement, licensure), the concept is beyond proof, even though hard evidence that it provides benefits for all clinical applications is not yet conclusive. Hospitals and clinicians are trying to figure out how best to proceed. In 2013, FDA and the Association for the Advancement of Medical Instrumentation held a joint Summit on Healthcare Technology in Nonclinical Settings. One of the summit’s chief messages was that new care locations enabled by advancing technologies like telehealth require new processes, practices, and products, not just those tweaked from traditional hospital care delivery processes. Any hospital with pilot telehealth programs has probably encountered this phenomenon – that modified traditional processes are not always the best solution. To develop best practices for telehealth services, processes need to be developed programmatically so that best practices can be easily shared.
One of these best practices relates to the technical platform used for implementation. Health care systems are realizing that one of the criteria for success lies in the software that supports the clinical workflow. As hospital administrators know from experience, one software platform will likely never be perfect for all clinical specialties and their appropriate workflows and documentation needs. Flexibility is needed and wanted. While the convenience of a single vendor/platform may look attractive from a telemedicine hub site’s perspective, it is not necessarily the best plan for telemedicine program development. Having a contractual agreement with just one telehealth platform supplier may not make sense to support all possible clinical applications of telemedicine.
As health care changes to a patient-centered model, which in turn drives many program development questions, health care leaders need to be ready to implement telehealth to improve patient care, optimize staffing and maximize what reimbursements are available for care provision.
This article is excerpted from ECRI Institute’s 2015 Top 10 Hospital C-Suite Watch List. The full white paper contains more guidance on telehealth and other novel, new, or emerging technologies. To download the full C-Suite Watch List, visit www.ecri.org/2015watchlist. For more information on ECRI Institute’s evidence-based health technology assessment or consulting services, contact communications@ecri.org, or call 610-825-6000, ext. 5889.
