Although life in rural communities offers many advantages, the rural healthcare system in America faces challenges not seen in urban areas, for obvious reason: population loss, poverty and access to healthcare have been problematic in recent years.
Taking a look at Pennsylvania, which is the sixth most populous and ninth most densely populated state in the US, based on information from the United States Census Bureau from 2010 and 2013, as a state it hosts a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of its 67 counties classified as rural, and all but two counties have rural areas. More than one quarter of Pennsylvanians live in rural counties.
Thus, it’s as good a place as any to examine some of the unique issues facing rural communities, who even though they may be within driving distance to some of the best medical care in the world, they are unable to access it each day without some sort of life altering obstacle.
In general, residents of rural communities in the U.S. are less healthy than those in urban environments. According to Unite for Sight, “rural residents smoke more, exercise less, have less nutritional diets and are more likely to be obese than suburban residents.” Already against the odds, residents in rural Pennsylvania face several specific problems that jeopardize the state of healthcare in the area.
Between 2000 and 2010, the Pittsburgh Post-Gazette reported that rural Pennsylvania counties grew by 2.2 percent while urban counties grew by 3.9 percent. However, the small increase in rural counties was only because of the eastern counties. Western rural counties decreased by 0.9 percent, and by another 0.5 percent from 2010 to 2012.
In some places, the situation is bleak. The newspaper highlights the population loss in Taylor Township, a part of Lawrence County that experienced a 13.6 percent population loss from 2000 to 2010. “Of its 1,052 residents, more than twice as many are over age 65 as under 18. That ratio is practically unheard of among municipalities and doesn’t bode well for the township’s future.”
In an ideal world, a patient should be able to visit the doctor whenever he has health concerns. However, for many patients, particularly the millions living with lifelong chronic diseases, such as diabetes, heart failure and chronic obstructive pulmonary disease (COPD), meeting this need is a challenge because of several reasons. Key among these are: lack of time and limited access to a nearby health facility. These obstacles, in turn, sometimes create even bigger problems, such as patients’ failure to practice daily routines of disease prevention and management, resulting in worsening of their conditions and triggering the need for emergent care.
Fortunately, a solution is underway. Experts are taking advantage of today’s modern technology—telehealth — and are using it to bring healthcare education and services closer to consumers. Most simply put, telehealthcare provides contact between clinicians and patients who are at some distance from each other, and uses telecommunication-ready tools to “see” each other and undergo clinical examinations even at a distance.
Through telehealth, patients can easily get in touch with their doctors without having to worry about geographical distances. From a residential setting, not only can a simple and known tool like a telephone be used as an audio communications device to connect patients with their clinicians, but an array of monitoring devices, such as blood pressure cuffs, pulse oximetry measurement tools, weight scales, and others, can also be used to transmit current vital sign readings for clinicians’ review. In the same manner, physicians can use today’s information technology to easily access their patients’ electronic health records and monitor their patients’ development outside the walls of their clinics or hospitals.
Truly, telehealthcare and remote monitoring have enabled many healthcare practitioners to help manage the chronic health conditions of their patients, and subsequently, help improve their patients’ quality of life.
Here are some selected FAQs about telehealth service delivery that focus most particularly on the home healthcare arena, which is most probably the health service sector most unaffected by new technology introduction and use until recent decades. Strictly hands-on, or ‘high touch” care service delivery was the order of the day throughout the 20th century. Yet home healthcare is likely to become a very critical component for achieving the much broader and longer term view of patient care delivery after patients’ discharge from hospital. It is then and at home that patients will receive subsequent services through their continuum of care that will keep them well over a long term.
Can I get reimbursed for providing telehealth?
The answer is yes, usually, for providing home telehealth services but not in the usual billing scenarios most home healthcare organizations are used to for submitting bills to Medicare or other insurers. As of now, mid-2015, changes in Medicare and Medicaid fee for services are just coming on-board affecting home telehealth service delivery. There is still a long way to go until Medicare will not very much require face-to-face home healthcare visits during a patient’s admission period—this is the same insurer who absolutely required specific documentation about every portion of nurses’ contact with patients and let the home health agencies (HHAs) know that to CMS, if something was not documented [e.g., a telephone call between nurse and patient about wellness directives] , it didn’t happen [and the bill would therefore not be paid]. Today there are many insurers beyond Medicare that are paying for home telehealthcare (e.g., Aetna, United Healthcare), but it’s very early on—we need to return to this question later this year.
How will I develop a home telehealth service capability? How will I develop a strategic and operating plan for this new delivery channel? Where will I get the technology? What type of training will be required of my people and what will the cost of training be and how many employee hours need to be dedicated to this training?
It’s best to keep in mind that, although the technology is new, you’re not beginning with a blank slate for running a healthcare service delivery business. While all of these questions about telehealth tool acquisition and use are important, the very first question to ask, not mentioned in this list of questions is, hands down, who are my HHA’s most costly patients? An agency-wide chart review would reveal that these are the patients that require the most visits, and additional training in self-management skills and routines.
Once identified, and these are usually patients living with specific chronic diseases and conditions, such as congestive heart failure (CHF) and non-healing wounds, then the subsequent questions can be addressed. In earlier days of home telehealth service delivery (ca. mid-1990s), a full-scale workstation was typically available that could be assigned to any home healthcare patient and came fitted with telecommunications-ready vital sign measuring peripheral devices such as a blood pressure cuff and pulse oximeter, as well as glucometer for measuring diabetic patients’ blood sugar levels even though some patients didn’t have diabetes. These were kind of a one-size-fits-all system, though these proved to be too costly for HHAs and too complicated for patients to use regularly and correctly. More common now is to order and assign only needed and stand-alone telecommunications-ready peripherals devices for patients to perform daily measurements and transmit them to their clinicians.
Interoperability standardization is a critical element of e-health innovation. Varied and complimentary standards will be needed in the decades ahead to accelerate development of life-saving and life-enhancing capabilities and to ensure that the greatest potential benefits of e-health are realized around the world.
The IEEE Standards Association is at the tip of this spear and is working to make progress in the field of medical device interoperability. Illustrating the benefit of interoperability of standards in the monitoring and assessment of patients, and creating awareness of current medical device standards, this following infographic gives a short description of six medical device standards that strive to improve medical treatment for both patients and providers.
Utilizing smart phones, people can track and send their data to doctors from a variety of personal health devices such as, sleep monitors, insulin pumps, sleep apnea equipment, health and fitness monitors, health weighing scales and glucose meters. The standards specify the use of specific term codes, formats and behaviors in telehealth environments that promote interoperability of multi-vendor products to create an over-all more seamless tracking of health.
If you’ve ever watched a person go through the first stages of coping with type 2 diabetes – and with the disease at epidemic levels, many of us have a close friend or relative with the disease – you’ve seen them struggle to put into practice all the information, advice and strategies they are given.
This is true of most people with newly diagnosed chronic diseases, not just diabetes. To avoid complications, and the huge costs in both suffering and money that come with them, they have to learn a new way of living. Medication and other treatments can’t take the place of lifestyle changes. And despite their best efforts, many people are defeated by the challenge.
We now spend 70 percent of our healthcare dollars on chronic disease care, much of it to treat complications that lifestyle changes could avert. All that money isn’t really helping. People continue to suffer and to lose years of productive life. If we could find a way to help these people improve their health, we could dramatically reduce both suffering and costs.
Chronic disease patients need tech support
One thing we’ve learned here at Dell is that in helping hospitals implement an electronic health record (EMR), at-the-elbow tech support makes a big difference. And learning to use a new EMR has many of the same challenges as learning to live with diabetes.
To go live with a new EMR, doctors and nurses have to learn a new way of working. It’s more than just a software change. It’s changing everyday habits that have kept the operation running for years. That’s why it is crucial to have someone to guide the caregivers through the first days and weeks. The right support lowers users’ frustration, increases their confidence and makes the difference between a quick, smooth transition and a drawn-out, rocky transition.
That kind of tech support could also help patients with diabetes and other chronic diseases learn a new set of habits. For diabetics, even a simple thing like breakfast can be a challenge. If you can’t pick up your usual donut, what’s the alternative? Friendships can be harder. “No, sorry, I can’t go to happy hour for chips and a margarita,” isn’t what your friends want to hear. Add in blood sugar checks, medication and a new exercise routine, and it can be overwhelming. None of it is fun, and all of it distances you from friends and daily comforts.
Diabetes education classes can help, just as training classes for doctors and nurses can help them learn a new EMR. But patients also need the same at-the-elbow tech support for their new life that caregivers need for their new EMR. They need a knowledgeable, friendly healthcare tech support agent who can suggest a happy hour walk with your friends or what to drink instead of a sugar-loaded margarita. Or tell you about a healthy breakfast sandwich that is right on your way to work. Or how to tell your mom that you won’t be eating her famous pancakes at Sunday brunch. Someone to boost your confidence and make you feel like you can succeed at this new life.
New technology makes at-the-elbow support possible for patients
Sadly, most of patients are pretty much on their own. The result is confusion, loss of confidence and a sense that it is all just too hard. And that means expensive complications and more suffering.
The good news is that new telehealth technology can bring at-the-elbow support to patients at home, at a price that is affordable. While support can’t be literally at a patient’s elbow, secure video conferencing can give patients access to doctors, nurses and health coaches who can answer questions, give advice on medications, food, exercise and how to lose the unhealthy foods without losing the relationships that are tied to them. And most patients already have the technology needed – a smartphone, tablet or computer.
Guest post by Grant Kohler, vice president, Innovation and co-founder, REACH Health.
I began my healthcare career in the hospital setting. While working at Georgia Regents University (formally the Medical College of Georgia), my colleagues and I developed one of the nation’s first telestroke systems. It was rudimentary at first, literally pieced together on an IV pole from existing equipment: web-enabled video cameras, flatbed scanners for CT scans and spare CPUs, with a landline telephone to provide audio. Since then, I’ve worked with many facilities across the country to set up telemedicine platforms. Over that time, I’ve witnessed a variety of approaches to telemedicine.
One major transformation I’ve witnessed more recently: Many hospital systems are now choosing software-based platforms over hardware-based technologies. As I’ll explain shortly, this shift in thinking has important implications worth considering.
Core Technology: Software vs. Hardware
Telemedicine platforms are evolving rapidly with no signs of slowing. It is prudent to ensure that your hospital is in a position to take advantage of the rapid pace of improvements without being locked into a solution that hinders or prevents future technological enhancements or program expansion.
To appreciate the difference between focusing on software vs. hardware, consider the evolution of mobile phones. In 2007, the first smartphone was introduced. At the time, flip phones were considered leading edge. Less than five years later, flip phones were deemed antiquated by most. Why? The cell phone is a hardware-centric device and the smartphone is a software-centric device.
In the telemedicine industry, first-generation solutions such as tele-presence carts and robots began as single-function, hardware-centric devices. Even if they work satisfactorily for their narrow purpose, they lack the flexibility needed to support cost-effective upgrades and expansion for multiple service lines. Also, because the hardware is proprietary, it often isn’t subject to commoditization and is priced at a premium. As telemedicine technologies have evolved, software-centric platforms have become available and offer increased flexibility, including new capabilities and multiple endpoint options.
Support for Creating a Telemedicine Network – Thinking about the Subscribers
The literal goal of telemedicine is to create networks where provider hospitals offer specialty care or expertise to subscribing hospitals. Successful execution produces improved outcomes and patient satisfaction for a larger number of patients and creates economic benefits for both the provider and subscriber hospitals.
Your telemedicine platform can impact your ability to recruit hospitals into your network. In competitive markets where other provider hospitals are vying for the same potential subscribers, a well-designed telemedicine platform provides a recruiting advantage. If a large hospital balks at expensive hardware investments that easily become dated, a smaller hospital will have similar concerns but a tinier budget. Hospitals of all sizes seek to leverage maximum utility out of all investments with a minimal disruption to existing processes and workflows. With hardware-centric platforms, the inherent focus is often on the technology itself rather than the patient. This is unpalatable for most hospitals considering telemedicine, as their primary objective is better patient care.
Deb Dahl, vice president of patient care and innovation at Banner Health, discusses her experiences managing the telehealth program for the health system. Banner Health is a nonprofit health system based in Phoenix operating more than 20 hospitals and specialized facilities. It is the second largest employer in Arizona, providing emergency care, hospital care, hospice, long-term care, outpatient surgery centers, labs, rehab services, pharmacies, and ambulatory clinics, which include Banner Arizona Medical Clinic and Banner Medical Group.
The health system is a long-time user of telehealth technology, which has had a profound positive impact on providing patient care and is seen as a major benefit to the organization.
Have you used telehealth services in your practice to provide care?
Yes, we have had a long standing relationship with Philips collaborating on telehealth programs, using a “technology, people and process” approach to healthcare. We started with a single facility in 2007, and our telehealth program now reaches more than 400 beds at 18 facilities in Arizona, Colorado, Wyoming and Nebraska with plans to cover our Fairbanks, Alaska, facility and Nevada site some time in 2015. Across these facilities we utilize telehealth in the intensive care unit, acute care, skilled nursing facility, and ambulatory space (patients at home). We use a command center approach, which allows a dedicated team of physicians, nurse practitioners, nurses, pharmacists and social workers. We provide coverage to more than 400 ICU beds in five states, more than 200 medical/surgical patients, neuro and behavioral health ED coverage, 500 complex chronic members at home, as well as simple low acuity on demand home visits.
What’s it like? Is it all it’s cracked up to be?
Yes, we went live with our first 50 ICU beds in 2006. With our program growth, we’ve experienced great results: in 2013 our ICU results were among the top three in the U.S. Using APACHE as the actual to predictive model Banner saved more than 33,000 ICU days, 47,000 hospital days and 1,890 lives in 2013. We are expecting similar results for 2014.
A Baton Rouge, La.-based data company has set its sights on Jackson, Mississippi, announcing it will build a technology center that, in part, will house one of the University of Mississippi Medical Center’s fastest growing services – telehealth.
UMMC has entered into a lease agreement with Venyu Solutions, LLC, which will construct a stand-alone, 16,000-square-foot facility to accommodate the increase in the services UMMC’s Center for Telehealth provides to hospitals, clinics, corporations and patients across the state. The lease will begin on or around July 1, 2016.
The Venyu Technology Center will be constructed at the site of the former McRae’s department store on the corner of Meadowbrook Road and State Street in the Fondren neighborhood. In addition to the new building, existing structures such as the former McRae’s building will be renovated to host a data center for Venyu, with plans for other businesses in the future.
“Throughout the years, Venyu has provided data center services and other critical services to many health-care organizations, but few have embarked upon such an innovative approach to delivering medical advice and care,” said Scott Thompson, founder and CEO of Venyu. “We are proud the University of Mississippi Medical Center has selected our new Technology Center in Jackson to help host their telehealth operations. We greatly look forward to the positive impact these new services will have within the community.”
The technology center site falls in line with a health-care corridor that’s been lauded by state leaders.
“Mississippi is a national leader in telehealth, and today’s announcement marks an important step toward even more innovation and development,” Gov. Phil Bryant said. “We are not only growing the medical corridor in the Jackson metro area, we are ensuring we have the infrastructure in place to develop new health-care solutions that can improve the lives of Mississippians.”
Girish Navani is CEO and co-founder of eClinicalWorks, an electronic health record company exceeding in the B2B field since 1999. Under the leadership and foresight of Navani, the company is expanding its services to B2C with the launch of healow – an app for patients to easily find new doctors, schedule appointments online and access their personal health records.
Here, Navani speaks about his path to eClinicalWorks, he offers his expert insight on EHRs and their benefits to healthcare, and he speak of likely trends that will continue to change the healthcare landscape.
Tell me your story. About how you got here, how you developed your technology and the reasoning for a private company set up?
We wanted to use technology as a way to completely transform the healthcare delivery model to streamline processes, prevent errors and provide easily accessible information to both providers and patients. Not only was our primary goal to make doctors’ jobs easier by providing them with a way to operate more efficiently, but we also wanted to improve the patient experience.
I’m a strong believer in keeping my company private and concentrating on building a solid product. Selling shares and depending on investors means that they will always have a say in how we conduct our business. We use our profits to continue building our company and our products.
What about the leadership inside the company? Is it true the no employees have titles? What’s the reasoning?
I have an open-door policy, which allows the opportunity for anybody to approach me to ask questions and brainstorm ideas. Over time, I’ve learned to listen more. I’m okay with second guessing my own decisions and receiving feedback from my colleagues, even if what they say is “no.”
Yes, our employees do not have titles, but instead, the whole company is team-based with team leaders being the only leadership position. Employees’ careers grow with bigger projects. I think titles are self-fulfilling and short-term objectives that people quickly get tired of. With a team-based structure, employees can work together to achieve successful results instead of individuals striving for the next title.
What drew you to healthcare? Why does it stand out for you?
I have always worked in technology, and in 1999, I heard a lecture in Geneva about using wireless computing in healthcare and the idea of “connected healthcare” really stuck with me. I loved the idea of a doctor and patient sitting in the doctor’s office reviewing charts on a tablet instead of pieces of paper, so I wanted to build a technology that connects all parties involved in healthcare, including the doctor, patient and insurance company.
Prior to launching Webbed Marketing (the previous name of Fathom Columbus), founder Bill Balderaz worked with some of the largest publishers in the world to plan, execute and measure Internet marketing programs. He began working on search engine optimization, pay-per-click advertising and link-building in 1998, prior to the launch of Google. He has spoken on Internet marketing topics at events sponsored by the Public Relations Society of America, the American Marketing Association and the National Fuel Funds Network. Bill holds a bachelor’s degree in public relations journalism from Bowling Green State University and an MBA from Franklin University.
Here, he discusses health IT trends, the future of wearables as he sees them and the consumerization of healthcare.
What are the biggest changes we will see in 2015 in terms of healthcare technology?
Hospitals and health systems across the country will be adopting or upgrading EHRs, telehealth capabilities, and mobile tools. Look for increased reliance on and more sophisticated use of data analytics, as well as individualized medicine, ‘doctor-less’ patient models, and quantification of population health via social media. Patients will take more control of their health.
Also look for integration. Patients have so many inputs: lab results, wearable data, fitness plans. Then they have outputs, newsletters, emails, patient portals. The smart money is on the technology to connect and simplify.
What is driving these changes?
At the consumer level, where patients are more informed and involved than ever, what some call the ‘democratized future’ of healthcare is bringing more accountability and transparency to both the methods and costs of care. The parallel needs to cut skyrocketing costs, increase access to care, improve quality of service, and encourage patient engagement are all factors contributing to the growing potential of health IT to transform the delivery and experience of healthcare at fundamental levels.
You work with healthcare systems across the country in a variety of markets. What trends are common to all hospitals and healthcare systems? What differences do you see?