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Using telemedicine to treat chronic disease 

Using telemedicine to treat chronic disease  | Healthcare and Technology news | Scoop.it

Flash back to the brink of the Patient Protection and Affordable Care Act. On the cusp of the passage of the ACA, more than 41 million Americans were uninsured or underinsured, driving one of the largest health care overhauls in history. While controlling costs was an important consideration, the main focus of the ACA was expanding coverage. To increase accessibility to affordable health insurance options, the law employs a mixture of mandates, subsidies, tax credits, and penalties to increase coverage of the uninsured, spur health care innovation, and provide for new payment models to reward quality of care and improved health care outcomes.

 

More than five years into the ACA era, the White House touts that the number of people without health insurance continues to decline and has dropped by 15.8 million since 2013. Of the roughly 11 million people who enrolled in state or federal Marketplaces in 2015, about 4.2 million were auto-renewals or renewals, indicating that roughly half of all 2015 enrollees kept their 2014 Marketplace insurance plan.

 

The rurally ignored

 

Despite the widely publicized successes of the ACA, many rural Americans were forgotten by health care reform. Although the ACA proclaimed a renewed focus on rural America, little was accomplished for rural populations outside of Medicaid expansion. A policy brief published by the National Advisory Committee on Rural Health and Human Services stressed the importance of coverage in rural areas, where the population is disproportionately older, more chronically ill, lower in income, and less insured compared to urban areas.

 

Where are the rural communities? "Rural" encompasses all populations, housing, and territories not included in an urban area; essentially, it is defined by what it is not. In 2010, the U.S. Census estimated that 59.5 million people – 19.3 percent of the population – lived in rural areas.

 

Rural residents tend to be poorer, earning a per capita average income of $19,000, which is nearly $7,000 less than what their urban counterparts earn. Although rural Americans account for only 22 percent of the population, rural residents account for 31 percent of the nation's food stamp beneficiaries. Only 64 percent of rural residents are covered by private insurance, and the rural poor are less likely to be covered by Medicaid benefits than their urban counterparts (45 percent versus 49 percent, respectively). Compounding the issue of obtaining affordable coverage, rural areas rarely have access to the same types of coverage. According to the National Rural Health Association, only about 10 percent of physicians practice in rural America, even though nearly 25 percent of the population lives in rural areas. There are only 401 specialists per 100,000 people, compared to 910 in urban areas.

 

"Rural Americans face a unique combination of factors that create disparities in health care not found in urban areas. Economic factors, cultural and social differences, educational shortcomings, lack of recognition by legislators, and the sheer isolation of living in remote rural areas all conspire to impede rural Americans in their struggle to lead a normal, healthy life."

 

Perpetuated by the inability to find and afford care, rural populations face higher incidences of chronic disease. Obesity, diabetes, heart disease, and alcohol and substance abuse are all chronic conditions that disproportionately affect rural populations.

 

Turns out, chronic disease is costly

 

In the U.S., chronic diseases and the health risk behaviors that cause them account for highest health care costs. In fact, 86 percent of all health care spending in 2010 was for people with one or more chronic medical conditions. The total estimated cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity. Medical costs linked to obesity were estimated to be $147 billion in 2008. Annual medical costs for people who are obese were $1,429 higher than those for people of normal weight in 2006. Of the top 10 states with the highest rural populations, half fell on the list of the states with the highest rates of adult obesity and diagnosed diabetes

 

So what is the government doing? Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services recently awarded $2.7 million to improve rural health, however, those grants will support 3-year pilot programs designed to train health professionals and expand health insurance coverage in rural areas, rather than impact rural health directly. Essentially, the 20 recipients of the grants (ranging from $75,000 to $200,000) are community colleges, hospitals, health education centers, individual counties, and other various providers, which are to use the money for formal training programs for health professional students. To put it in perspective, HRSA responded to the outcry by millions of rural Americans by awarding grants equal to the price of 17-year-old Kylie Jenner's first home, after spending hundreds of millions of dollars implementing the ACA and federal and state Marketplaces.

 

Is telemedicine the perfect solution? Maybe

 

Although the ACA does not specifically link telemedicine to rural populations, "telehealth" or "telemedicine," which is using telecommunication and information technologies to provide clinical health care at a distance, is a critical component of transitioning to value-based treatments, and to better serving rural communities and chronic conditions.

 

For rural populations, telemedicine has the potential to increase accessibility to providers and specialists who can remotely monitor and treat chronic disease, without the hassle or costs associated with traveling. In many states, telemedicine services are covered by insurance to the same extent as in-person services. It helps eliminate distance barriers to medical services that would often not be consistently available in distant rural communities.

 

Although it seems like a catch-all, it is important to note that telemedicine is not a replacement for an annual, in-person physical; it is used most effectively to manage chronic condition and preventive health care costs. Even the best physicians in the world cannot take the blood pressure of a patient or press on the abdomen of a sick patient remotely. While certainly this represents a drawback, it also presents an opportunity. The rules governing the practice of medicine do not need to be the same rules that govern the practice of telemedicine. By linking patients with doctors either via telephone or video chat, barriers of distance can be eliminated, which proves crucial for rural areas.

 

Telemedicine snapshot: Mississippi

 

To address the prevalence of chronic conditions, Mississippi became the 16th state to pass advanced telemedicine provisions. In 2014, the American Telemedicine Association (ATA) graded existing state telemedicine programs based on reimbursement and physician practice standards, rating Mississippi with the highest possible composite score. Evidence of a collaborative landscape accommodating telemedicine, Mississippi requires telemedicine services to be a 'real-time' consultation, which does not include the use of audio-only telephone, email, or fax. Additionally, the Mississippi legislature also required that telemedicine services are covered to the same extent as in-person services, although a health plan may limit the number of telemedicine providers to a local network.

 

With the highest prevalence of adult obesity and diabetes in the country, Mississippi prioritized remote patient monitoring services to coordinate primary, acute, behavioral, and long-term social service needs for high-need, high-cost patients. For telemedicine services to be reimbursed, patients must be eligible for remote patient monitoring and specific patient criteria must be met. For example, qualifying patients for remote patient monitoring must be recommended by their physician, be diagnosed in the last 18 months with a chronic condition like diabetes or heart disease, and have a history of costly services because of that condition.

 

Initial barriers to telemedicine implementation

 

Although Mississippi has faced relatively little resistance incorporating these laws, many states still need to consider a number of issues or barriers when developing telemedicine programs and policy.

 

1. Requiring coverage for telemedicine under private insurance, state employee health plans, and public assistance


Reimbursement continues to be a barrier to telemedicine adoption in some states. Medicare, which typically sets reimbursement standards, reimburses for telehealth services with relatively stringent requirements. Medicare pays for telemedicine services only when patients live in Health Professional Shortage Areas (HPSAs) and those who engage in "face-to-face" interactive video consultation services and some store-and-forward applications (e.g., teleradiology, remote electrocardiogram applications). As stated in a report by the American Hospital Association, "Without adequate reimbursement and revenue streams, providers may face obstacles in investing in these technologies."

 

Plan administrators and providers need to work together to discuss telemedicine benefits and determine coverage options and reimbursement policies, similar to the Mississippi State Legislature passing a bill requiring private insurance to pay for telemedicine services at the same rate as it does for in-person care. States considering telemedicine will have to wrestle with similar decisions about what to cover (e.g., video consultations, asynchronous store-and-forward platforms, patient monitoring) and review technology guidelines that determine reimbursement eligibility to ensure maximum reimbursement. To put it simply, if providers are not getting paid, they cannot provide.

 

2. Patient consent and education

 

Consent is a vital component of health care and is more complicated with a telemedicine platform. States must consider requirements for how to approach and obtain patient consent. The risk of consent-based claims for providers is a concern, and malpractice laws are currently geared toward face-to-face interactions; if consent-based claims become rampant, the willingness of providers to administer health care via telemedicine will likely decrease. Nebraska, for example, requires written informed consent, while California and Arizona law permit verbal consent to satisfy the statutory informed consent requirement. Since telehealth is a new and emerging field, patient education is critical to patients' health and providers' ability to practice.

 

Ideally, patients need to understand details about the expected risks and benefits of telemedicine, available alternatives, and how telemedicine fits into their personal wellness plan.

 

3. Geographical restrictions on telemedicine services


Although many states are ironing out provisions for health professional licensure requirements, including implementing special telemedicine licenses, border state and consultation exceptions, and interstate reciprocity and endorsements, little research has been done regarding restrictions on limitations for patient location while receiving telehealth services. For instance, can a patient on vacation in another state or country meet with his or her physician for an appointment? If the physician prescribes medication, can the patient fill his or her prescription outside of state lines?

 

Consideration needs to be placed on not just where the provider is operating from but also where the patient is located at the time of treatment and how treatment is administered.

 

4. Establishing the provider-patient relationship


Trust is an essential factor in a provider-patient relationship. It has been historically built during face-to-face interactions. States need to consider whether an in-person examination component is necessary or telemedicine can be used instead of an initial in-person patient evaluation.

 

The face of health care is changing, but prioritizing relationships is at the core of what creates value and better outcomes in health care. When implementing telemedicine programs, it is essential to consider the health of the patient first and design an interaction model that will create the most effective patient-provider relationship.

 

Overwhelmed? Here's what we know, and where we're going. We know that there are a significant number of rural Americans in the U.S. who have a difficult time accessing and affording health care. We know that many of these Americans are the ones who really need it, given their higher incidence of chronic disease. We know that chronic disease costs a lot and that most rural Americans cannot afford to treat it conventionally. We know that on its face, telemedicine may be one solution to solving the problem of rural health care.

 

A continued focus on this population of Americans and a renewed sense of urgency will allow for thoughtful state legislation and progressive development. Using Mississippi as a model of telemedicine implementation that is more thorough than many of its counterparts, other states can review their successes and challenges, with specific focus on the issues identified in this piece. For instance, considering where a patient must be located to receive care from providers, as well where they are legally able to fill a prescription from that provider are critical considerations for every state developing and amending telemedicine laws. There are a number of stakeholders involved in the telemedicine field. To ensure comprehensive, thoughtful laws and reforms, state legislature should reach out to local health care providers, nonprofit research centers, state insurance and Medicare/Medicaid departments, private insurance companies, state legislators, and patients to evaluate needs and requirements, and implement suitable legislation.

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Adoption of Telehealth Can Generate Cost Savings for Hospitals 

Adoption of Telehealth Can Generate Cost Savings for Hospitals  | Healthcare and Technology news | Scoop.it

The adoption of telehealth technologies in rural areas can result in significant cost savings for hospitals and their communities due to transportation cost savings, lost wages savings, hospital cost savings and increased revenues for local labs and pharmacies, according to a white paper by the NTCA-The Rural Broadband Association.

 

In the white paper, titled “Anticipating Economic Returns on Rural Telehealth,” Rick Schadelbauer, manager, economic research and analysis at the organization, outlines the case to be made for increasing adoption of telehealth in rural areas, and throughout the country, by keeping patients using local health care services rather than traveling to bigger, nearby cities for health care services. Schadelbauer noted that within the United States, there is a distinct health disparity between rural and non-rural Americans, primarily as a result of demographics and limited access to health care.

 

Telehealth and telemedicine, or the remote delivery of health care services and clinical information using telecommunications technology, holds potential to improve the quality, cost and availability of health care in rural areas. However, telemedicine is not viable without access to robust, reliable broadband service, Schadelbauer wrote. “Rural areas currently lag in broadband deployment, but continue to make impressive gains due in large part to the efforts of small telecommunications providers. Wireless applications require wireline infrastructure in order to be viable options,” he wrote.

 

The white paper examines the rural health care challenges, telehealth adoption and the potential benefit of telehealth technologies, both non-quantifiable and quantifiable. And the white paper drills down into challenges for rural health, such as reimbursement, cost, patient privacy and licensing.

 

According to the paper, the non-quantifiable benefits of telehealth are numerous: improved access to specialists, speedier treatment, the comfort of remaining close to home, eliminating the need for long-distance transportation, the ability for health care providers to sharpen their skills, and improved patient outcomes.

 

The white paper also quantifies several categories of quantifiable benefits of telehealth: transportation cost savings (median cost savings: $5,718 per medical facility, annually); lost wages savings ($3,431 per medical facility, annually); hospital cost savings ($20,841 per medical facility, annually); and increased revenues for local labs ($145,109 per medical facility, annually) and pharmacies ($8,558 per medical facility, annually.)

 

More specifically, hospitals in rural communities could potentially save more than $81,000 a year on employing doctors, and the white paper presented as one example a hospital that reduced its use of a full-time radiologist from five days a week to one. And, at the same time, hospitals could potentially generate revenue from lab work and pharmacy services that would remain local as a result of telemedicine, according to the white paper. For example, the authors estimated that tens of thousands of dollars could generated by local MRIs, CTs and other lab and pharmacy billings.

 

“The decision to implement telemedicine is unique to each medical facility, and should take into account not only costs but also non-quantifiable benefits and quantifiable benefits accruing to parties other than the medical facility, such as the patient and local labs and pharmacies located in the communities where telemedicine takes place,” the authors wrote.

 

As potentially significant as the potential benefits to telehealth—both non-quantifiable and quantifiable—may be, , Schadelbauer wrote that “it is critically important to remember that rural telehealth’s role in addressing the significant health problems inherent to rural areas will depends upon the availability of an underlying, future-proof, fiber-based broadband infrastructure. Further investment in, and expansion of, broadband infrastructure is a critical need not only for rural Americans but also our country as a whole.” Further, he noted, “Absent access to such an infrastructure, the benefits of telemedicine will remain merely theoretical.”

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How telemedicine is transforming treatment in rural communities? 

How telemedicine is transforming treatment in rural communities?  | Healthcare and Technology news | Scoop.it

There's no denying it: rural hospitals are in trouble.

 

More than 48 rural hospitals have closed since 2010, according to the National Rural Health Association, and another 283 are in danger of closing.

 

The malaise effecting rural healthcare comes from several vectors. Reduced populations, higher percentage of uninsured and elderly patients, equipment underuse, and the absence of high-margin specialty services makes for a bleak economic outlook. A shortage of doctors willing to work in remote areas creates quality of care and a staffing issues. Then, there is the challenge of getting patients into rural hospitals in a timely manner because travel distances sometimes are too great.

 

Many believe that telemedicine and mHealth offer a way out for struggling rural hospitals, however.

 

A 2012 report by the Institute of Medicine for the National Academies, entitled The Role of Telehealth in an Evolving Health Care Environment, found that telehealth drives volume, increases quality of care, and reduces costs by reducing readmissions and unnecessary emergency department visits for rural communities. Through telemedicine, rural hospitals can serve rural patients at better costs and help cut down on the time it takes rural patients to receive care, particularly specialty care.

 

"When rural patients know their hospital is using telemedicine, they have higher regard for that hospital and are less likely to bypass it for treatment at an urban facility," noted James Marcin, director of the UC Davis Children's Hospital Pediatric Telemedicine Program, a pioneer in remote medicine.

 

The ways that rural hospitals can take advantage of telemedicine and mHealth technology advancements are many, and include remote consultations, in-home monitoring, outsourced diagnostic analysis, and remote specialist consultations.

 

Instead of waiting days or weeks for a healthcare professional to travel to a remote area, or traveling into a hospital and waiting for an appointment, telemedicine enables remote physician consultations that are faster, cheaper and more efficient than traditional healthcare appointments. For consultations on simple health concerns, or follow up on existing conditions, remote consultations can dramatically improve the patient experience while helping rural hospital economics at the same time.

 

The Georgia Partnership for Telehealth, for instance, assesses and treats students so that they do not need to travel to a clinic for healthcare, and currently has replaced more than 350 locations where a traditional doctor's visit was formerly required.

 

A second way that rural hospitals are leveraging telemedicine is through in-home monitoring. One example is decreased hospitalization rates for seniors enrolled in the FirstHealth Home Care Chronic Disease model in North Carolina. Patients previously diagnosed with heart failure, diabetes, or COPD and who experienced frequent hospitalizations are monitored by telehealth at home between periodic visits from nursing staff. Response and intervention times have improved substantially, according to the program.

 

Another benefit to struggling rural hospitals is outsourced diagnostic analysis and access to remote specialists. It is difficult for many rural communities to staff their own diagnosticians, but mobile imaging centers and lab specimen kiosks that can take X-rays and perform collections can work in conjunction with remote analysis labs in larger urban areas to bridge the gap.

 

One study that looked at 24 hospitals in four rural states in the Midwest including Kansas, Oklahoma, Arkansas, and Texas found that telemedicine brought an annual economic impact of at least $20,000 per year, with an impact of up to $1,300,000. The majority of these savings came from increased lab and pharmacy revenues due to additional work performed locally.

 

In addition to outsourced diagnostics, telemedicine also enables consultation with remote specialists at larger, urban hospitals instead of the need for having these specialists on staff. This can be particularly good for attracting doctors to rural hospital settings.

 

"Telemedicine fosters a collaboration that reduces the feelings of isolation that physicians may experience when they go to practice in a small town," noted Dr. Wilbur Hitt in a report, Telemedicine: Changing the Landscape of Rural Physician Practice. "With telemedicine, it's like having one foot in the city but being able to live and practice out in a rural area. It's also reassuring to know that you're on the right track with the treatment plan and are staying current."

 

Still, roughly 66 percent of rural hospitals had no telehealth services or were only in the process of implementing a telehealth application when the RUPRI Center for Rural Health Analysis reviewed 4,727 hospitals in the 2013 HIMSS Analytics database. Part of the reason comes from broadband access challenges.

 

Rural communities not only suffer from a population shortage and a lack of resources, they also typically have trouble with the necessary broadband infrastructure for telemedicine. The benefit of remote consultation by video conference for rural patients is clear, for instance, but these remote consultations amount to nothing if there isn't the broadband infrastructure to support it.

 

"The ability for physicians to connect with those in areas that don't have much of a wireless connection is the biggest problem when trying to treat these patients," noted Tony Zhao the CEO of Agora.io, a video SDK company that provides easy video conferencing with quality-of-service guarantees so telemedicine and e-learning initiatives work even in rural settings.

 

"With weak connections, video streams for telehealth are blurry, choppy or just won't work," he added. "Implementing technology that doesn't rely on the general internet but which relies on an infrastructure that strengthens signals in the most remote areas is crucial."

 

Another barrier for rural hospitals is the challenges that surround reimbursements. Medicare reimbursement is a major challenge for telemedicine, with states each having their own standards by which their Medicaid programs will reimburse for telemedicine expenses.

 

There is no single standard telemedicine reimbursement system for private payers, either. Some insurance companies value telemedicine and will reimburse for a wide variety of services while others do not.

 

These and other challenges put a drag on rural telemedicine at the same time as the need for it grows. Rural hospitals have a path toward recovery in the form of telemedicine, but obstacles still remain.

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More patients could soon be seeing a virtual "doc in a box"

More patients could soon be seeing a virtual "doc in a box" | Healthcare and Technology news | Scoop.it

For many people, getting an appointment to see their doctor can be challenging. And if you don’t have a doctor but need to see one, it can take weeks to months to get one of those coveted new patient slots.

As a result, “Doc in a box” and urgent care clinics have taken off across the country. And as with everything else in healthcare, that trend has gone digital. And this year, the success of two companies in particular could make this a breakout year for the virtual doctor visit.

Teladoc

Teladoc made headlines this week with a very successful IPO that saw share prices go up 50% in the first day of trading. Teladoc is a company that offers on-demand doctor visits to patients through their smartphones, computer, or regular old phone for under $50. Basically, you put in a request for a consultation to Teladoc and they connect you with a board certified internal medicine, pediatrics, or family practice physician. Teladoc boasts that patients get connected with a physician in under 10 minutes.


Teladoc offers members an EHR that is basically a patient-provided medical history. Consulting physicians review that record and get a history from the patient. If needed, they can e-prescribe medications to a local pharmacy.


Patients can sign up directly for Teladoc and pay out of pocket if they want. Health plans and companies are also contracting with Teladoc to provide this service to their members and employees in the hopes of averting more expensive urgent care and ER visits.

Doctors on Demand

One of this years most successful digital health companies is Doctors on Demandwhich, according to StartUp Health, has raised $50 million in just the first six months of 2015.


Doctor on Demand offers video visits to patients through their smartphone or computer. Like Teladoc, Doctor on Demand offers consults in general medicine and pediatrics. They are more varied in their physician pool; for example, their highlighted medical physicians include preventive medicine, emergency medicine, and internal medicine physicians. A really interesting feature here though is that they also offer mental health consults with psychologists and lactation support with certified lactation consultants.


Patients sign up directly with Doctor on Demand. Visits with a medical physician or pediatrician cost $40; visits with a psychologist or lactation consultant range from $40 to $95. And as with Teladoc, companies and health plans are signing directly with Doctors on Demand to provide that service to their employees and members.


The support that these two companies have garnered this year is a strong sign that this area is poised for some serious growth.

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A Strive Towards “Meaningful” Data Exchange in the Midwest

A Strive Towards “Meaningful” Data Exchange in the Midwest | Healthcare and Technology news | Scoop.it

Although the successful exchange of health data has been a struggle in most U.S. regions, a commitment to the free flowing of information on a patient’s history—regardless of what local healthcare facility they have been at—has helped spur health information exchange (HIE) in the Midwest.

Indeed, the Lewis and Clark Information Exchange (LACIE) is one of the first fully operational, multiple-state HIEs in the country, providing patient information to healthcare systems and providers in Kansas and Missouri. Getting the HIE up and running to a point where it could successfully exchange data required a few key elements, starting with getting hospitals on board that were willing to share data. To this end, in the last 18 months, LACIE announced two major connections: first with the Kansas Health Information Network (KHIN), another major HIE in Kansas. This was a significant moment for data exchange in the Midwest, as in the past, the two organizations had failed to reach an agreement on sharing data.

A few months after that, LACIE announced that patients' electronic medical records (EMRs) were being securely shared with Tiger Institute Health Alliance (TIHA) in Columbia, Mo. In total, LACIE is now connected to 17 hospitals in two states in addition to three accountable care organizations (ACOs), the two aforementioned regional HIEs, multiple private HIEs, and the Kansas City Metropolitan Physician Association (KCMPA), a large independent physician group with 80 clinics and 350 providers. The 24 different EMRs those organizations use have been connected via a hub that has been put in place from Cerner, says Mike Dittemore, the executive director for LACIE. Dittemore says that LACIE connects to that hub so it doesn’t have to do all of the independent connections, leading to greater efficiencies and cost savings.

However, getting different provider organizations on board has not been easy, Dittemore admits. “There are always challenges with provider participation, and one of reasons we had the strategy to work with hospitals and get them on first is that we felt if we did a good job with them, that would spur participation from others. The best marketing out there as far as HIEs go is word of mouth by providers who actually use it,” he says. What’s more, LACIE’s board of directors consists of several physicians, including multiple CMIOs of organizations in the Kansas City area. “That’s really helped us, having these physicians have conversations with other providers or their clinics and talk to them about why it’s important to share this information and participate,” says Dittemore. “They can show other [providers] the value by being able to not tie up so much staff in administrative time in tracking information down that already exists in the HIE.”

Still, there are additional challenges for independent providers who have all kinds of mandates and rules they are struggling with, in addition to low reimbursement rates, Dittemore notes. “So we try to have a price point that works for them, and we also have found some grant funds through the Office of the National Coordinator for Health Information Technology (ONC). In Kansas, we used some of those funds to help folks to connect, but it’s always an uphill climb to get individual providers on board. We do think that if we can get in and meet with clinic managers, maybe not the providers themselves, but a trusted person they go to, and show them the value, getting these smaller providers on board might not be as hard,” he says.

One of these physicians on LACIE’s board is board chair, Gregory Ator, M.D. CMIO and practicing physician at the University of Kansas Hospital. Ator says that as of late, LACIE has become much more focused in getting smaller practices on board. “It’s been a great experience, it’s very refreshing to see all of these large organizations that are not competing around the ‘this is my data and you can’t have it’ concept, but rather the ‘let’s compete around quality of care and let information freely flow’ concept. That’s been quite refreshing, and moving forward we’re looking at the next tier of smaller physician practices,” Ator says.

LACIE further attempts to make the exchange process more doable by not charging organizations a fee to connect. “We have always believed in connecting to other HIEs, be it community, regional, or state. But we don’t pay other organizations to connect nor do we charge others to connect to us,” Dittemore says. “LACIE is a public type of entity. We think that’s why it’s here, for the spirit of moving information regardless of where they reside. We have been adamant about that, but not all facilities feel the same way. So that’s been a barrier,” Dittemore notes.

Making HIE Valuable

Currently, LACIE is consistently seeing 100,000 queries per month going through the HIE, and according to Dittemore, one of the things that really helps provide value to its providers is getting robust information trading rather than just checking a box. “If checking a box is what you want, our HIE won’t be for you. We’re about the meaningful trading of information,” he says.

To this end, all of LACIE’s connected providers are encouraged to share radiology reports, discharge reports, clinic visits, and any summaries, Dittemore adds. “What we have found is that when you have that type of information above and beyond the continuity of care document (CCD) or consolidated-clinical document architecture (C-CDA), it really provides a great platform for providers to go in and look at the information and find out what is really going on with patients in those last visits,” he says. “We want to try to get rid of the fax machine, or reduce its use by as much as possible. Having this robust information available does help providers to move onto other duties like taking care of patients. They become valuators rather than investigators,” says Dittemore.”

Expanding on the notion of meaningful data exchange, Ator notes that fax machines are how providers are doing HIE right now, and what’s more is that Direct also has issues with people’s addresses as well as its own technological problems. “I am an Epic customer at KU, so we have a number of Cerner operations in town as well as Epic operations, and when you log into Epic for instance, we can go out to the HIE and search for a patient, at which point a very robust matching algorithm kicks in and we get textual documents presented in reverse chronological order. Operative notes, progress notes and discharge summaries are all within Epic without a separate log-in,” Ator explains. “Our providers don’t have to dig through exchange formats such as CCDs and CCDAs to see it in a meaningful manner. And that’s Cerner shop looking at Epic and vice versa,” he says.

Value to providers is further seen in the form of impacting patient outcomes. According to Ator, the strongest use case now is in the ER. “The patients here in a big city circulate around the EDs, and it’s fabulous to have the notes as it was was signed from an organization right down the street that a person might have checked into,” he says. “So we have seen improved outcomes around the ED, and the literature backs that up. I think that it is clear there is benefit in ED world, but rest is bit too soon to call,” Ator says.

Dittemore also says that value has been seen on the care management side. Kansas City has multiple medical facilities and acute care facilities, but even more non-acute facilities, he says. Just because a patient happens to go to a provider or an urgent care clinic that they have affiliation with, they might not go there for all care, and that’s something that needs to be seen in the HIE, he says. Also with specialists, making sure to ensure patients have done the appropriate follow up and have been to specialists allows care managers to see if that has happened and if not, find out why, Dittemore says. “Was it a transportation problem, an illness or what? It gives them something to go off of when they reach back out to the patient. Care managers have seen great value in this to manage that care between multiple facilities that might not be financially related to one other. That’s been rewarding,” he says.


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Medicine and Health Care Will be Personalized Thanks to Technology

Medicine and Health Care Will be Personalized Thanks to Technology | Healthcare and Technology news | Scoop.it

From wearable fitness trackers to virtual doctor visits to smartphone apps and attachments that can collect sophisticated medical information, new technology is giving users unprecedented direct access to their own health data. In his new book, “The Patient Will See You Now: The Future of Medicine Is in Your Hands,” Eric Topol, a cardiologist, professor of genomics and director of the Scripps Translational Science Institute, explores how this “great inversion of medicine” will transform the future of health care. He recently spoke with U.S. News about how new capabilities might impact the quality and cost of care, as well as what some of the barriers will be. Excerpts:

What have been some of the drivers of technology changing the world of health care?

I equated the impact of the smartphone in medicine to parallel the Gutenberg printing press in terms of how it affected civilization. That sounds like a reach, but in fact, when you think about it, you will have sensors measuring almost any medical metric known to man; you would be able to check the cost of any procedure, scan, visit, hospitalization; and you could contact a doctor at any moment, 24-7, through your phone. It’s almost kind of limitless how this little device, which changed the rest of our lives so dramatically, is now going to have a similar analogous effect on our health.


How will this impact the cost and quality of care?


That’s a really important unproven concept. Work needs to be done to certainly shore that up. There’s a lot of promise. There’s a big change from having physical office visits to see doctors to these virtual visits, and that has already been shown to reduce in a striking way the costs per visit. Hospital rooms will not be necessary in the future. You could have all monitoring done for very inexpensively in the comfort and safety of one’s home. There’s so much waste in our system. The patient is driving things much more and is alerted to the unnecessary aspects and trivial costs.


Who will resist this change the most?


The medical community, especially in the U.S. This challenges all aspects of reimbursement. There’s also the other issue of the loss of control. This is a very paternalistic profession. This is the greatest challenge it will ever face. Also there are knowledge gaps. This will be the case with sequencing data – for example, matching up drugs and a person’s DNA interactions – and even a lot of the ways that wireless devices can be used to do things like the physical exam. These things are not in the comfort zone of many physicians and health care professionals.

What role will the Affordable Care Act play?


It’s kind of in a different orbit. The only thing where there’s some overlap is it is trying to promote the concept that the patient has access to their medical information. But it needs to go much further. Patients have a hard time getting their data, and it isn’t right. The Affordable Care Act doesn’t get to the core issues here of the democratization of medicine. I’m hoping, of course, that in the future we’ll get governmental support. That’s essential. No one’s suggesting that we don’t need doctors and the infrastructure that exists today, but in a very different way, in a more equitable partnership model going forward.


What should policymakers do?


The hope is that we recognize the fact that this is an inevitable progression of medicine, and while it represents quite a radical change, it’s time to grant [patients] rights ownership and acknowledge that the flow of information is going to be completely different than in the past. These data are going directly to one’s own devices, that they own, about their own body, for services that they pay for; it’s about time that we adopt this new philosophy. This is something that is not in our culture, not in the medical culture. But I do think that it can be fostered, it can be embraced, and eventually consumers will demand it.

What risks should patients be worried about with new technology?

I think privacy and security is one of the greatest factors that will potentially prevent this from moving forward in a catalytic way. We’ve seen all these various hacks and breaches. People’s health data is quite precious. It isn’t even just the privacy. This whole concept that one’s medical data is being sold – for example, one’s prescription use is being sold to pharma companies. This can’t go on. We’ve got a lot of work to do.


What can consumers expect ahead?


You can have your child’s ears examined through your own smartphone attachment and get a diagnosis of whether they have an ear infection, or get a skin lesion diagnosed immediately through a picture and an algorithm. Can you imagine getting data while you’re sleeping or while you’re in traffic? We have the exciting potential to get involved with pre-empting disease for the first time. By having all that data on populations of people, then that affords new ways to foster better treatments and preventions. That takes the information era to new heights.


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Cameron's curator insight, March 27, 2015 2:25 AM

The author carefully explains how healthcare apps can change our lives. Even with a paragraph dedicated to the risks of healthcare apps, the 'beneficial paragraph' is directly after it, giving the readers a choice to weigh out the bad with the good. 

Ben Simpson's curator insight, March 27, 2015 9:19 AM

This source provides great in depth detail and explanation on how technology will impact the future of medicine.

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Survey: 76% of Patients Would Choose Telehealth Over Human Contact

Survey: 76% of Patients Would Choose Telehealth Over Human Contact | Healthcare and Technology news | Scoop.it

76% of patients would choose telehealth over human contact according to recent survey that highlights the increased trust in telehealth by consumers. 

Consumer trust in telehealth is growing with 76% of patients choosing access to care over human interaction with their care provider according to recent survey by technology vendor Cisco.

The survey studied the views of consumers and HCDMs on sharing personal health data, participating in in-person medical consultation versus remote care and using technology to make recommendations on personal health.  Views on these topics differed widely between the two groups (consumers and HCDMs) and the ten geographies surveyed.

“The patient and care provider experiences are top of mind in health care around the world.  Due to the increasing convergence of the digital and physical, there is an opportunity to provide increased collaboration and information sharing among providers to improve the care experience and operate more efficiently,”  said Kathy English, Public Sector and Healthcare Marketing, Cisco.

The global report conducted in early 2013, includes responses from 1,547 consumers and HCDMs across ten countries.  Additionally, consumers and HCDMs were polled from a wide variety of backgrounds and ages within each country.


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Harmony Balance's curator insight, March 8, 2015 2:15 PM

interesting....

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Telemedicine market could grow by $5 billion in next five years

Telemedicine market could grow by $5 billion in next five years | Healthcare and Technology news | Scoop.it

By the year 2020, the patient monitoring market in the U.S. is expected to grow by about $5 billion--mostly because of the expansion of telemedicine use, according to a reportby iData Research.

The report also looks at the impact vital sign monitors, fetal and neonatal monitors, cardiac output monitoring devices and blood pressure monitors will have on the market, among others. In addition, the telehealth market in the U.S. is projected to grow in double digits in the next five years, according to an announcement on the report, with telehealth for disease conditions management set to make up more than half of that market. 

Public and private organizations will also help telemedicine grow as they budget more funds for the technology in the ensuing years, according to the announcement.  

Another industry report also says major growth in telemedicine is on its way, predicting the market will double in the next four years, FierceHealthIT previously reported. The market will see growth at 18.88 percent CAGR, from 2014 to 2019, according to ReportsnReports.com.

Other factors moving telemedicine forward are changes in reimbursement and healthcare policies, which will increase physician confidence in spending money on the technology. according to the iData report.


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CMS is making telehealth a cornerstone in its first Rural Health Strategy.

CMS is making telehealth a cornerstone in its first Rural Health Strategy. | Healthcare and Technology news | Scoop.it

CMS has unveiled its first-ever Rural Health Strategy in an effort to improve access to healthcare for the estimated 60 million Americans living in rural areas. The plan includes an emphasis on modernizing and advancing telehealth and telemedicine.

 

The Centers for Medicare & Medicaid Services unveiled the first-ever program this past week, releasing a five-point, eight-page initiative to improve access to care for the estimated 60 million Americans living in rural and underserved communities.

 

“For the first time, CMS is organizing and focusing our efforts to apply a rural lens to the vision and work of the agency,” CMS Administrator Seema Verma said in a press release. “The Rural Health Strategy supports CMS’s goal of putting patients first. Through its implementation and our continued stakeholder engagement, this strategy will enhance the positive impacts CMS policies have on beneficiaries who live in rural areas.”

 

One part of the strategy focuses on using connected care technologies to bring healthcare to those residents.

 

“Telehealth has been identified as a promising solution to meet some of the needs of rural and underserved areas that lack sufficient health care services, including specialty care, and has been shown to improve access to needed care, increase the quality of care, and reduce costs by reducing readmissions and unnecessary emergency department visits,” the plan states. “To promote the use of telehealth, CMS will seek to reduce some of the barriers to telehealth use that stakeholders identified in the listening sessions, such as reimbursement, cross-state licensure issues, and the administrative and financial burden to implement telemedicine.”

 

In its strategy, CMS says it will look to modernize and expand telehealth and telemedicine programs, particularly through the Next Generation Accountable Care Organization Model, Frontier Community Health Integration Project Demonstration and Bundled Payments for Care Initiative advanced model.

 

CMS has long come under criticism for its guidelines on reimbursing healthcare providers for telehealth delivered in rural areas, including restrictions on what services can be reimbursed under Medicare, where those services can be delivered, and even how rural areas are defined.

 

The agency has been the focus of several lobbying efforts to improve telehealth and telemedicine reimbursement, as well as several bills introduced in Congress. But few of those bills have become law, and healthcare providers still see Medicare reimbursement as one of the biggest barriers to pushing sustainable virtual care into rural America.

 

Last year, The Healthcare Information and Management Systems Society (HIMSS), American Medical Association (AMA), American Medical Informatics Association (AMIA), Center for Connected Health Policy (CCHP) and Personal Connected Health Alliance (PCHA) all called on CMS to go beyond current proposals to amend the Medicare 2018 physician fee schedule and open the doors to more connected care services.

 

“HIMSS encourages CMS to embrace a reimbursement system that recognizes the unique characteristics of connected health that enhances the care experience for the patient, providers and caregivers,” former HIMSS President and CEO H. Stephen Lieber and Denise W. Hines, chair of the HIMSS North America Board of Directors and CEO of the eHealth Services Group, wrote.

 

In that letter, HIMSS called on CMS to support:

 

Collaborative decision-making involving diverse care-teams. “Decisions are no longer just between a doctor and patient,” the organization wrote. “Connected technologies allow for the incorporation of a patient’s family and trusted advisors, as well as other allied health professionals, in the decision-making process.”
Expanded care locations and always-on monitoring. “When patients are always connected, care (the interpretation of data and decision support) can occur at any time and in any place,” HIMSS said.


A reliance on technology, connectivity and devices. “Connected health involves communication systems using a variety of components; these may be managed by the provider, the patient, or other parties in the care team,” HIMSS said.
And “empowerment tools and trackers that enable patients to become active members of the care continuum outside of the hospital setting and promote long-term engagement which, in turn, leads to a healthier population.”


Recognizing the challenges faced by healthcare providers in sustaining and scaling telehealth, the National Quality Forum (NQF) issued its own report last year, in which it proposed to set a national framework for measuring and supporting success in telehealth and telemedicine.

 

“Telehealth is a vital resource, especially for people in rural areas seeking help from specialists, such as mental health providers,” Marcia Ward, PhD, director of the Rural Telehealth Research Center at the University of Iowa and co-chair of NQF’s Telehealth Committee, said in a release accompanying the 81-page report. “Telehealth is healthcare. It is critically important that we measure the quality of telehealth and identify areas for improvement just as we do for in-person care.”

 

CMS’ Rural Health Strategy, developed by the CMS Rural Health Council, formed in 2016, and culled from input gained at 14 public hearings, features five objectives:

 

  • Apply a rural lens to CMS programs and policies;
  • Improve access to care through provider engagement and support;
  • Advance telehealth and telemedicine;
  • Empower patients in rural communities to make decisions about their healthcare; and
  • Leverage partnerships to achieve the goals of the strategy.
    The effort was met with words of support from several organizations.

 

“(The) AHA is pleased CMS put forward thoughtful recommendations to address the unique challenges of providing care to patients in rural communities,” Joanna Hiatt Kim, the American Hospital Association’s vice president of payment and policy, said in a release. “We look forward to working with CMS and Congress to take meaningful action to stabilize access in rural communities, such as creating new alternative payment models, expanding coverage of telemedicine and access to broadband and reducing regulatory burden.”

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5 Ways Telemedicine Is Helping Hospitals & Their Communities 

5 Ways Telemedicine Is Helping Hospitals & Their Communities  | Healthcare and Technology news | Scoop.it

Change has been hard on rural hospitals and their communities. Since 2010, more than 48 rural hospitals have closed and much more are on the brink of the same fate. Patients are seeking higher levels of specialized care from urban hospitals while rural communities are struggling to find top-notch providers willing to reside in remote areas. Lack of resources, provider shortages, and all-time low patient censuses are causing more and more hospitals to consider closing their doors.

But according to a Becker’s Hospital Review article, many believe that virtual health could be the answer to much of the woes rural hospitals are experiencing.

 

1- Patients are looking for more specialized services
When patients within rural communities contract long-term illnesses that require more extensive testing and monitoring, they’re often forced to spend additional time and resources on traveling to larger hospitals and health systems that are more equipped to provide the care they need. This could include regular check-up appointments with specialty physicians or more in-depth tests that require equipment their rural hospital doesn’t have access to. This can cause a snowball effect by taking away the same patient for general care needs that they can certainly receive from their community hospital.

 

Rural hospitals have quite a number of options when it comes to providing telemedicine to their patients and all are helpful in their own ways to combat the potential churn of a patient.

 

Remote specialist consultations can allow a rural hospital to connect with the nearest urban hospital and their physicians for specialized services while still retaining the patient and making their care more convenient and low-cost.

 

Outsourced diagnostic analysis allows patients to receive diagnostic tests followed by top-notch care depending on the outcome. Patients no longer need to travel for hours just to have an x-ray or specialty lab work performed.

 

Remote consultations allow doctors to perform routine check-in appointments with patients from home. Not only do they get to skip the long drive to their nearest urban hospital, they can even avoid the short commute to their rural hospital while still seeing their same physician.

 

Direct-to-consumer telemedicine allows rural hospitals to expand their services to new patients. Patients who don’t typically take the time to see a doctor can now have virtual consultations for urgent care needs without making an appointment, driving to an urgent care, or spending time waiting in the emergency department.

Telemedicine consultations of any kind save time for both the patient and the doctor, leaving room in the physician’s schedule for more appointments with other patients who do require in-person care. Patients in rural areas benefit by removing the barrier of transportation, long drive times and the costs associated with both.

 

2- Rural hospitals are experiencing provider shortages
There is expected to be an overall shortage of 46,000 to 90,000 physicians by the year 2025 and rural hospitals will feel it. Rural communities are having a hard time attracting physicians who are willing to live in remote areas. Rural communities have about 68 primary care doctors per 100,000 people compared with 84 in urban areas.

 

Rural hospitals who are experiencing provider shortages can utilize telemedicine platforms that come completely staffed with physicians who are fully trained in providing virtual care, and at a much less expensive rate. Telemedicine platforms who come staffed with 24/7 physician coverage are the perfect solution for small rural hospitals whose emergency departments get overwhelmed with patients not experiencing a true emergency. Patients can access a doctor from home and leave the resident physicians available for truly urgent conditions. Most physicians who staff a telemedicine platform are not primary care physicians, so there is no risk of losing patients to outside providers. In most cases, the physicians can help refer patients back to the hospital for other medical needs.

 

For hospitals who need an extra benefit to attract physicians from urban areas, according to Dr. Wilbur Hitt in an NEJM career resources article, “telemedicine fosters a collaboration that reduces the feelings of isolation that physicians may experience when they go to practice in a small town,” he said. “With telemedicine, it’s like having one foot in the city but being able to live and practice out in a rural area. It’s also reassuring to know that you’re on the right track with the treatment plan and are staying current.” In addition, it gives rural physicians the opportunity to specialize in something high-tech and innovative that will surely be the way of the future.

 

3- A high percentage of a rural hospital’s patients receive Medicare
Medicare and the subject of reimbursement often hinder the way a rural hospital can deploy telemedicine to their patients, especially in North Carolina where telemedicine parity doesn’t exist.

 

Currently, patients in rural areas who are covered by Medicare Part B can be reimbursed for telemedicine services, like office visits and consultations, as long as they are located at one of these places during the telemedicine consultation:

  • A doctor’s office
  • A hospital
  • A critical access hospital
  • A rural health clinic
  • A federally qualified health center
  • A hospital-based or critical access hospital-based dialysis facility
  • A skilled nursing facility
  • A community mental health center


An additional advantage of telemedicine for any patient, including those on Medicare, is that the cost of a visit is much less expensive compared to an urgent care facility or an emergency department visit which often tend to be the first choice for unscheduled care. With most virtual consultations costing less than $50 per visit, patients are able to save on both routine and urgent medical care costs. The savings also applies where insurance isn’t concerned. Non-existant commutes save on the cost of transportation and allow those without means of reliable transit to see a doctor from the comfort of their home.

 

4- Helping rural hospitals reduce readmissions
Telemedicine is already a proven tool for helping rural hospitals lessen the penalties they receive from value-based reimbursement policies. Rural hospitals who are using telemedicine in addition to implementing care coordination and patient experience improvement strategies are receiving fewer penalties than their urban counterparts.

 

While rural hospitals are already excelling, there is always room for improvement. According to RevCycle Intelligence, rural hospitals still have ways to go under the Hospital Readmissions Reduction Program. 79% of participating rural hospitals faced value-based penalties in 2015 under the program. This year, hospitals will see a 3% maximum rate of penalty and CMS estimates that will total $528 million dollars in penalties across the US.

 

A big factor in reducing readmissions is providing better preventive care, this is where telemedicine excels. Remote monitoring allows patients to check in more frequently with their physicians or nurses and also increases the chance that they’ll seek advice when experiencing an unscheduled medical care need before it advances to a more serious condition. By catching a sudden change in status, a patient can be seen by a primary care physician rather than being readmitted to the hospital, thus impacting a hospital’s penalties.

 

For some patients managing at-home care can be the challenge, especially when dealing with lengthy discharge instructions. When patients aren’t following their discharge instructions correctly, disease symptoms can flare, causing a trip back to the hospital. With remote monitoring via a HIPAA secure video connection, physicians and nurses have the ability to check in on a patient to see if they’re following their discharge instructions correctly and can also administer help remotely for patients who need a little extra hand-holding, this is especially useful for those who do not have at-home care or someone to assist with the fine details.

 

Prescriptions can also cause problems. Elderly patients may have trouble remembering to fill a prescription, especially when it involves scheduling an additional doctor appointment. By communicating via telemedicine, prescriptions can be refilled during a regular, virtual consultation and can be ready for pick-up at their preferred pharmacy in just a few short hours.

 

5- Increase patient census & reach the remote and underserved
As mentioned under section #1, direct-to-consumer telemedicine increases a hospital’s reach by attracting patients who otherwise wouldn’t seek care from a rural hospital’s network. Those who live and work in the corners of rural areas have the longest drive time and those who are underserved and do not have reliable transportation usually go without medical care. Even established patients will find value in seeing a doctor from home, greatly increasing their satisfaction of care received.

 

Telemedicine providers today are able to provide a white-labeled app, meaning they can design both the desktop and mobile interface where patients receive care to use a specific hospital’s brand standards- allowing a patient to seek care from a known and trusted healthcare provider. But, the branding isn’t the most important part. You should also consider how a patient is recognized when using telemedicine provided by your hospital and how their PHI is delivered back to your EHR. While most telemedicine providers can white-label the app, some cannot connect the patient back to your hospital, this creates a fragmented patient record contributing to disparate care coordination.

 

In addition to being able to tell where a patient is coming from, it also allows the physician providing the virtual care to help the patient determine where they should receive follow-on, in-person care, if necessary. Patients who are linked to one rural hospital can be referred back to that hospital’s network if it makes the most sense.

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5 ways technology will change the future of healthcare

5 ways technology will change the future of healthcare | Healthcare and Technology news | Scoop.it

Companies preparing to launch their health business ventures under the Trump administration's policies have met a state of flux around insurance and regulations.

But this is nothing new for businesses to grapple with, according to Mike Strazzella, a federal government healthcare attorney at Buchanan, Ingersoll & Rooney, PC. Our healthcare system has been in a state of flux for the past eight years, Strazzella said, with former president Barack Obama's commitment to reshaping the healthcare delivery system with the Affordable Care Act.

Back in the early 2000s, healthcare providers such as hospitals would put together five-year strategic plans. Now, the field changes so rapidly that they can only build one- to three-year plans, Strazzella said.

However, technology advances faster than the government can keep up, Strazzella said. "While the industry will have an appetite for more, entrepreneurs have to be ready for slow public sector progress, which is always a frustration," he said. "I think we're going to see the FDA implement processes and regulations to spark greater competition, whether that's a generic medication or a device."

Strazzella recommends businesses stay in touch with the latest trends within the industry, and build relationships with customers to gain a better understanding of their needs. He also advises business leaders to keep up with the happenings in Washington, DC, as much innovation in healthcare is driven by government regulation.

"We're still in flux," Strazzella said. "As long as people continue to think outside the box, and try and shape the policy debate around the delivery of healthcare, it will without a doubt trickle down to new ideas and concepts to try and help make health more effective."

Here are five predictions from Strazzella on the future of healthcare technology.

1. Advances in data mining and record keeping

 

"I think we're going to find that there will be a much stronger need for data mining and record keeping by a lot of people along all providers that touch the delivery system," Strazzella said. That includes information on a patient's income, Medicaid, and citizenship eligibility. "We're going to see more requirements put on places within the delivery system, and checks and balances of whether somebody should be receiving the type of insurance they're receiving, or if they're better suited for another option," Strazzella said.

2. Tailoring the health plan to the patient

"We're starting to see health plans gear people toward the right type of insurance for that person," Strazzella said. "We're starting to see them looking toward tech companies with that information, and how to parcel it out, and either gear future products that are the right fit for people based on that information, or try to help the patient move toward an existing product."

3. Moving to a fee-for-service system

Strazzella predicts that we will move toward a fee-for-service, value-based outcomes system in US healthcare, based on how successful a provider is at treating a patient. That might mean testing a medication to see if it works in three days instead of six days, for example. "It's going to require more metrics as we move to this, so there is going to be high demand on the IT side of things, and higher levels of competition," Strazzella said.

4. Electronic health records that talk to each other

The Centers for Medicare & Medicaid Services (CMS) is going to transition away from investing in electronic health record infrastructure, Strazzella said. Instead, meaningful use will be more about the interoperability of these systems. "We'll see systems that are user-friendly and will minimize time spent interacting with EHRs versus patients," Strazzella said.

5. Rise of telehealth

"Telehealth is starting to get its deserved recognition for how it can help save on costs to the healthcare system and patients in terms of hard dollars, time, and accessibility," Strazzella said. The field is growing in terms of care for patients in neurology, behavioral health, dermatology, and remote monitoring of chronic conditions. "As those tech advances advance, we can see those services can be removed from face to face encounters, and will progress a lot faster," he said.

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Are State Laws Holding Back Telehealth?

Are State Laws Holding Back Telehealth? | Healthcare and Technology news | Scoop.it

When it comes to telemedicine—a market that stood at $17.8 billion globally in 2014, and is anticipated to grow at a compound annual growth rate of 18.4 percent through 2020, according to recent research—one of the segment’s most critical issues is that there is so much variance in its regulatory policy. While there has been evidence showing the benefits of telemedicine in the healthcare industry, the realization of those benefits may come to an abrupt stop at the state border.


In fact, the American Telemedicine Association (ATA) recently analyzed how all 50 U.S. states grade out on telemedicine policy, finding a supportive landscape for physician practice standards and licensure in slightly less than half of them. The widespread differences in state law that prevent the seamless use of telemedicine across state borders include diverse state medical practice rules, restrictions on the interstate practice of medicine, the complex state insurance landscape, state privacy laws, and conflicting rules and guidance across state agencies.


“Telehealth has the ability to breakdown geographic barriers to care, but the lack of uniformity in state law makes it very challenging to operate in a multi-state environment,” says Dale Van Demark, partner in the health law group at the Chicago-based McDermott Will & Emery, a full service law firm with an active healthcare practice representing provider organizations that are interacting with telemedicine companies, and the companies themselves. Van Demark recently spoke with HCI Associate Editor Rajiv Leventhal about these telehealth variances, possible ways to break regulatory barriers, and what the future holds. Below are excerpts from that interview.


How big of a barrier is it to the telehealth industry that states have varying laws?


Healthcare is a highly regulated industry; any business has to think about the regulatory environment, as they have to act in within the confines of the legal and regulatory structure. Insurance companies are regulated by each state and they have to comply with the state law. Telemedicine companies are no different. In addition to that, states are not consistent from a policy perspective in how they view telemedicine. While there has been a general and rapid acceptance of this form of care in many states over the years, it’s not a universal truth. Some states have taken a much more restrictive approach, be it via a legislative body or board of medicine. There is more acceptance generally, but plenty of states are not marching down that path in the same way. As a national business in some instances, there are vastly different requirements via telemedicine, and in some instances, these variances are impractical.


What are some examples of the variances you’re seeing?


When you talk about the delivery of care in any situation, you’re thinking about in a basic sense, someone needing a license to practice medicine. One issue is the practice of medicine itself—What does it mean and require? In Texas, you’re seeing a rulemaking body taking a conservative approach to telemedicine. They have accepted that certain kinds of care can be delivered by telemedicine, but they believe it’s important for a patient to first see a doctor physically prior to any services being delivered via telemedicine. That falls into the category of “What is a telemedicine encounter and what’s required?” In Texas, an initial first visit is required.


Separately, each state has its own licensing rules. A New York license doesn’t permit me to practice in Colorado.  If I wanted to start a telemedicine company in South Carolina and treat patients across the country somewhere, you have to ask that if I am a doctor in South Carolina and I’M seeking video conferencing with a patient in Arizona, am I appropriately licensed to do that? As a general matter, states take the view that if you’re going to do that, you need a license in that state to engage in the state where the patient is. The multi-state licensure issue is another big one. Some states are more open to accepting “foreign” doctors and will be more liberal in the recognition of an out-of-state license. You can get a telemedicine license specifically in some cases too. There are different ways, but it’s another variation.


Other variances are with reimbursement and privacy. On the reimbursement side, some telemedicine services are reimbursed by Medicare or Medicaid. That is fairly restrictive, especially on the Medicare side where a number of circumstances have to be met. The structure of Medicare telemedicine reimbursement has been geared towards communities with a lack of healthcare resources. That element is often necessary, though it has been expanding slowly. Individual states have mandated that insurance companies to reimburse for telemedicine services, but again, it’s not uniform.

There is also a whole array of state privacy laws that come into play when dealing with healthcare that need to be addressed for any sort of healthcare company. This is another layer of complexity, as laws could be stricter than the Health Insurance Portability and Accountability Act (HIPAA).


With so many variances, are there ways to eventually get around these barriers and make things more uniform?


It’s a great question. We tend to think of the government as a single entity when it isn’t. What we’re talking about here are 50 jurisdictions—each state has different privacy laws, ways to govern medicine, and approaches to reimbursement. The feds have their own approach, and within governments you have different perspectives. A state legislature may pass a law saying you have to reimburse for telemedicine, but that state medical board could do what they did in Texas. If you have that dynamic, you have essentially two different parts of the government heading in two different directions. And that’s overlaid with privacy, which may be more restrictive than HIPAA.


You take a look and wonder if the state is supportive of telemedicine or not. The answer could be a little bit of everything. You need to keep in mind that we’re talking about multiple governments and multiple branches that have an impact on the delivery of healthcare via telemedicine. So a governmental fix to all of this is a little unrealistic and optimistic. Having said that, there has been a clear movement across governments to accept and embrace the delivery of healthcare via telemedicine. But it is a lack of coordination that creates the problem.


The only multi-jurisdictional effort that I have seen that could impact the nation broadly is the proposed Federation of State Medical Boards Compact Act, which provides a way for states to more readily accept a physician practicing within its boarders who does not have a license in that state, but does in another state. It’s a form of reciprocity, like your driver’s license. If states adopt the Compact, and a number have or are considering, then the licensure issue could be addressed. But that’s just one issue, and it doesn’t address the others such as privacy and reimbursement. But it’s the one effort I can point to where you would see a barrier to multi-state telemedicine licensures being lifted.


How does the physician community feel about all this?


The physician community is very diverse, so you can’t really make a broad statement. The advent of telemedicine, like the advent of urgent care centers that are out there, present a potential economic threat to other types of practices of medicine that we think of more traditional. There is an economic impact there, so you can see there being a reaction to this, and you are seeing that in places.  


There is also a reaction to telemedicine in terms of what a physician should be able to do in a telemedicine encounter as opposed to a face-to-face clinical encounter. If you’re there with a patient and able to perform a full clinical examination, a physician has more information than if he or she is speaking with the patient over the phone. No one would argue with that. Technology can overcome some of those limitations, but there are so many different versions. It’s a legitimate issue that the physician community is still wrestling with. What is it that a telemedicine encounter should be able to do? What are the best practices?


Moving forward, how will this play out— in the favor of telemedicine or against it?


I think it will be generally embraced, and the reason I say that is assuming efficacy of telemedicine programs, that they do no harm and benefit the patient, there is the the promise of telemedicine being cheaper and expanding access to care—both things we want to have in our healthcare system. Will we see it die away or be embraced? I would say embraced, not in every version, but definitely in general. In the history of humanity, we haven’t had many instances in which we made technological advances and not used them.

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Telehealth Program at Banner Health Reduced Costs, Hospitalizations

Telehealth Program at Banner Health Reduced Costs, Hospitalizations | Healthcare and Technology news | Scoop.it

The Phoenix, Az.-based Banner Health has announced successful results from its at-home telehealth pilot program for patients with multiple chronic conditions.


The Intensive Ambulatory Care (IAC) pilot program, done in partnership with the Netherlands-based Royal Philips, focuses on the most complex and highest cost patients —the top five percent of patients who account for 50 percent of healthcare spending. The program first launched in 2013 and aims to improve patient outcomes care team efficiency and prevent IAC patients from entering the acute care environment where costs are significantly higher.


As part of the pilot, Philips and Banner assessed the results of 135 patients to determine the effectiveness of the IAC program in meeting its clinical and financial goals. An analysis of the results of each patient's first six months demonstrated that the program:

  • Reduced costs of care by 27 percent. This cost savings was driven primarily by a reduction in hospitalization rates and days in the hospital as well as a reduction in professional service and outpatient costs.
  • Reduced acute and long term care costs by 32 percent. This cost reduction was primarily due to a significant decrease in hospitalizations.
  • Reduced hospitalizations by 45 percent. Prior to enrollment in the IAC program there were 11.5 hospitalizations per 100 patients per month; after enrollment the acute and long-term hospitalization rate dropped to 6.3 hospitalizations per 100 patients per month.
  • What’s more, the acute short term hospital stays decreased from 7.7 hospitalizations per 100 patients per month to 4.9; long term care home health or other facility stays decreased from 3.9 hospitalizations per 100 patients per month to 1.4; and the average number of days in the hospital per 100 patients per month also trended down from approximately 90 to 66.   


“The results of our at-home telehealth pilot with Philips have been dramatic and are indicative of the exponential success such a program could have by engaging patients in their own care and building a strong support system around them" said Dr. Hargobind Khurana, senior medical director of health management Banner. "As we continue to expand this program we anticipate seeing further proof that telehealth programs can address readmissions rates reduce costs and improve the health and quality of life for patients with multiple chronic diseases."


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Health checks by smartphone raise privacy fears

Health checks by smartphone raise privacy fears | Healthcare and Technology news | Scoop.it

Authorities and tech developers must stop sensitive health data entered into applications on mobile phones ending up in the wrong hands, experts warn.

As wireless telecom companies gathered in Barcelona this week at the Mobile World Congress, the sector's biggest trade fair, specialists in "e-health" said healthcare is fast shifting into the connected sphere.

"It's an inexorable tide that is causing worries because people are introducing their data into the system themselves, without necessarily reading all the terms and conditions," said Vincent Genet of consultancy Alcimed.

"In a few years, new technology will be able to monitor numerous essential physiological indicators by telephone and to send alerts to patients and the specialists who look after them."

More and more patients are using smartphone apps to monitor signs such as their blood sugar and pressure.

The European Commission estimates the market for mobile health services could exceed 17.5 billion euros (19 billion euros) from 2017.

The Chinese health ministry's deputy head of "digital health", Yan Jie Gao, said at the congress on Wednesday that the ministry planned to spend tens of billions of euros (dollars) by 2025 to equip 90,000 hospitals with the means for patients to contact them online securely.

Patients are entering health indicators and even using online health services for long-distance consultations with doctors whom they do not know.

"There is a steady increase in remote consultations with medical practitioners," particularly in the United States, said Kevin Curran, a computer scientist and senior member of the Institute of Electrical and Electronics Engineers.

"Your doctor can be someone who's based in Mumbai. We have to be very careful about our data, because they're the ones who probably will end up storing your data and keeping a record of it."

- Cloud-based healthcare -

Other users are entering personal health data into applications on their smartphones.

This kind of "e-health" could save governments money and improve life expectancy, but authorities and companies are looking to strengthen security measures to protect patients' data before such services become even more widespread.

"I think tech companies are becoming more concerned with privacy and encryption now," said Curran.

"The problem quite often is that a lot of this data is stored not on the phone or the app but in the cloud," in virtual storage space provided by web companies, he added.

"We are at the mercy of who the app providers are and how well they secure the information, and they are at the mercy sometimes of the cloud providers."

Others fear that insurance companies will get hold of customers' health information and could make them pay more for coverage according to their illnesses.

Various sources alleged to AFP that health insurance companies have been buying data from supermarkets about what food customers were buying, drawn from the sales records of their loyalty cards, following media reports to that effect.

The kind of "e-health" indicator most sought after by patients is fitness-related rather than information on illnesses, however, said Vincent Bonneau of the research group Idate.

A study by Citrix Mobile, a specialist in wireless security, showed that more than three quarters of people using e-health applications were doing so for fitness reasons rather than for diagnosing illnesses.


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New Legislation Helps Remove Telemedicine Barriers

New Legislation Helps Remove Telemedicine Barriers | Healthcare and Technology news | Scoop.it

There is no doubt that the practice of medicine has changed in many ways over the years.  Local physician practices that used to serve those within their community, now own or work for medical entities offering services across state lines and physicians practice in multiple states, both via telemedicine and in person. 

Legislation in this country has largely not kept up with the times, but it is expected that we will soon see many legal changes to catch up with the increasingly national practice of medicine. 

One of the major hurdles that has delayed the growth of telemedicine and the expansion of healthcare providers is the control of every state over licensure of physicians within their own borders.  This means that physicians must be licensed in every state in which they desire to practice medicine. 

Although there are some general exceptions among certain states that allow reciprocity (and many states allow for second opinions and special consultations), most states consider a physician to be practicing medicine without a license if he provides services to an in-state patient without a license (whether via telemedicine or in the state where the patient is located).    

For example, if a patient is in Illinois and obtains a diagnosis and prescribed treatment from a physician licensed only in California, then absent an applicable exception, that physician has practiced medicine in Illinois without a license.  The same would be true if the physician came to Illinois to see the patient in person.

In the fall of 2014, the Federation of State Medical Boards finally came out with the Interstate Medical Licensure Compact, which is intended to streamline the process of physicians obtaining licenses outside their own state.  With this legislation, more states will join in the effort to allow physicians to engage in medicine freely across borders.   

Under the proposed legislation, a physician would generally follow these steps to gain licensure in multiple states:

1. The physician files an application with the state in which she is are primarily located.  This is known as the “Principle Board.”  This does not have to be, but would generally be the board in the physician’s state of residence. 

2. The Principle Board would then decide whether to recommend that the physician be issued an expedited license with another state.  This recommendation would be made to the “Interstate Commission.”  This is the body that has been charged with administering the Compact. 

3. Once a physician is recommended to the Interstate Commission, that physician would then complete a registration process and pay the applicable fees to practice in each state for which he is applying.  The normal license fees would still apply for every state in which the application is being made. 

4. Each of the “State Member Boards” will share information related to any complaints and actions concerning a physician’s professional performance in another state.  Although states already share in this manner, information will likely be shared more quickly under the compact.  Similarly, future actions taken against a physician in one state will cause similar action to be taken by the other states, most likely in a more expedited manner. 

5. Physicians will still need to comply with the medical practice requirements of every state in which they obtain a license.  In no way does the Compact alter a state’s jurisdiction over medicine in any state. 

The compact makes a lot of sense for licensees who know how cumbersome the process is to apply for multiple licenses.  Through the compact, a single set of verified documents will be shared with multiple states, rather than repeating the same process multiple times.  This saves time and money and opens up new market for physicians (and companies) who were deterred by the licensure process. The compact will hopefully also speed up the growth of telemedicine and mhealth throughout the country.

While there are many details still to be worked out about how the compact will work, it does seem to be a step in the right direction in keeping up with the current state of medicine.


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Mentoring, Telemedicine Offer Paths to Better Rural Health Care Access -- AAFP News

Mentoring, Telemedicine Offer Paths to Better Rural Health Care Access -- AAFP News | Healthcare and Technology news | Scoop.it

One doesn't have to look too hard to find long-standing obstacles to providing rural health care: too few primary care physicians in sparsely resourced areas and limited support for specialty care referrals. And even as new technologies are enabling greater access for patients and enhanced training to improve care coordination, old education and payment standards persist..

Long-distance Mentoring

In 2003 in New Mexico, gastroenterologist Sanjeev Arora, M.D., was treating patients with hepatitis C virus infection -- many of whom faced an eight-month waiting period to see him. Moreover, some had to drive as much as 250 miles each way for their appointments. Patients were dying of liver cancer and other ailments because they could not obtain timely care.

"I knew if we had treated them earlier, we could have cured them," he said.

Ultimately, Arora realized that the best way to manage patients with complex chronic conditions was not simply for the subspecialty physician to see patients around the clock. Rather, an entire network of health care professionals could be trained to provide needed care. The idea of spreading that knowledge gave birth to Project ECHO (Extension for Community Healthcare Outcomes), where Arora serves as executive director.

ECHO is a mentoring network that seeks to teach primary care physicians and other health care professionals how to care for specific chronic conditions. To make this "telementoring" system work, subspecialty physicians provide guided instruction to primary care physicians, nurse practitioners and physician assistants.

"We know that chronic disease management is a team sport," Arora said. "You become a mentor as opposed to a doer."

Such interactive training sessions are a necessity in a changing medical environment, according to Arora, who said he thinks the traditional graduate medical education (GME) curriculum is no longer effective.

"The system of GME where we educate residents and fellows and just send them out there isn't going to work in a knowledge-based workforce," Arora said. "Academic medicine needs to take responsibility for training the entire health care workforce for their entire career."

Arora said funding for such career training efforts should be considered an infrastructure investment similar to the U.S. National Library of Medicine, a publicly funded institution.

Perinatal Care Via Telemedicine

In rural states such as Arkansas, some residents must drive for hours to meet with a physician. Forty-four percent of the state's population resides in rural areas, and the number of obstetricians, in particular, is inadequate to meet population needs. Curtis Lowery Jr., M.D., medical director of the University of Arkansas for Medical Sciences ANGELS (Antenatal and Neonatal Guidelines, Education and Learning System) program, outlined how telemedicine has helped to close the gap in regions without enough physicians to provide care for women with high-risk pregnancies.

"It's very difficult to get physicians to go to the (Mississippi) Delta," said Lowery, who is also chair of the university's department of obstetrics and gynecology. "They feel alone, like they are on an island with no support. So we use technology to support them."

When the ANGELS program started in 2003, there were only three maternal/fetal specialists in a state that saw 45,000 deliveries each year. Initially, a few telemedicine hubs were set up around the state with local government support. Thanks to an infusion of $102 million in federal funding, however, the program soon expanded to cover the entire state.

Instead of expecting rural patients to meet physicians in urban areas, telemedicine enables physicians to connect with those patients by teleconference. A 24-hour call center is available for patients and physicians to coordinate care. And telemedicine efforts that originally focused on management of high-risk pregnancies have expanded to include care protocols for patients with stroke or sickle cell anemia, as well as those in need of surgical consultations.

Much as the influx of patients newly insured under the Patient Protection and Affordable Care Act has initially added to overall health care system expenditures, wider adoption of telemedicine will also likely lead to increased costs in the short term as more patients are seen via this method. But, Lowery predicted, the system will ultimately save costs on travel and the long-term care that becomes necessary when appropriate preventive and management services are unavailable.

Still, for telemedicine to achieve its full potential, Lowery said changes that permit payment for telemedicine consultations are needed.

"The biggest problem with the adoption of telemedicine is the payment," he said. "We need to change the way we pay and need to be able to pay for new systems. In my career, I've done thousands of telephone consultations, but I've never been paid for one."

Effecting this change is particularly difficult, Arora chimed in, when one considers the fact that elderly patients -- those in their 80s and 90s -- consume 10 times more health care than an individual in his 60s. And it's certainly conceivable that these older people would be using telemedicine services frequently.

"The payers are terrified," Lowery said. "When a lot more care is given, a lot more money is spent in fee-for-service. That's where we are in telemedicine."



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