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Reimbursements red herring, trust, and key infrastructure needs for Telemedicine success  

Reimbursements red herring, trust, and key infrastructure needs for Telemedicine success   | Healthcare and Technology news | Scoop.it

Telemedicine is a growing part of modern healthcare and could play a pivotal role in the U.S.’s efforts to streamline and expand preventative services. Virtual, video-based doctor’s appointments can help alleviate the general practitioner shortage and encourage preventative care. They also offer a cheaper, more convenient alternative to in-person appointments for many patients. Unfortunately, there’s a lot of hype and misinformation being reported so I was pleased to see that TechnologyAdvice (TA) surveyed 504 U.S. adults about telemedicine and their willingness to use such services. I think the results shed important light on where healthcare providers and telemedicine vendors still need to gain acceptance with patients so I reached out to Cameron Graham, Managing Editor at TA to see if he can give us the facts on the ground. Cameron heads market research for healthcare IT, business intelligence, and other emerging technologies and is uniquely qualified to help shed some light on the subject. Here’s what Cameron said:

 

1. It’s not just about reimbursements

Despite the promise of telemedicine, the vast majority of Americans still aren’t using such services. One oft-cited reason for this is the lack of insurance reimbursement for many telemedicine procedures. While some private insurers will cover telemedicine, many only cover select types of visits or specific applications. Medicare, for instance, covers face-to-face interactions, but only when the originating site (point of care, not the patient’s home) is in a Health Professional Shortage Area (HPSA). Although coverage is slowly improving in many states, the American Telemedicine Association gives just five states (plus DC) an A grade in coverage and reimbursement.

 

However, the current hodgepodge of reimbursement rules is not the only thing holding back telemedicine from widespread use. An equally important factor is likely Americans general comfort with video-based platforms and their trust in remote appointments. According to our study, less than half of adults (44.9%) said they would be comfortable conducting a doctor’s appointment over video. Only 35.3% of respondents said they would choose a video appointment over an in-person one. Until patients are more comfortable with the notion of remote care, it is unlikely that telemedicine will gain significant traction.

 

In order to facilitate acceptance of telemedicine among Americans, providers and vendors need to work on educating patients about the benefits of such systems. Telemedicine vendors, in particular, should help patients navigate the complex reimbursement rules currently in place, and promote the cost-savings of remote appointments. By doing so they will not only gain brand awareness among patients but will be able to recruit patients as advocates for more comprehensive insurance reimbursement policies.

 

2. Trust is a key component of effective telemedicine

Americans are not only hesitant about scheduling telemedicine appointment, they are also sceptical about diagnoses made through video platforms. Forty-five per cent of respondents said they would trust a virtual diagnosis less than one made in person. An additional 29.3% said they simply would not trust a virtual diagnosis. This suggests there is a distinct lack of trust among Americans in the quality of medical services that telemedicine platforms can provide.

 

Much of this scepticism is likely due to a lack of familiarity with the services. It also reinforces the fact that telemedicine providers must earn patients trust before they can effectively increase adoption rates. Once that trust is established, it appears people are far more likely to consider using remote appointments. While initially, only 35.3% of respondents said they would choose a virtual appointment over an in-person visit, 65% of respondents said they would be more likely to conduct a virtual appointment if they have first seen the doctor in-person.

 

It’s unlikely that providers or vendors will be able to dramatically change such preferences given the personal nature of many medical visits. However, increased awareness about the qualifications of physicians could make potential patients more comfortable about conducting preventative care via video. Incorporating a rating system, or minimum quality threshold for participating physicians is one potential solution.

 

3. Personal and professional infrastructure is key

The personal infrastructure for telemedicine is already in place across much of the United States, in the form of video-enabled smartphones. According to the latest PEW research, 64% of Americans own a smartphone. In theory, this provides them with the basic means to access remote, video-based health care. Smartphones will likely serve as first means of exposure to such services for many people.

 

More advanced, capable systems (such as dedicated telemedicine kiosks) however are far from established. Aside from a few test programs in select areas, there is no nationwide, professional infrastructure or technology for telemedicine. This hinders adoption and limits the use of telemedicine to basic, preventative care that can be conducted entirely remotely. Dedicated kiosks can greatly expand the use-case for telemedicine, by incorporating sensors, multiple cameras, and other advanced technology. Further investment from telemedicine vendors and insurance companies could help to boost the nationwide profile of telemedical services and expand access for many Americans.

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Can technology break the silos in the healthcare sector?

Can technology break the silos in the healthcare sector? | Healthcare and Technology news | Scoop.it

Digital health or the use of information and communication technology (ICT) to provide health services, has the potential to advance the goal of universal health coverage and improve the quality and efficiency of health services, according to a new report published by the Broadband Commission for Sustainable Development’s Working Group on Digital Health.

 

But can technology also break silos between the technology and healthcare sectors? 

 

The study group, co-chaired by the Novartis Foundation and Nokia, noted that key challenges remain in making digital health a reality, including fragmentation in digital health solutions, risks to funding continuity and capital expenditure, workforce capacity constraints, and collaboration problems across the health and ICT sectors. 

“Despite the promise and potential of global connectivity, we cannot lose sight of the fact that nearly four billion people have no access to the Internet. We need to look at innovative cross-sectoral strategies that can leverage the power of high-speed networks to improve education, healthcare and the delivery of basic social services to everyone, especially the poorest people, who need healthcare most urgently,” said ITU Secretary-General Houlin Zhao.

 

The report, “Digital Health: A call for Government Leadership and Cooperation between ICT and Health,” recommends that the industry look into at least three things: the importance of senior government leadership with committed financing, effective governance mechanisms with defined roles, and a national ICT framework to facilitate alignment between the ICT and healthcare sectors.

 

“We need continuous committed leadership from government with sustained financial resources to ensure a strong national digital health strategy,” Ann Aerts, Head of the Novartis Foundation, and Chair of the Broadband Commission Working Group on Digital Health.

 

She said many technology-based health initiatives have been introduced in the past but they never reached scale or achieved long-term sustainability because more government support and intergovernmental collaboration are needed to take these initiatives past the pilot stage.

 

“To help solve these challenges and to uncover how we can truly harness the power of information and communications technology (ICT) for health, we need a better understanding of the key elements involved,” she explained in the report.

Rajeev Suri, CEO of Nokia and Chair, Broadband Commission Working Group on Digital Health, added that many technology companies are pushing the frontiers of healthcare to reach the remotest of locations, harnessing the power of mobile devices to help health professionals bring the most efficient medical techniques.

 

“The next step is to share the technology with every corner of the globe. To do that we need the leadership of national governments. Health and telecommunication should be united, working closely with regulators—to avoid potential roadblocks, change old practices and spread new knowledge on how to leverage technology for healthcare,” he said.

 

Case Study: Malaysia

With a population of 30 million, Malaysia is currently implementing the Health Information System Strategic Plan (11th MP). This plan builds on the first Health Information System Strategic Plan (10th MP) rolled out between 2010-2015. 

According to the report, the government is currently scaling of a hospital information system deployed in 25 percent of hospitals, in the process of integrating primary care and oral health clinical information system, rolling out a pharmacy information system and building the Malaysia Health Data Warehouse.

Because Malaysia began using digital health in the late 1990s when the Malaysian Ministry of Health (MoH) unveiled the first
telemedicine blueprint and created the first paperless hospital in the world, it has adopted a progressive approach.

“The MoH provides digital health leadership, strategy and program implementation in the form of three divisions: ICT, Planning and Telehealth,” the report noted. “MoH’s ICT strategic plan and ensures alignment with the national ICT strategic plan.”

However, even after years of digital health implementation, some challenges still remain. “Our biggest challenges are still the user, change management and training. And clinical leadership is so important! If you don’t get buy-in from the clinicians, the system won’t work. We learned from experience,” said Dr. Fazilah Shaik Allaudin, Director of Telehealth Division at MoH.  

 

Other challenges include monitoring, evaluation, and private sector engagement. “ “We’re still struggling with M&E and how to do it effectively. We haven’t really come up with a mechanism for this yet. We’ve seen hospitals give up on digital systems and go back to paper or situations where the core team involved in implementation leaves and the project dies or loses momentum. How do you keep this when the leader leaves? How to keep the fire burning?” he explained.

 

Case Study: Philippines

The Philippines launched the National eHealth Strategy in 2010. This was followed in 2014 with the release of the eHealth Strategic Framework and Plan for 2004-2020. The overall goal of the plans is to achieve universal health coverage, which means access to affordable health services for all citizens.

Some of the key performance indicators (KPIs) the 2014 eHealth framework set out to do include the increasing use of the DoH/PhilHealth eClaims, deployment of telehealth devices, the establishment of a government data warehouse and implementation of health data standards.

According to the report, a joint memorandum between the Department of Health (DoH) and the Department of Science and Technology (DoST) created the basis for a shared understanding of roles and responsibilities. Each agency has its own IT teams which make it hard to know which team is responsible for what. 

“In our country, the DoST was keen to start working on eHealth but realized that it needed to be led by the health sector as per the WHO-ITU Toolkit. Fortunately, our DoH also shared the same view. From this common ground, the seeds for the multisectoral approach emerged. The key is to get those two persons engaged, one from the DoH and one from the DoST, and involved in the development of the national eHealth strategy” Dr. Alvin Marcelo, Executive Director of AeHIN and former CIO of PhilHealth.

Meanwhile, the creation of advisory groups allowed universities and private-sector representatives to share their expertise and views. 

 

“Cross-sectoral collaboration is not easy. Players come from different backgrounds, with different approaches and priorities, and may understand different things on the basis of the same words or phrases,” affirmed Zhao in the report’s foreword. “Nowhere is this truer than in digital health, where the needs are great, the investments are significant and lives are at risk.”

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Health IoT creates huge opportunities for public health and software companies 

Health IoT creates huge opportunities for public health and software companies  | Healthcare and Technology news | Scoop.it

Connecting smart biological sensors to the internet is not a new idea. There are already dozens of products in the market that continuously monitor blood glucose and heart function, for example, and enable secure remote management for clinicians and caretakers. The safety of life implications are enormous, and the commercial opportunities untold. Some analysts predict a $100 billion-plus market for the healthcare segment of the “internet of things” (IoT).

 

What is new and emerging is the physical scale of the devices on the one hand, and the need to aggregate, reconcile, and consolidate those data streams for downstream clinical care services. Advances in semiconductor device manufacturing will relentlessly drive down the price and the size of these electrophysiological sensors, literally to the nanometer scale, which will ultimately be able to do more than detect, they will be able to intervene. At the same time, our ability to make sense of the torrents of information is catching up to our ability to create them.

We believe that these are tremendous opportunities for public health and software companies like ours. It is why we are investing so much of our own resources to promote the open design, secure exchange, and value-added analysis of health data systems. Perhaps the largest inhibitor to a promising future of longer, healthier, less expensive life are the software merchants and device manufacturers who still and astonishingly insist on keeping data closed, isolated, and trapped in proprietary systems. We believe this is about to change too.

 

The interoperability troubles with electronic medical records are legion, and we won’t waste our page space or your attention lamenting the deeply ignorant and the nearly criminal. The immortal words of Forest Gump’s assessment about doing dumb things find purchase here.

 

What we can do, however, is find clever ways leverage of IoT as yet-another, and maybe decisive, the fulcrum of connected care. For what is today true in isolation – progressive plans, concerned parents, engaged patients – will soon-enough be more the ubiquitous standard of coordinated care; that coordination will reach deeply into pocketbooks as well as bodies.

We know that there are legitimate concerns about individual privacy and device safety and that some people would literally rather die than compromise on either. We respect that, even as we actively promote more automation and digital services in health care.

 

Some of us believe that the existential benefits of independence and longevity outweigh the potential risks of intrusion and malfunction, some of us don’t. The point is that everyone should have the choice and that no one should be coerced or manipulated into choosing one side of the argument. Fear mongering (about privacy) and fabrication (about intrusion) are forms of manipulation. In the case of health care, they cost lives and money.

 

Let’s, instead, imagine a world of seamless, secure, and reliable health data interoperability. Let’s find a better way to safely liberate data at its source – labs, pharmacies, hospital and clinics, insurance claims, as well as implantable and wearable devices – pass it through hygienically sealed pipes, and receive it in places where it does the most good. That may be during a clinical care or remote telemedical encounter (to give you the best possible advice based on evidence and your personal health history), it may be when you pick up your medicines (to check for interactions with other medicines), or it may be to help your insurance company help you (because they have always had a bird’s eye view of your services, and they can’t kick you out for pre-existing conditions anymore).

 

Because of changes in the law, it may be with a loved one or trusted caretaker. It may be you.

The data could be as simple as a reminder message about an upcoming appointment, a warning message that a clinical value seems out of range, or an answer to a securely-texted question to your doctor. We have imagined that future and it is, as Ray Kurzweil likes to say, near.

 

There are two challenges, and they are slowly receding.

The first is that the data holders are still reluctant to share, even though it isn’t “their” data.  This will become less of a problem, as forward-looking providers like VA and DoD have shown, as well as payers like CMS, Aetna, and HCSC among many others have demonstrated.  All are outspoken supporters of the Blue Button program, now in its fifth year, and still growing.

 

The second falls squarely on our shoulders:  we need to make the user experience attractive, convenient, and useful.  The health IT community has made terrific strides recently – we-two have worked on the InCircleand a soon-to-be-announced medication management app, for example –  and there are many companies that target data-driven patient-provider interactions, including AmericanWell and covers health.

 

The beautiful thing is that IoT fits so neatly into this conversation. The goal, of course, is to help us achieve our best-possible health. The best way to do this is with data. And the best data is coming at us in ever more granular packages, from patient-hosted sensors that monitor, detect, interact, and intervene. Weaving those into the tapestry of your personal health history is the next vanguard of coordinated and managed care.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

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