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5 Barriers to Telemedicine Adoption and How to Overcome Them

5 Barriers to Telemedicine Adoption and How to Overcome Them | Healthcare and Technology news | Scoop.it

Telemedicine is one of the most notable advancements making waves in the digital transformation of healthcare. Telemedicine poses wins for healthcare organizations seeking to improve patient access while controlling costs, as well as healthcare consumers looking for more convenient ways to engage with providers.

 

With 71 percent of providers reporting the use of telehealthand telemedicine tools, it’s clear that the industry is sold on the benefits of virtualized care. Telemedicine market projectionssuggest that the industry will reach roughly $20 billion by 2025.

 

The patient and provider benefits of telemedicine are manifold—including reduced readmissions through remote patient monitoring, reduced costs via virtual access to specialists, and improved patient engagement—but barriers to adoption still linger. Here are five key challenges giving healthcare executives pause when it comes to telemedicine adoption and recommendations on how to successfully navigate those hurdles.

 

1) Understanding what comprises telemedicine. Due to varying state and federal definitions, as well as variance between Medicare, Medicaid, and commercial payer guidelines on what constitutes telemedicine, confusion still exists regarding what services will and won’t be reimbursed. Establishing a keen understanding of what virtual services qualify and how those services are reimbursed for each payer is vital. This will lay the foundation for quantifying the potential revenue impact of adoption.

 

2) Concerns around the cost to implement. Costs associated with telemedicine program adoption can include a myriad of factors, from video conferencing adoption to remote patient monitoring expansion. To mitigate the potential for expense sprawl, executives should identify key, phase-one telemedicine service offerings. Weigh earnings potential against anticipated program implementation and support costs to justify those telemedicine coverage areas.

 

3) Added data vulnerability. With healthcare security breaches on the rise, executive teams remain cautious of any patient data exposure risk. Many view virtual care delivery as an additional layer of potential threat. As with other IT implementations, thorough security protocols and routine audits should be put in place to guard against the real-time exposure of protected health information (PHI).

 

4) Potential for fraud and abuse. Telemedicine agreements can be subject to federal kickback laws, particularly in situations involving referrals for additional services. Providers must remain up-to-date on the regulations governing telemedicine services to ensure regulatory compliance and proper eligibility for reimbursement.

 

5) Patient awareness of and trust in virtual care offerings. Even with the proper broadband and internet resources in place to support patient adoption of telemedicine, providers may encounter patient reluctance to engage virtually. Healthcare organizations must cultivate trust by educating patients on offerings and what they can anticipate during virtual visits. Providers should also address security concerns with patients.

 

To ensure that engagement in telemedicine is a long-term trend as opposed to a short-term fad, healthcare providers will have to address and overcome these challenges. By implementing a telemedicine strategy that addresses these challenges head-on, providers can overcome barriers and rise to meet growing consumer demand for more convenient provider engagement options. As more healthcare organizations pivot to embrace new digital health platforms, telemedicine adoption, specifically, is quickly emerging as a key differentiator in an increasingly competitive landscape.

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Rural Health Professions Training: Teaching Medical Students the Benefits of Telemedicine

Rural Health Professions Training: Teaching Medical Students the Benefits of Telemedicine | Healthcare and Technology news | Scoop.it

For medical students with the University of Arizona College of Medicine – Tucson, weeks of suspense will end on March 15. Otherwise known as Match Day, it’s the day the students will learn where they will go for their residency training, in their chosen medical field, after they graduate from medical school in May.

 

Sarah Joy Ring, who has completed the College of Medicine – Tucson’s Rural Health Professions Program and a 16-week Rural Health Distinction Track, is hoping for a residency focused on both pediatrics and emergency medicine, potentially in a rural location.  Her “capstone” paper, an in-depth research project that all Distinction Track students are expected to complete, carries the impressive title of “A Survey of Rural Emergency Medicine and the Discrepancy of Care for Pediatric Patients that Present to Rural Emergency Departments.”

 

During her training, she had opportunities to see how important telemedicine can be in rural communities.

 

“I was at sites that had telemedicine capabilities and spent some time chatting with the physicians about them. "I can specifically remember two experiences, one while on my family medicine rotation in Tuba City (in northern Arizona, where students learn about American Indian healthcare) and one during my RHPP summer in Flagstaff” (also in northern Arizona).

“Tuba City experiences a significant shortage of mental health providers in general, and specifically for children and adolescents," Sarah says.

“As such, they found using telemedicine helpful to connect the children of that region with services that they would otherwise struggle to receive, due to having to travel large distances to receive help, which incurs financial and time burdens for families.

“Moreover, a point that I found particularly enlightening when learning about this service, was with regard to what it means to live in a small population where it is quite likely you know most people living in the region," Sarah says.

“The physicians found that because of this, many adolescents experiencing difficulties often felt uncomfortable sharing with people who lived in the region, out of fear that they may tell someone, or that they were themselves a relative or family friend, which can be a common experience. Having someone to share with who lived out of the region and was not specifically invested in the region and an integral member of the community made many of these adolescents more comfortable with disclosing their experiences.  

“I also worked on writing about how telemedicine can be used to augment pediatric services in rural emergency departments for part of my "capstone" project and found some very positive results from multiple studies. For critically ill patients, one study found that in particular, telemedicine consults improved the access to critical care specialists, resulting in a reduced frequency of physician-related medication errors. Moreover, another study found that parent satisfaction was higher with telemedicine consults than with phone consults, which is a particularly important outcome when caring for pediatric patients and their family. Many of these same findings also translated to the pre-hospital environment, where ambulances that utilized telemedicine resulted in better assessments, more interventions in the pre-hospital environment, and improved outcomes for pediatric patients in pre-hospital care. 

“Overall," Sarah says, I think that we will continue to find that telemedicine is an excellent resource for rural providers that allows patients to have clinically significant access to additional resources and care that would otherwise be difficult or unavailable to the region."

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Telemedicine’s Pivotal Role in Improving Mental Health

Telemedicine’s Pivotal Role in Improving Mental Health | Healthcare and Technology news | Scoop.it

Living with a mental illness can be isolating and difficult. The long-standing stigma connected with mental illness, along with limited treatment accessibility, patients’ fear of the potential repercussions of family, friends, and employers finding out about their condition, have kept many individuals from seeking the support they need. Fortunately, these trends are starting to shift in a more positive direction.

 

Although some stigma and shame still surround such illnesses as depression, anxiety, OCD, and bipolar disorder, people are beginning to feel more comfortable about sharing their own strugglesand finding support from others online. Telehealth and an interconnected world are coming together to end stigma, and help people manage their mental health in a more effective way.

 

Perspectives About Behavioral Health Problems Are Improving

Technology has helped us to connect with one another in many positive ways, but this interconnectivity has been a double-edged sword for mental health. Social media and smartphones have led to a 24/7 lifestyle that can exacerbate or even create mental health issues. With that said, technology has also opened up a dialogue that is beginning to change the conversation and do away with the stigma surrounding mental illness.

 

Thanks to those who have shared their experiences online, more people are beginning to realize that mental illness is quite common. Ultimately, this change should mean that more people feel comfortable seeking treatment so they can live a healthy, more productive life.

Services Are Becoming More Accessible

Limited access to treatment has always been an obstacle for people seeking mental health services. Finding a therapist locally can be a challenge, because many mental health professionals may not accept some forms of insurance, or do not treat a patient’s needs. A 2017 Milliman report illustrated the shortage of mental health professionals nationwide, with only 8.9 psychiatrists for every 100,000 people, which leads to many people seeking treatment while waiting months to get help.

 

The American Psychiatric Association fully supports telepsychiatry, now that telehealth has shown it can improve accessibility and enable patients to get the help they need without the struggle. Patients and professionals have found that therapy sessions via video chat and other remote services are as good as “face to face” sessions. Telehealth support is also key for patients with  mental health needs; they can consult with a specialist without having to travel.

 

Telehealth is increasingly being utilized in emergency situations. Patients who are experiencing a mental health emergency can reach out to professionals 24/7 and receive remote monitoring when necessary. This helps to allow patients to maintain their independence while ensuring they have the support they need.

 

More Specialists Are Needed to Pave the Way Toward Change

Now that more people are opening up about their mental health challenges, many others are becoming inspired to take charge of their own mental health. That’s creating an unprecedented demand for behavioral health services in both traditional models and telemedicine. While this signals a positive cultural shift, the healthcare system is not prepared for this growing influx of new patients.

 

There are many mental health resources available to help people cope with common mental illnesses, but what is needed long-term is more mental health specialists. To ensure that every American has access to high-quality behavioral healthcare, we need more people to enter this growing field. According to some estimates, 70,000 mental health specialists in several disciplines will be necessary to meet demand by 2025.

 

The good news? Healthcare organizations are increasingly adapting to new trends to meet patients’ needs. Thanks to new same-day programs and mental health professionals at primary care facilities, patients can now get help in as little as 30 minutes.

 

Should You Pursue a Career in Behavioral Health?

A career in mental health is a great option for people who are committed to helping others.  While becoming a behavioral health professional takes time and extensive education, it can be a satisfying career, and specializing in telemedicine is a great way to help solve the shortage of qualified professionals.

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4 Things to Know About Telehealth

4 Things to Know About Telehealth | Healthcare and Technology news | Scoop.it

Telehealth has emerged as a critical tool in providing health care services. [1] The practice covers a broad range of medical technology and services that collectively define the discipline. Telehealth is especially beneficial for patients who live in rural communities and other remote areas where medical professionals use the Internet to gather and share information as well as monitor the health conditions of patients by using peripheral equipment and software such as video conferencing devices, store-and-forward imaging, and streaming media. The following information details important factors that are shaping this burgeoning field.

 

The Changing Face of Telehealth Law
Today’s competitive health care marketplace has created an environment where patients demand lower costs, higher service quality, and convenient access to services. [2] Telehealth is an innovative and valuable mechanism that provides patients with efficient access to quality services. Lowering costs and removing barriers to service access, are critical components in promoting patient wellness and population health. Convenience and cost-effectiveness are important commodities in the modern health care marketplace, as patients tend to avoid treatment that is difficult to access or too expensive. As a result, telehealth technology is emerging as a preferred choice among patients and providers. Telehealth has also attracted the attention of US legislators. They utilize this tool for improving the competitiveness of American health care services. This is especially important, seeing as health care represents 17 percent of the nation’s gross domestic product (GDP). In fact, the resource has helped to define the role that lawmakers play in ensuring that patients benefit in a competitive health care market.

 

Reimbursement for Services Delivered by Telehealth
The laws regarding reimbursements change regularly as more service providers incorporate telehealth technology into their practices. Reimbursement procedures can vary by state, practice, insurer, and service. [3] Care providers need to understand several facts, regulations, and laws to navigate Medicare telehealth reimbursements. They must first scrutinize whether the distance between the facility (the originating site) and the patient is far enough to qualify as a distant site. The location must also qualify as a Health Professional Shortage Area (HPSA) per Medicare guidelines. Additionally, the originating site must fall under Medicare’s classification as a legally authorized private practice, hospital, or critical access hospital (CAH). For instance, the Centers for Medicare and Medicaid Services ranks the Harvard Street Neighborhood Health Center as a top facility in need of physician services based on these criteria. Care providers must also use proper insurance coding to be reimbursed for hosting services that use telehealth technologies. For now, collecting reimbursements for telehealth services remains simpler for practitioners who limit the scope to which they apply the technology.

 

Telehealth or Telemedicine?
The term ‘telehealth’ is gaining popularity among medical professionals, compared to the original term, ‘telemedicine.’ [4] Some medical professionals use the names interchangeably. However, telemedicine is a term that may apply to the application of any technology in the clinical setting, while telehealth more distinctly describes the delivery of services to patients. Telemedicine is a familiar term, but telehealth more appropriately describes the latest trends in using technology to deliver treatments to patients. Depending on the organization, service providers may use a different definitions of telehealth. Although the basic premise remains similar, the context may change according to factors such as organizational objectives, and the needs of the patient population being served. Medical experts do agree on one point; telehealth is an innovative way of engaging patients, and it is highly beneficial for both providers and patients.

 

The Road Ahead
There are several areas where telehealth medicine could make a significant impact. It could be used as a tool to remotely monitor patients who have recently been discharged. It may also help treat individuals with behavioral health issues who might normally avoid treatment due to its high cost, or to avoid any perceived public stigma. [5] The largest area where technology could advance medicine is in treating the chronically ill. These patients usually require many visits with several specialists who may practice at different and distant originating sites. To move telehealth forward, organizational leaders must present evidence to peers and patients that the technology offers value. In addition, care providers must work to transition patients from using telehealth services only for minor conditions (for headaches, colds, etc.), to accepting the technology as a viable replacement for costly physician office visits. Advocates for telehealth medicine must also develop quality controls, so that this potentially transformational tool can maximize its problem solving capabilities and its service effectiveness. To harness the benefits of telehealth technology, America’s brightest medical professionals (both experienced and up-and-coming) must make a concerted effort to incorporate the tool into their practices and make it a regular service offering. Today’s medical students — as they enter a world where telehealth is becoming more pervasive — can take part in what might be a monumental change in the way health professionals think about medical treatment.

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Why is Telehealth so Important in Our Healthcare System? 

Why is Telehealth so Important in Our Healthcare System?  | Healthcare and Technology news | Scoop.it

Telehealth is emerging as a critical component of the healthcare crisis solution. Telehealth holds the promise to significantly impact some of the most challenging problems of our current healthcare system: access to care, cost-effective delivery, and distribution of limited providers. Telehealth can change the current paradigm of care and allow for improved access and improved health outcomes in cost-effective ways.

 

Telehealth increases access to healthcare:

  • Remote patients can more easily obtain clinical services.
  • Remote hospitals can provide emergency and intensive care services.

Telehealth improves health outcomes:

  • Patients diagnosed and treated earlier often have improved outcomes and less costly treatments.
  • Patients with Telehealth supported ICU’s have substantially reduced mortality rates, reduced complications, and reduced hospital stays.

 

Telehealth reduces healthcare costs:

  • Home monitoring programs can reduce high cost hospital visits.
  • High cost patient transfers for stroke and other emergencies are reduced.

 

Telehealth assists in addressing shortages and misdistribution of healthcare providers:

  • Specialists can serve more patients using Telehealth technologies.
  • Nursing shortages can be addressed using Telehealth technologies.

 

Telehealth supports clinical education programs:

  • Rural clinicians can more easily obtain continuing education.
  • Rural clinicians can more easily consult with specialists.

 

Telehealth improves support for patients and families:

  • Patients can stay in their local communities and, when hospitalized away from home, can keep in contact with family and friends.
  • Many telehealth applications empower patients to play an active role in their healthcare.

 

Telehealth helps the environment:

  • Reducing extended travel to obtain necessary care reduces the related carbon footprint.

 

Telehealth improves organizational productivity:

  • Employees can avoid absences from work when telehealth services are available on site or when employees can remotely participate in consultations about family members.
  • These examples illustrate the some improved outcomes and cost savings being achieved by Telehealth and telehealth programs:
  • Home monitoring of chronic diseases is reducing hospital visits by as much as 50% by keeping patients stable through daily monitoring.
  • The national average for re-admission to hospitals within 30 days following a heart failure episode is 20%. Telehealth monitoring programs have reduced that level to less than 4%.
  • Timely provision of treatments that effectively reverse the consequences of a stroke have risen from 15% to 85% due to the availability of telestroke programs.

 

Telehealth support to Intensive Care Units (often called eICUs) is reducing mortality rates by 15 – 30% and substantially reducing complications and length of stay.

 

Telehealth retinopathy screening programs support early identification of serious eye disease and reduce the incidence of blindness in diabetic patients.

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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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Amazing Technologies Changing The Future of Dermatology 

Your body’s best guard in a hostile world: your skin

Everything is written on your skin. Every wrinkle, spot, and color tells a story, and not only a medical one. This miraculous organ can show you as a litmus paper whether you have a disease. For example, people with few red blood cells may look pale, while patients suffering from hepatitis have yellowish skin color. Yet, this is just the tip of the iceberg.

The skin protects you against moisture, the howling winter winds, the scorching sun rays, the swarm of germs and toxic substances. It acts as the most reliable thermostat: helps you prevent dehydration and protects you from the consequences of too much heat or cold. It allows you to feel sensations: touching, itching and even pain. As weird as it sounds, the skin also acts as a storage room: its deepest layer can store water, fat or metabolic products. If it is injured, it produces wounds. And while it protects you from an unimaginably huge amount of parasites, bacteria, viruses, and germs, sometimes the price for not letting these disease agents into the organism is its own disease.

Skin cancer is too common

According to statistics from the WHO, currently, between 2 and 3 million non-melanoma skin cancers and 132,000 melanoma skin cancers occur globally each year. Data from the US Skin Cancer Foundation suggests that each year over 5.4 million cases of non-melanoma skin cancer are treated in more than 3.3 million people only in the US. The annual cost of treating skin cancers there is estimated at $8.1 billion: about $4.8 billion for non-melanoma skin cancers and $3.3 billion for melanoma, which is an insanely huge number. And what is even scarier? For example, the fact that according to the estimations One in five Americans will develop skin cancer in the course of a lifetime.

The situation is not a tiny bit better in other countries. In 2014, 15,419 new melanoma skin cancer cases were diagnosed, Cancer Research UK found. The results of their surveys also indicate that incidence rates have increased by 119 percent in the UK since the early 1990s. And if you look at the last decade, this number still reaches 45 percent. International trends aren’t a cause for more hope, either. A study found that the incidence of cutaneous malignant melanoma has steadily increased over the past 50 years in predominately fair-skinned populations. Moreover, incidence rates of melanoma continue to rise in most European countries (primarily Southern and Eastern Europe), whereas, in Australia, New Zealand, the U.S., Canada, Israel and Norway, rates have become rather stable in recent years.

Luckily, digital technologies are on their way to help dermatologists diagnose and treat skin diseases better and more effective. Innovative solutions have a huge impact on healthcare in general, but in case of certain subfields, such as surgery, even the transformation of the whole specialty can be expected. Looking at dermatology, it will probably not experience such a radical turn as surgery, but the shift will still be determining. Technology has been shaping dermatology praxises for years, and this will accelerate in the coming years. Here, I decided to enlist all the digital solutions which help medical professionals truly bring dermatology into the 21st century.

Telemedicine

As you can easily detect if you have a skin problem, and smartphones coupled with super-fast internet connection make it easy to send pictures or footage anywhere, telehealth solutions appeared naturally in dermatology. The options of teledermatology services are soaring. FirstDerm, Spruce, Direct Dermatology, SkinMDnow, Zwivel or iDoc24. They all work based on the same principle: they promise patients to connect them to a dermatologist online for consultation within a very short period of time. Usually, people can load up their photos to a certain platform, and dermatologists give advice based on it.

The popularity of the platforms shows there was an urgent need for this solution. iDoc24 had already more than 7,000 cases submitted from all over the world. It also turned out that the majority of the issues were rather harmless: iDoc24 found 70 percent of all their reviewed cases could be self-treated and they advised the patient to undertake further tests in all the remaining 30 percent of cases. It is a win-win for everyone: patients do not have to wait in crowded waiting rooms for an exam, while dermatologists can deal with the easier cases in shorter time online.

2) Big Data

The analysis of Electric Health Records (EHRs) and other huge data sets allows for the optimization of even such mammoth-like systems as healthcare. Data analytics help improve the quality and coordination of care, reduce the incurred costs and avoid unnecessary use of resources. Dermatologists also recognized the huge potential of big data to bring lasting change to their specialty.

The American Academy of Dermatology introduced a clinical registry called DataDerm in 2016. The database was created by dermatologists and connects data on millions of patients from thousands of dermatologists throughout the US. It eases the pain of reporting and allows medical professionals to demonstrate the quality of care they provide, to payers, policy makers, and the medical community. At the same time, it gives every member a private analysis of his or her practice’s data against national averages – down to the patient level. It is great for setting standards in dermatology, measuring each participant how they perform and ensuring the average quality of care.

3) Robotics

Amazing high-tech machines appeared on the stage of medicine lately. The New Jersey-based company, Canfield Scientific have recently installed the first commercial Vectra WB360 whole-body skin lesionmapping system. It is able to take a 360-degree scan of the entire body and identifies all the lesions on the skin. But what is even more exciting, the potential in robots helping dermatologists, especially aesthetic dermatologists in the future.

Many skin cancer types and other skin problems are treated with laser therapies, and a study found that robots might be able to help there. Researchers compared the accuracy and consistency of laser irradiation treatments carried out by humans and robotic arms, and investigators found the robot-guided treatments to be superior to the manually guided treatments. In the future, we can expect laser therapies to be carried out by “robotic surgeons” with humans controlling the process.

4) Artificial Intelligence

Deep learning algorithms are especially good at recognizing certain images, thus they will certainly have a place in the future of medical specialties dealing with medical imaging, such as radiology or dermatology. For example, IBM decided to let dermatologists leverage on the results of its deep learning platform, Watson in order to diagnose melanoma and other types of skin cancer faster, more accurate and preferably without the need for many biopsies. At the IBM T.J. Watson Research Center, experts found that their deep learning system was able to achieve a 76% accuracy at diagnosing melanoma cases based on dermatology images, while the average accuracy for the eight dermatologists on that data set was 70.5%. It is a very promising result!

Researchers at Stanford University carried out a similar experiment. They created an artificially intelligent diagnosis algorithm for skin cancer with the help of an algorithm developed by Google that was already trained to identify 1.28 million images from 1,000 object categories. Then, they made a database of nearly 130,000 skin disease images representing over 2,000 different diseases; and trained their algorithm to visually diagnose potential cancer. From the very first test, it performed with inspiring accuracy. It performed at least as well as dermatologists participating in the research, which is very impressive! Now, the team is considering to make the algorithm smartphone compatible in the near future, bringing reliable skin cancer diagnoses to our fingertips. Mind-blowing innovation in sight!

5) 3D Printing

The answer for organ shortages of all kinds, including skin, as well as to the increasing reluctance to test new cosmetic, chemical, and pharmaceutical products on animals, is 3D printing. Many innovators recognized it already and plenty of research is going on. Scientists at the Spanish Universidad Carlos III de Madrid in collaboration with the bioengineering firm BioDan Group have presented a prototype for a 3D bioprinter that can create an entirely functional human skin. James Yoo and his team at the Wake Forest School of Medicinein the US has also developed a similar prototype that can create synthetic skin. San Diego-based bioprinting firm Organovo teamed up with cosmetics giant L’Oréal in 2015 to supply 3D-printed skin.

3D printing could ensure that critical tissue shortages, which were reported for example in Australia in 2016or in Japan in March 2017, would never again hamper the tasks of medical professionals.

6) Regeneration

Injuries of the skin take a long time to heal. For a 10 mm cut, it takes 1-2 weeks to turn into a scar and then slowly fade away. Researchers are working on various innovations for shortening the healing process and accelerating the natural responses of the human organism for more effective skin regeneration.

Healthpoint Biotherapeutics developed a skin cell spray to improve conventional treatment for leg ulcers. According to a study, applied prior to wrapping the leg with compression bandages, the spray both improved the extent of healing and did it in less time than healing with bandages alone. Another remarkable innovation is ACell’s MatriStem, an extracellular matrix, which helps regrow tissues – it even induced the regrowth of an amputated fingertip in 2010. A very similar extracellular matrix helped treat a US Marine who lost 70 percent of his thigh muscle in a mortar explosion in Afghanistan. Researchers at the McGowan Institute for Regenerative Medicine at the University of Pittsburgh applied a “cocktail of proteins” and growth factors derived from pig bladders. After a few weeks, his leg muscles started to grow back! Simply amazing!

7) Social media

Facebook, Twitter, and LinkedIn are the social media platforms which everyone with an internet connection knows and uses. They are wonderful communication tools, sources of information and common knowledge, they function as community building platforms and spaces for promoting great causes. It is no different regarding healthcare – or dermatology, for that matter.

For example, Webicina, the first medical web 2.0 guidance service, offers Dermatology and Web 2.0, a free comprehensive resource containing all the web 2.0 tools from quality blogs and communities to online slideshows and mobile applications. It was designed to help medical professionals interested in dermatology find the best resources online. Moreover, La Roche-Posay, a division of L’Oreal, uses social media to promote its SOS Save our Skin campaign, which it does in conjunction with the US Women’s Dermatologic Society. The American Academy of Dermatology launched its 2017 SPOT Skin Cancer campaign, which is encouraging women to check both their partners and themselves for signs of skin cancer. The AAD started the #SpotSkinCancer hashtag on social media and encourages everyone to share their photos or videos to raise awareness how important it is to detect skin cancer in time.

8) Health sensors

As the market for wearables and health sensors is exploding, you can find all kinds of tiny gadgets measuring your vital signs and health parameters. In the future, some of these devices will not only do measurements but offer diagnosis or participate in the treatment of certain diseases. Skin-related conditions might be the first to diagnose or treat with small, sensor-like materials or gadgets. This year, L’Oréal introduced its wearable sensor for measuring sun exposure and notifying the user when they are about to get sunburn. The patch changes color to warn against skin cancer.

What’s more, a group of Indian researchers presented a unique patch for treating skin cancer at the Society of Nuclear Medicine’s Annual Meeting in 2012. The patch is infused with phosphorus-32, a radioactive isotope used to treat some types of cancer. The researchers carried out a small study on the effectiveness of the patch and the results were very promising. Ten patients with skin cancer on their faces were treated with the patch, and three months after the treatment, biopsies showed no sign of their tumors. When biopsies were performed again at six months, however, the basal cell carcinomas had returned in two of the patients. I believe it is a great achievement, and I hope to hear about more similar research projects in the future.

9) Nanotechnology and nanoparticles

Nanotechnology proves to be a fertile field in dermatology and especially in cosmetics; as nanoparticles make their way into UV-light absorbing sunscreens and anti-aging products. When properly engineered, nanomaterials may be able to topically deliver retinoids, antioxidants, and drugs such as botulinum toxin or growth factors for rejuvenation of the skin in the future.

Yet, nanotechnology also has to offer a lot in the fight against cancer. Researchers also are reviewing the use of nanomaterials for the treatment of melanoma. In particular, gold, when turned into a nanomaterial called nanoshells, has been shown to be a useful treatment for melanoma in animal studies. So, perhaps skin cancer will be treated by gold in the future. Who knew that everyone’s favorite jewelry material has such beneficial traits?

 

Although the above list certainly has its limitations, it shows the vast potential of digital technologies to change the landscape of dermatology very soon. Thus, a student who wants to become a dermatologist might better become friends with disruptive innovations to get the most out of them when they start practicing.

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4 Important Ways Healthcare Technology Improves Your Patient Care

4 Important Ways Healthcare Technology Improves Your Patient Care | Healthcare and Technology news | Scoop.it

Healthcare technology continues to be a hot topic of conversation, as the world that we’ve long visualized gets closer to being our reality.

It’s changing how healthcare providers diagnose, treat, manage and monitor. Health tech has the potential to save lives, improve quality of life, and completely redirect the downward trajectory of hard to manage patients.

Let’s explore how 4 important health techs are improving patient care.

Predictive Analytics & Machine Learning

Physicians today utilize predictive analytics & machine learning to better identify high risk patients and put the right interventions in place to:

  • Prevent admissions
  • Prevent readmissions
  • Reduce decline and relapse
  • Improve medication compliance
  • Speed up recovery
  • Help patients respond to triggers
  • Better engage patients in between visits

Patients today want more personalized care Health tech like this helps give patients what they want as it improves patient care and patient outcomes.

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Wearable Technology

For patients suffering from chronic conditions, wearable technology provides a better way for patients to meet their health metrics.

This is because they receive immediate feedback about their health, current state of being, and behaviors that will impact those metrics. In many cases, the data can even be accessed by their physician in real time.

Wearables provide tools patients need to track and adjust behavior on a moment-to-moment basis rather than waiting until they have a doctor’s visit.

Today doctors are using wearables to:

  • Help patients be more active
  • Keep patients informed about day to day heart health
  • Help those with musculoskeletal injuries and physical developmental delays regain or gain mobility, including paralysis of the lower extremities
  • Track sleep patterns
  • Better understand mood disorders
  • Painlessly monitor glucose levels
  • Relieve chronic pain

The potential of remote monitoring to improve care has long been studied, but more recently we are finding it within our reach.

Virtual Reality

Medical students today can use virtual reality (VR) to get hands-on without a real patient in sight. This allows for more in-depth training and real time feedback that doesn’t include your patient screaming when you make a wrong move.

Furthermore, doctors today use VR to help treat patients with:

  • Anxiety
  • PTSD
  • Depression
  • Phobias

Through systematic desensitization, patients can face their fears, anger and sadness in a controlled setting. Before VR, such “facing of fears” would have been much more logistically challenging and less controlled.

Telemedicine

As part of the patient’s desire for more personalized care, they’re looking for healthcare services that align with their personal needs. This goes beyond medical treatments.

Telemedicine does this in several very effective ways.  For example, telemedicine:

  • Provides ultimate convenience to patients who think they don’t have time to see the doctor, so patients don’t delay seeing the doctor.
  • Meets the needs of the elderly and other individuals who may be home-bound or even bed-ridden.
  • Eliminates that boring waiting room experience.
  • Helps keep patients with immune disorders out of medical facilities that, despite best efforts, become breeding grounds for infections and even superbugs.
  • Delivers most of the benefits of face to face, especially when combined with wearable technologies.
  • Provides a secure, HIPAA-compliant platform on which doctors and patients can connect.

Healthcare Technology Makes a Big Difference in Patients’ Lives

Whether you’re a doctor, nurse or other medical services provider, you understand that it’s not about medicine. It’s about people.

Through healthcare technology, you can make sure every patient gets the care that they deserve. You can tear down barriers to care, expand your reach, and improve patient outcomes.

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What are the Top Healthcare Industry Challenges in 2017?

What are the Top Healthcare Industry Challenges in 2017? | Healthcare and Technology news | Scoop.it

Healthcare Industry challenges are always going to be evolving alongside the breakthroughs and innovations. In 2017, there are new healthcare industry challenges that go alongside the age-old difficulties.

For doctors, nurses and medical teams, here are 7 of the key healthcare industry challenges they are currently facing in the year ahead for 2017.

1) Retail Care offering increased access

Retail giants like CVS and Walgreens are pushing further into care delivery, continuing to put pressure on traditional providers to increase access to care.

According to Laura Jacobs, writing for Hospitals and Health Networks “The greatest challenge for most organizations will be finding the right pace for adapting to or embracing new [healthcare] payment models.”

Doctors will be required to step up their efforts to optimize the patient experience, beyond measuring patient satisfaction.

2) Behavioral healthcare

The healthcare industry is starting to recognize that Mental Health is important to the well-being of employees and consumers, according to a report from PWC.

The report notes that one out of five American adults experiences a mental illness every year. These conditions cost businesses more than $440 billion each year. Healthcare organizations and employers will look at behavioral care as ‘key to keeping costs down, productivity up and consumers healthy’ the report said.


3) Meaningful Use and Value Based Payments

Eligible providers and eligible hospitals are continuing to work on meaningful use of EHRs.

Value-based purchasing programs are solidly in place, and eligible physicians are starting to experience the penalty phase of CMS’s quality reporting and Meaningful Use initiatives. In fact, CMS revealed that more than 257,000 eligible professional providers who are not meaningful users of certified EHR technology would have their Medicare Fee Schedule cut by one percent.

Eligible physicians also need to comply with CMS’s new Value-Based Payment Modifier program, or face penalties. It’s part of Medicare’s efforts to improve healthcare, but the program adds yet more regulations physicians need to monitor.

All these changes and new reporting requirements can become overwhelming for already busy physicians, which is why the American Medical Association has repeatedly asked for relief.


4) Switching to ICD-10

The much anticipated and maligned change to ICD10 codes in 2015 led to a lot of discomfort for physicians. The increase in codes from 14,000 to 68,000 means a lot of diagnosis criteria must be re-learned.

There is a great deal of planning, re-training and new systems that go along with the upgrade in codes. For doctors, finding the time to do this proved to be a huge challenge, and still is.

5) Data Security

Patient privacy issues, including concerns about data breaches, continue to be a challenge for providers, payers, and consumers.

Providers and payers will need to be aware of the best practices for data security to avoid the type of Health Insurance Portability and Accountability Act (HIPAA) violations that can negatively impact an organization.


6) Managing Patient volume

While new payment models will are aiming to reduce acute hospital utilization, the continued expansion of Medicaid and the insured population through the public exchanges will seemingly keep demand up.

The rise of obesity and chronic disease and population aging are creating a demand for medical services like never before.

Emergency departments will continue to be overworked until efforts to decant volume through urgent care, better care management or redesigned primary care models begins to take effect..


7) Implementing Telemedicine

The idea of a doctor seeing you via a computer screen may no longer be new, but the adoption of the Telemedicine services by doctors with their own patients is still a struggle.

The Information Technology and Innovation Foundation shares a vision of how Telemedicine can reduce patient backlogs. “Imagine a world where patients in rural areas far from a nearby doctor can easily find a health care provider to consult with online from the comfort of their own homes; where doctors living in Pennsylvania can help reduce the backlog of patients waiting to see doctors in Mississippi; and where patients can connect to a doctor over the Internet for routine medical purposes with a few clicks of the mouse—like they do when ordering a book on Amazon.”

Finding a balance between in person visits and telemedicine will require doctors to adjust their approach to care. Learning to diagnose remotely also requires new skills and detailed reporting.

Of course, Healthcare Industry Challenges are nothing new. Technology and legislation will continue to change the landscape. Doctors and their medical teams must evolve their approach and focus to meet them.

 

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How Technology is Driving the Next Wave of Telemedicine

How Technology is Driving the Next Wave of Telemedicine | Healthcare and Technology news | Scoop.it

The growth in business cases for new models of healthcare delivery and integration of digital health technology is reaching the point of convergence — creating powerful synergies where there was once only data silos and skepticism.


We have not quite achieved this synergy yet, but opportunities emerging in 2015 will move the industry much closer to the long-awaited initiatives in connected, value-based care.

Individuals are constantly hyper-connected to a variety of technology networks and devices. Wearables will continue to enter the market, but their features and focus will go well beyond fitness. Even the devices entering the market now are more sophisticated than ever before. Some are now equipped with tools like muscle activity tracking, EEG, breath monitoring, and UV light measurement.

It will be fascinating to watch how consumer electronics, wearables, and clinical devices continue to merge and take new forms. Some particularly interesting examples will be in the categories of digital tattoos, implantable devices, and smart lenses.

As the adoption of wearables continues to grow, we will continue to see more value placed on accessing digital health data by healthcare and wellness organizations. This will be especially important as healthcare shifts towards value-based models of care. The need to gain access to the actionable data on connected devices will only grow as innovation creates more complex technologies in the market.

This is the year the promise of telehealth will be realized. It is projected that by 2018, 65 percent of interactions with health organizations will take place via mobile devices. Those statistics speak to the need of satisfying the growing demands being placed on providers, along with the growing discernment among patients when it comes to selecting affordable and convenient medical services. The continued adoption of telehealth will extend the point of care for providers and provide ubiquitous access to medical professionals for patients.

A number of entities are already putting this into practice: Walgreens, in partnership with MDLIVE, recently expanded their mobile platform to offer virtual doctors visits for acutely-ill patients; Google is testing a HIPAA-compliant medicine platform for video chats with doctors; and, digital urgent care solutions, like Doctor on Demand, are growing in popularity due to their convenience and low cost.

Telemedicine will not only extend the point of care, but will also be critical in better combatting chronic disease. Managing chronic health conditions will become the focus of many healthcare providers, as models of reimbursement and population health management (PHM) continue to replace fee-for-service models. One issue with chronic disease management is that it is difficult to monitor at-risk patients outside of the hospital. This is where telemedicine comes in.

Prescribed devices and applications to better handle chronic conditions will increase in pervasiveness. This idea of prescribing mobile health to better manage disease states translates to a host of chronic conditions – obesity, diabetes, heart disease, arthritis, cancer.

For example, our client UCSF uses devices like step trackers, sleep trackers, scales and blood pressure monitors to track patients at-risk for heart disease or cardiac readmissions. Another client, UNC is creating a Gastro-Intestinal tracking application (GI Buddy) that leverages fitness devices and scales to monitor Chron’s disease. There are thousands of studies pioneering innovations to improve the efficiency and effectiveness of healthcare. And, they are making serious strides.

The automatic transmission of pertinent patient data from these mobile health technologies is propelling forward capabilities for cost-effective, efficient and successful remote patient monitoring, population management and patient engagement programs.

However, as telehealth and telemedicine capabilities continue to develop, the major hurdle for most providers is integrating and the mobile health data collected outside of the hospital back into the clinical story for use in the provision of care. In a value-based healthcare system, the key to better outcomes lies in data, and specifically, obtaining access to data generated outside of the provider setting.

Platform services will continue to be vital partnerships as healthcare systems are expected to quickly execute on all these initiatives simultaneously and successfully. Bottom line:  The industry is transforming, and if you have not started talking about how to connect to those external data sources, then you need to start.

These emerging trends will continue to bind the landscapes of technology, healthcare, and business. The road set upon long ago by medical professionals and legislators is finally coming to fruition. The walls of interoperability are beginning to come down, investments are growing, partnerships are forming, and consumers are starting to take notice. We are moving towards a digital health revolution. We have the opportunity, the responsibility, and the honor, to align healthcare and technology innovation to exponentially improve our care system. It is a tall task, but we are off to a promising start.


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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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Cybersecurity: What Every Telemedicine Practitioner Needs to Know

Cybersecurity: What Every Telemedicine Practitioner Needs to Know | Healthcare and Technology news | Scoop.it

Telemedicine, which enables health professionals to provide treatment to patients remotely, is especially useful in rural areas, where people are distanced from healthcare facilities. It can also play a considerable role during natural disasters when professionals cannot reach affected areas or must operate outside of traditional medical settings.

 

But because of the nature of the platform — and the technology used — telemedicine is susceptible to outside attacks, particularly cyberattacks. Communication and digital exchanges are often done via the open internet. A patient will have a live video chat with a health professional via a mobile app, for instance. That feed and any data from the exchange is vulnerable to snooping or outright theft, especially if one of the parties is using an unsecured network connection.

 

Cyberattacks Are More Dangerous in Health Fields

There’s no reason to downplay general theft. The risk of hackers scooping up personal data is always a concern, but when attacks involve highly sensitive health details, the risks are much higher. Not only could the data be used to harm and damage others, but its misuse can also harm the professionals and, by proxy, the facility they work for. HIPAA law dictates that all communications and data exchanged between doctors and patients be secure — if not, healthcare providers face massive fines and penalties.

 

What makes the whole thing even more alarming is that, in today’s landscape, it’s not a matter of “if” you will experience a cyber attack or data breach, but “when.”

Norton Security, which claims "protection against viruses, malware and more," estimates that by 2023, cybercriminals will successfully steal 33 billion records per year.

 

To provide an even better perspective, consider this: By 2018, nearly 70 percent of businesses had experienced some form of cybersecurity attack, with over half experiencing a data breach. Out of all small businesses that suffer attacks, 60 percent close within six months of an event.

 

It’s a very costly, very damaging problem from which the healthcare and telemedicine industry is not exempt.

How to Prevent Attacks and Mitigate Damage When They Do Happen

Preventative measures are important, and understanding how to deal with an attack or breach can be instrumental in lowering risks. Assuming that a breach can and will happen allows you to better lock down your systems and data. For example, putting stringent authentication and user access measures in place help ensure that only the right people can interact with certain types of data. This means if a lesser user’s account were to be hacked, the attacker wouldn’t have access to sensitive information.

The first recommendation is that you follow ISO 27001 standards and develop a process of internal audits to measure compliance and performance. This set of management standards deals specifically with information security and proactive protection measures.

 

Here are some ways to improve general security and mitigate the risks of a breach:

  • Hire a third-party data security provider or a consultant to understand what’s necessary to protect your network, systems and hardware
  • Establish user access protocols to prevent unauthorized users from accessing high-level information; in other words, keep people in their lanes
  • Use strong authentication measures to identify users and require the use of strong passwords
  • Educate personnel on the importance of security and ensure they understand what role they play
  • Use data encryption for all information sharing and open streams so that any exchanged information is locked behind a security protocol
  • Develop the entire platform, app or tool with security in mind as a foundational element
  • Create a response plan for cyberattacks: how you lock down affected systems and networks, prevent future data loss and tampering, and regain control
  • After a breach, always inform the necessary parties involved, including customers and patients, as well as regulatory bodies

 

While many of the solutions discussed here are valuable, many tactics can help telemedicine practitioners prevent and protect against cyberattacks. The most obvious involves awareness and preparedness, which means educating yourself and your personnel on modern security.

 

This is not something that can be continually brushed aside or avoided. Security must always be a “now” practice that is honored and put into place as soon as possible. It’s especially true of for telemedicine, which involves the facilitation and exchange of highly sensitive information across open channels.

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Telehealth Nurse Researcher Collaborates with Mayor in Chile

Telehealth Nurse Researcher Collaborates with Mayor in Chile | Healthcare and Technology news | Scoop.it

Phase One: Using Simulation Labs to Teach Future Telehealth Providers

 

For 15 years, I was a home hospice nurse who went out on emergency nighttime visits to patients who were experiencing symptoms that terrified their family. The travel distance added to the anxiety and suffering of family and patients. I always thought that just because a family chooses to live in a rural area, they should not have to accept suffering as “the price they have to pay.”

 

Since then, I have focused on enabling the provision of healthcare services to patients who choose to live in the beauty of a rural environment.  Using telehealth technology to rapidly view, assess and improve a patient’s situation has been foremost in my program of research.

 I know I do not have to describe the explosion of telehealth during the last 15 years to readers of this blog. In my telehealth experience, I have gone from home hospice organizations, thinking that I was suggesting a cold and unfeeling method of providing end-of-life care, to a Global University interest in me sharing my telehealth expertise as an international Fulbright Specialist.  

 

In December 2018, I was invited to spend 10 days at the Universidad Mayor (UM) in Chile, South America. The purpose of my visit was to investigate the use of simulation to teach telehealth at the university’s science campuses. The UM is a private university with 11 campuses in Santiago and one in Temuco.  Despite the fact that UM was founded in 1988, only 30 years ago, there are currently 20,000 students enrolled in seven academic programs.  It was clear to me that the reason behind the rapid, yet well-planned, expansion is the attention given to providing students with an education for the future, especially in the areas of healthcare.  The Universidad is intentional and does not let time waste! 

Thanks to a combined effort between UM administrators and Arizona Telemedicine Program initiatives, by January 6, 2019, I was in Santiago.  Chile is a very long country, stretching 2,670 miles but only 217 miles at its widest point. The entire country covers almost 300,000 square miles.  Forty-one percent of the population lives in three large cities, resulting in 10 million people living in rural areas.

I visited two campuses – Alameda and Huechuraba – in Santiago, Chile’s capital, during my first five days in the country.  Both campuses have state-of-the-art simulation mannequins for training. At the Alameda Campus, I observed healthcare simulation training for dental surgery and odontology, the scientific study of the structure and diseases of teeth.  At the Huechuraba campus, I observed medical, nursing and obstetric students all learning together, using the simulation mannequin to give birth as the focus for their collaboration.  

My research program examines human factors that improve the use of telehealth. Effective communication is a critical variable. The technology can be of the best quality possible, but if the communication between the sender and the receiver is not effective, the outcome will not be optimal.  With each new technology addition to our healthcare system, we should expect improvement, not merely substitution for existing processes.

 

Using the “seven Cs” of effective communication: being courteous, clear, correct, complete, concrete, concise, and considerate, contribute to teaching skills when in person.  However, when instructing remotely, due to limitations of other senses -- smell, 360-degree visualization, and touch – verbal attention to “the seven C’s” of effective communication becomes critical.  Simulation is a great way to allow healthcare providers to learn skills without risk to the patient. This exciting collaboration with the forward-thinking Universidad Mayor will utilize existing simulation technology to teach healthcare providers of the future how to communicate effectively.

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How Telemedicine Can Help Stroke Victims Faster 

How Telemedicine Can Help Stroke Victims Faster  | Healthcare and Technology news | Scoop.it

In developed countries like the United States, stroke is still the third leading cause of death. In fact, each year stroke occurs in more than 700,000 patients, leaving many with disabilities and unable to resume a normal life.

 

When a stroke occurs, every second counts. The sooner a stroke victim is treated with medication that breaks up blood clots and restores blood flow to the brain, the less chance the patient will suffer permanent damage such as the loss of muscle control, mobility, or the ability to speak.

 

According to the American Stroke Association, ‘time lost is brain lost.’ That’s because every minute that passes before a stroke patient is treated, means the death of millions of brain cells.

 

Unfortunately, less than 30% of stroke victims receive clot-dissolving medication inside a recommended window of an hour or less for maximum effectiveness, according to information from Healthcare delivery network Kaiser Permanente.

 

But the same study reveals how telemedicine – or a telestroke system to be precise – can be a vital tool in getting stroke victims faster treatment – and thereby limiting the debilitating effects of the attack.

 

A Race Against Time

Basically, a telestroke system requires a neurologist and attending nurse to have a high-speed Internet connection and videoconferencing capabilities on a laptop, tablet or desktop computer.  The purpose is for the consulting neurologist to be able to talk to the patient or an emergency response team about what symptoms the patient is experiencing, evaluating the patient’s motor skills, viewing a computed tomography (CT) scan, making a diagnosis and prescribing treatment.

 

Data gathered from 300 stroke patients being treated in 21 Kaiser emergency rooms in Northern California shows that those who were diagnosed as having a stroke via a telehealth consultation received clot-busting medication intravenously much faster than the 60-minute guidelines from the American Heart Association and American Stroke Association.

 

The Kaiser emergency rooms were equipped with telestroke carts, which included a video camera and access to patients’ electronic scans and test results. When emergency room staff contacted a staff neurologist and a radiologist via a telestroke cart, patients received anti-blood clot medicine in an average of 34 minutes. Eighty-seven percent of stroke patients received the intravenous medication in 60 minutes or less, 73% in 45 minutes or sooner and 41% in 30 minutes or less.

 

A Clear Priority

According to the American Stroke Association, American Heart Association, and the American Telemedicine Association, telestroke services could save thousands of lives each year and cut costs by $1.2 billion over the next decade.

 

The reason is because processes that used to happen sequentially during a stroke alert are now happening at the same time. That allows medical staff to provide evaluation and treatment to stroke patients more quickly, safely, and confidently, to avoid further brain damage.

 

The addition of specialized stroke services helps hospitals improve patient outcomes, decrease patient disability related to stroke, and reduce costs, while keeping patients in the community. Providing expert stroke consults remotely via telemedicine allows prompt care close to home for these patients, making a priority for health care providers nationwide.

 

If you are interested in bridging the gap of care for patients in need, whether they be in remote areas or unable to leave home, telemedicine can help provide quality care to more people in need. Contact TeleMed2U today, at (855) 446-TM2U (8628).

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Health System began exploring telemedicine as a way to connect its physicians and specialists with patients 

Health System began exploring telemedicine as a way to connect its physicians and specialists with patients  | Healthcare and Technology news | Scoop.it

In 2005, Tift Regional Health System began exploring telemedicine as a way to connect its physicians and specialists with patients in the rural area surrounding its Tifton, Georgia, home base.

At that time, telehealth technology largely consisted of a hub-and-spoke network, based out of large tertiary care centers or academic medical centers.

 

"We understood [telehealth] was the future and we needed to be a part of this technology that could get our patients to the specialists that they needed to see 200 or more miles away," said Jeff Robbins, MD, director of telehealth and neurodiagnostics at Tift Regional Medical Center.

 

The virtual visits idea was starting to be discussed in rural parts of the country. The Internet was slow, but the tech was getting close to making distant encounters possible.

 

"In the early days, every encounter was basically a telehealth network within itself," Robbins said. "The technology only allowed us to connect to one endpoint at a time. The technology didn't allow us to network to a new endpoint or customer without a lot of IT involvement. Internet was slow and the devices used to conduct a patient-to-provider encounter were primitive compared to what we have today."

 

These issues prevented Tift Regional from achieving the outcomes it knew were possible but staff understood, given its track record at other hospitals, that telehealth could play a very important part in delivering healthcare in the near future.

 

Tift at that point partnered with the Global Partnership for Telehealth, a nonprofit with a 12-year track record in developing and implementing sustainable, cost-effective telehealth programs.

 

The Global Partnership for Telehealth markets telehealth systems to hospitals and other medical facilities in 11 states. There are a variety of telemedicine technology vendors with varied offerings on the market. These include American Well, Avizia, Cisco Systems, HealthTap, InTouch Health, MDLive, SnapMD, TeleHealth Services and Tellus -- many of those are in the Healthcare IT News Buyers Guide: Comparing 11 top telehealth platforms.

 

GPT's network of caregivers and its technology gave Tift Regional the ability to connect to nursing homes, school clinics, emergency rooms, stroke teams, specialized wound care teams and advanced critical care teams hundreds of miles away from its rural location in South Georgia.

 

"I like to say the miracle of telehealth is that it gives us the ability to erase time and distance," Robbins said. "Our patients benefit with virtually no travel time or expenses, decreased time waiting for an appointment, reduced medical costs, and extra value to the patient encounter and extended access to consultations with specialists not offered in their area and usually hundreds of miles away."

 

The partnership with GPT also allows Tift Regional's employed physicians to increase revenue because they can see patients outside their area, reducing missed appointments, and giving them the tools to treat more patients over time and have better patient follow-ups that improve outcomes, which also cuts down on readmissions, he added.

 

Telehealth carts generally include a monitor, camera, keyboard and remote control. Peripherals give physicians the ability to monitor vital signs, use a digital stethoscope, and use high-definition cameras for specific types of care such as dermatology or wound care.

 

Telehealth has become a critical component in Tift Regional's ability to deliver quality healthcare, and the healthcare organization has seen success in using the technology.

 

"Telehealth has increased access to healthcare within our organization by making it easier for our patients to obtain clinical services," Robbins said. "It also allows our hospital to provide emergency services that we cannot always provide like advanced/emergency stroke care. We have also seen an increase in improved health outcomes."

 

Telehealth allows Tift Regional to get its patients seen, diagnosed and treated earlier. This leads to improved outcomes and less costly treatments, Robbins explained.

 

"Telehealth has allowed us to have advanced ICU support and that has reduced mortality rates, reduced complications and subsequent hospital stays," he added. "We are seeing a reduction in healthcare costs through home monitoring, which is lowering costly hospital visits. Our stroke program is reducing the high cost of transferring stroke and other emergencies."

 

And Tift Regional has used telehealth to address the shortage in healthcare providers by allowing its patient population to see specialists outside Tift's area, also enabling Tift's own specialists to serve more patients, he said.

 

Before telemedicine, a virtual encounter meant both the presenter and the provider had to switch between many different programs. This presented issues when programs failed and data didn't link up correctly.

 

"The provider can now see who is waiting to be seen in the virtual waiting room, and data entry has been streamlined to allow patient data and notes to be uploaded into our existing EHR," Robbins said. "And maybe the best improvement is the ability to switch programs, going from Pathways to the stethoscope then the cameras within the same encounter."

 

 

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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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Top Five Digital Transformation Trends In Health Care

Top Five Digital Transformation Trends In Health Care | Healthcare and Technology news | Scoop.it

Technology is changing every industry in significant ways. To help frame how, I’m starting a new series discussing top trends in various markets. First up: health care.

No one can dispute technology’s ability to enable us all to live longer, healthier lives. From surgical robots to “smart hospitals,” the digital transformation is revolutionizing patient care in new and exciting ways. That’s not all. National health expenditures in the United States accounted for $3.2 trillion in 2015—nearly 18% of the country’s total GDP. It’s predicted that the digital revolution can save $300 billion in spending in the sector, especially in the area of chronic diseases. Clearly there is value—human and financial—in bringing new technology to the health care market. The following are just a few ways how.

 

Telemedicine

Even back in 2015, 80% of doctors surveyed said telemedicine is a better way to manage chronic diseases than the traditional office visit. Why? Telemedicine offers patients and health care providers both a new wave of freedom and accessibility. For the first time, a patient’s care options are not limited by geographic location. Even patients in remote areas can receive the highest quality of care, providing they have an internet connection and smart phone. Telemedicine can also save both time and money. Patients no longer have to schedule their days around routine follow-up visits (and long office waits). Instead, they can hop on a conference call to get the prescription update or check-up they need.

Nowhere has telepresence been more useful than in the mental health field. Now, those seeking emotional support can find access to a therapist or counselor at the click of a button, often for far less than they would pay for a full office visit. Internet therapies, for instance, “offer scalable approaches whereby large numbers of people can receive treatment and/or prevention, potentially bypassing barriers related to cost, location, lack of trained professionals, and stigma.” Telemedicine makes it possible.

 

Mobility And Cloud Access

Have you ever played phone tag with your doctor while waiting for important test results? It’s so nerve-racking! That’s why mobility and cloud access have been such a tremendous help in increasing accessibility for patients and doctors alike. By 2018, it’s estimated that 65% of interactions with health care facilities will occur by mobile devices. Some 80% of doctors already use smartphones and medical apps, with 72% accessing drug info on smart phones on a regular basis. Gone are the days of paper charts and file rooms. Hospitals, insurance companies, and doctor’s offices are now storing patient medical records in the cloud, with patients able to access test results online 24/7.

Given HIPAA laws relating to patient privacy, it’s probably no surprise this has also led to an increased focus on data protection and security. According to one report, “the black-market value of medical data is greater than even that of financial information.” Believe me when I say: No industry is more focused on virtualization security right now than health care.

 

Wearables And IoT

I remember the days when going into the local grocery store and getting my blood pressure read at one of those prehistoric machines seemed exciting. Imagine: A machine that helped me manage my own well-being without setting foot in a doctor’s office. Now, mobile devices as small as my cell phone can perform ECGs, DIY blood tests, or serve as a thermometer, all without even leaving my house. With help from automation, patients can even be prompted to check their weight, pulse, or oxygen levels, and enter results into mobile patient portals. Even better: They can transmit the results to my doctor in real time. Those details, when entered regularly, can help predict one’s risk for heart disease and other illnesses, ultimately saving lives. This is far more than cool. It’s life-saving.

 

Artificial Intelligence And Big Data

Big data is king in the digital world, and health care is no exception. Yes, it can be gathered to measure customer satisfaction. But perhaps more importantly, it can be used to automatically identify risk factors and recommend preventative treatment. Even more exciting: with the rise of the Internet of (Medical) Things (IoMT), mobile and wearable devices are increasingly connected, working together to create a cohesive medical report accessible anywhere by your health care provider. This data is not just useful for the patient. It can be pooled and studied en masse to predict health care trends for entire cultures and countries.

 

Empowered Consumers

All of the above have led to an entirely new trend in healthcare: patient empowerment. While many of us have come to associate health care with high costs and long waits, patients are now in the driver’s seat, with better access to higher-quality doctors, and higher satisfaction rates overall. It’s a healthy new way to look at health care, and one that holds promise for all of us with easy access to the digital landscape. My blood pressure is already lowering just imagining the possibilities.

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Presenters's curator insight, October 24, 2017 4:16 AM
Al pensar en tecnología recurrimos a  muchos avances relacionados con la comunicación, educación... pero pocas veces nos planteamos que hay otros campos en los que también tiene una gran influencia. La industria tecnológica también está ayudando a cambiar el panorama de la salud. ¿Quieres conocer algunos de los avances tecnológicos más significativos en este campo?
Barbara Lond's curator insight, December 22, 2017 3:42 PM
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12 medical technology innovations likely to transform healthcare in 2017

12 medical technology innovations likely to transform healthcare in 2017 | Healthcare and Technology news | Scoop.it

1. 3D Printing is poised to make a big impact in 2017 - and is expected to be worth $1.2 billion by 2020. The first 3D-printed prescription drug received FDA approval in 2015 and medical devices made from 3D printing now include instruments used for surgery or devices implanted into patients. End-use parts, like surgical tools and device implants will become more common in 2017 as sophisticated metal materials for 3D printing are refined and gain approval for human contact. By 2019, 3D printing is expected to be a central tool in roughly one-third of surgical procedures involving prosthetic and implanted devices.i

2. Increased use of 3D visualisation and augmented reality for surgery - In 2016, two of the most intricate surgical practices, ophthalmology and neurology, began experimenting with 3D visual representations of their patients enabling them to operate more effectively and efficiently while also giving medical trainees a clear picture of what they're doing. Augmented reality glasses that display holographic images of human anatomy could also bring the end of cadaver labs at medical schools. Meanwhile virtual reality is also being used to accelerate behaviour change in patients in a way that is safer, more convenient, and more accessible.ii

3. Artificial intelligence (AI), predictive analysis and machine learning are developing in new areas - AI is starting to demonstrate the kind of impact it can have in medicine from accurately interpreting patient records including pathology slides, x-rays, skin lesions and scientific literature. These highly advanced AI systems are capable of employing deep learning algorithms to sort through massive amounts of structured and unstructured data to automatically detect, diagnose and suggest treatments regimes for medical conditions. There are numerous start-up companies working on AI applications in healthcare, with the engagement of the major technology companies who have all made major investments in this the space. A recent 60 Minutes US news segment suggested that AI could find an evidence-based therapy for 30 per cent of patients with cancer that was not identified by their oncologists.iii

4. Blockchain is starting to transform healthcare - blockchain can help organisations bridge traditional data silos, dramatically increase IT and organisational efficiencies, keep business and medical data secure, and streamline patients’ access to medical data. Blockchain offers "long data" as opposed to big data, capturing a full history of a patient's health. A 2016 IBM survey of 200 healthcare executives in 16 countries found that 16 per cent expect to have a commercial blockchain solution at scale in 2017. These companies expect the greatest blockchain benefits in three areas: clinical trial records, regulatory compliance, and medical/health records. They also anticipate widespread business model innovation but believe that regulatory constraints will keep new competitors and models in check.

5. Diabetes drugs and advanced monitoring technology will reduce complications and improve the management of diabetes - Experts predict 2017 could bring a shift in the medicines prescribed and ways of managing type 2 diabetes. Glucose sensing technology is advancing, moving away from low-tech finger pricks of the past to continuous glucose monitoring where a sensor is placed beneath the diabetic’s skin in the abdomen region and could dramatically reduce spikes in glucose levels. These monitoring technologies then link to medication administration devices, and often utilise mobile apps for sharing readings with physician as well as caregivers.iv

6. Drones, will play an increasingly important role in bringing medical care to people in emergencies - helping to link remote communities with distant clinics, and delivering blood, vaccines and other medical products and patient samples to and from regional hospitals.v For example a drone could transport an emergency medical kit along with say smart ‘glasses’ to people stranded in hard to reach places. A person attending the injured individual can then connect to a remote physician who can see the scene and guide treatment until paramedics get there. Another example is a drone that can transport patient samples or medical supplies over distances, using a drone that is fully automated, taking off, flying to its destination, and landing all on its own. This is already happening in Madagascarvi, but regulatory restrictions in many parts of the world don’t yet permit autonomous flying devices.

7. Gamification will come into its own as a healthcare tool - The 2016 worldwide phenomenon, Pokemon Go, showed how a game could be used to encourage people to get outside and become more active. This success is likely to lead to new ‘video games’ being used in 2017 to impact on people’s behaviors and actions. For example, creating healthcare-facing games that feel like, actual video games, can make rehabilitation exercises fun or simulate surgery functions.

8. Liquid biopsies will improve cancer detection and measurement of treatment responses - Analysing tumor genetics is enabling the development of targeted cancer drugs and ushering in the era of less toxic “precision” medicine. More specifically "liquid biopsies” are blood tests that uncover signs of highly abundant cell-free circulating tumor DNA which is shed from a tumor into the bloodstream.vii Several companies are developing testing kits expected to hit the market in 2017. Liquid biopsies are also hailed as a flagship technology of the Cancer Moonshot Initiative, a national effort across the US aimed at ending cancer.viii It remains to be seen whether a liquid biopsy will provide accurate detection, but the benefits over solid tissue biopsy include being less expensive and risky.

9. The microbiome will be used to prevent, diagnose and treat disease - the human microbiome is a community of trillions of bacteria, archaea, viruses and other microbes that are an integral for human physiology, including supporting vitamin production and helping provide an efficient immune response. However, unlike their fixed genome, people’s microbiome changes constantly, in response to changes in their environment. Scientific advances during the past fifteen years, among them the Human Microbiome Project, increased our understanding of the interaction between people and their microbiome. Biotech companies are increasingly looking at the microbiome's potential to develop new diagnostics or therapies and probiotic products to prevent microbe imbalances. Over the next 12 months the microbiome is likely to establish itself as one of the health care industry's most promising markets.ix

10. Use of Point-of-care (POC) diagnostics will accelerate - The growth of boundary-less hospitals and community care is increasing the need for rapid results outside of the clinical setting. Key factors include the increasing prevalence of lifestyle and infectious diseases and a move towards home healthcare. 70 per cent of POC testing takes place in provider locations and experts predict this will grow at an average of 15.5 per cent each year.x POC testing delivers precision medicine that will both improve quality and affordability of care at a time when outcomes-based medicine is the new model for healthcare. Providing faster access to test results expedites speed of diagnosis and treatment and can reduce unnecessary hospital associated costs. The ability of POC to rapidly and inexpensively diagnose a significant number of infectious diseases is increasing, with the list now including HIV, human papillomavirus and influenza , to name but a few.

11. Demand for surgical, rehabilitation, and hospital robots will continue to rise - Driven by declining costs, labour shortages, and successful pilot projects; healthcare robots deployed in the years ahead will be involved in surgery, hospital logistics, disinfection, nursing, exoskeletal rehabilitation and prosthetic limbs. Forecasts suggest that healthcare robot shipments will increase from approximately 3,400 units sold annually in 2016, to more than 10,500 units per year by 2021, representing an increase in revenues from $1.7 billion to £2.1 billion over the same time period.xi

12. The adoption of telemedicine will be mainstreamed - with an explosion in easy-to-use, clinical grade, consumer-facing devices that allow patients to administer readings on themselves and which can then be used (and trusted) by care providers. These advances in consumer-facing medical devices will increase the quality of care that is able to be delivered via these remote systems. Telemedicine also allows those who are homebound and/or geographically isolated, to obtain access to the medical attention they need.

While predicting the future is by its nature challenging, one thing all the above predictions have in common is that the developments are made possible by the advances in technology and the emergence of new collaborations and partnerships.

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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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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 26, 2015 10:25 PM

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 5:19 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 10:15 AM

interesting....

Shamma khan's comment, April 14, 2018 8:43 AM
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