Looking back at 2015, we see significant trends impacting inpatient telemedicine that will gain strength through 2016. Here are the Top Five: How they impacted healthcare, and how they will change hospital medicine moving forward.
More Legislation and Regulation Activity
A recent report from the National Conference of State Legislatures showed there were 200 telemedicine bills introduced in all but eight states in 2015. The federal government also introduced the TELEMedicine for MEDicare Act of 2015 and the Veteran’s E-Health and Telemedicine Support Act of 2015, which are aimed at creating an interstate license for those practicing telemedicine for these patient populations. Last year, 32 states and the District of Columbia enacted telemedicine parity laws, requiring health plans to reimburse telemedicine the same way—and at the same cost—as in-person service. We expect to see more of this activity as telemedicine becomes an increasingly integral part of healthcare in America.
Easier Licensure Across States
Currently, if you have a group of physicians caring for patients in hospitals in four or five states, they must become licensed in each of those states. As noted above, recent legislation (along with new telehealth licensing compacts between states) will make it easier for physicians to get a license across state lines. This will clearly help facilitate the use of telemedicine services
Growing Financial Support
Today, the payer response can best be described as a patchwork. Medicare typically doesn’t reimburse for inpatient telemedicine (except in rural areas as Medicaid), and the commercial payers tend to vary from state to state. There isn’t a uniform basis for reimbursements. Many hospitals end up financing most of the costs of inpatient physician services delivered with telemedicine?and we all know healthcare dollars are tight for everybody. However, the physician reimbursement is moving, albeit slowly. The state parity laws will help. So, too, will having more commercial payers recognize the value of telemedicine services. For example, UnitedHealth Group announced plans to expand coverage for virtual physician visits to employer-sponsored and individual plan participants, increasing those covered from approximately 1 million to well more than 20 million. Better reimbursement structures will help fortify hospitals’ financial underpinnings and alleviate some of the burden they’ve been forced to bear.
Guest post by Robert Williams, MBA/PMP, CEO, goPMO, Inc.
I continue to view 2016 as a shakeup year in healthcare IT. We’ve spent the last five plus years coming to grips with the new normal of meaningful use, HIPAA and EMR adoption, integrated with the desire to transform the healthcare business model from volume to value. After the billions of dollars spent on electronic health records and hospital/provider acquisitions we see our customers looking around and asking how have we really benefited and what is still left to accomplish.
All politics is local
Our healthcare providers are realizing their clinical applications, specifically EMR vendors, are not going to resolve interoperability by themselves. When the interoperability group, CommonWell formed in 2013 much of the market believed the combination of such significant players (Cerner, Allscripts, McKesson, Athenahealth and others) would utilize their strength to accelerate interoperability across systems. Almost three years late CommonWell only has a dozen pilot sites in operation.
Evolving HL7 standards and a whole generation of software applications are allowing individul hospitals to take the task of interoperability away from traditional clinical applications and creating connectivity themselves.
Black Book’s survey published last month, stated that three out of every four hospitals with more than 300 beds are outsourcing IT solutions. Hospitals have been traditionally understaffed to meet the onslaught of federal requirements. Can they evolve into product deployment organizations as well? Across all the expertise they need within the organization? Most are saying no and searching out specialty services organizations to supplement their existing expertise and staff.
Are you going to eat that?
Patient engagement is on fire right now at the federal level (thank you meaningful use Stage 3), in investment dollars and within the provider
community. But to truly manage hospital re-admissions and select chronic diseases (diabetes, obesity and congestive heart failure for example)
providers need data and trend analysis on daily consumer behavior. The rise of wearable technology and the ability to capture data/analyze data from them will be a major focus going forward. These technologies will likely help to make us healthier but with a bit of big brother side affect.
Guest post by Mohan Balachandran, co-founder and president, Catalyze.
As we look back upon 2015, we can reflect, review and based on that and other factors, make some predictions about what next year will bring us. John Halamka had an interesting post that reflect on the bigger challenges, such as ICD-10, the Accountable Care Act and its implications on data analytics, the HIPAA omnibus rule and its impact on cybersecurity and audits and the emergence of the Cloud as a viable option in healthcare. We can expect to see some of these trends continue and grow in 2016. So based on these key learnings from 2015, here are a few predictions for 2016.
Cybersecurity will become even more important
In 2015, insurers and medical device manufacturers got a serious wake up call about the importance and cost of cybersecurity lapses. Healthcare data will increasingly be looked at as strategic data because we can always get a new credit card but since diagnoses cannot change, the possibilities of misuse are significant. Just as the financial industry has settled on PCI as the standard, expect the healthcare industry to get together to define and promote a standard and an associated certification. HITRUST appears to be the leader and recent announcements are likely to further cement it as the healthcare security standard. Given all that, one can safely expect spending on cybersecurity to increase.
IoT will get a dose of reality
The so-called Internet of Things has been undergoing a boom of late. However, the value from it, especially as applied to quantifiable improvement in patient outcomes or improved care has been lacking. Detractors point out that the quantified-self movement while valuable, self selects the healthiest population and doesn’t do much to address the needs of older populations suffering from multiple chronic diseases. Expect to see more targeted IoT solutions such as that offered by those like Propeller Health that focus on specific conditions, have clear value propositions, savings, and offer more than just a device. Expect some moves from Fitbit and others who have raised lots of recent cash in terms of new product announcements and possible acquisitions.
By Tom Bizzaro, vice president, health policy and industry relations, First Databank
Healthcare delivery is changing drastically. Demographics, technology, economics, societal forces and many other factors are prompting the industry’s transformation as we head into 2016 and beyond. And, while change is always a bit jarring, sometimes it actually makes sense.
Here are eight emerging trends that are changing healthcare for the better:
The move toward telemedicine
Is there anyone out there who can honestly admit they are thrilled about traveling to a provider’s facility for their care? In today’s world, time has value and patients are much less willing to spend their time waiting for care. Now, in some cases, it is critical to be face-to-face with your caregiver. However, in many cases, it is just an inconvenience. I am pretty sure that surgery and treating a broken bone won’t lend themselves to a virtual visit, but think about all those things that do. Using Skype for virtual doctor visits; reading medical images taken in Indianapolis by a physician in Australia; and using a kiosk to get access to a nurse consultation have become commonplace — and much more is expected as telemedicine continues to expand.
The adoption of evolving electronic communication tools
I read recently that people under the age of 25 prefer texting as a means of communication with their doctors. It seems that phone calls and even emails are too intrusive and time consuming. In a world where email is too slow, where people are cutting the cord to cable TV, and newspapers are the last place young people get their news, healthcare organizations must stay on top of their constituents’ constantly changing communication preferences.
The return of home care
While patients are pushing healthcare providers to adopt the latest technologies, at the same time “what is old is new again.” Home healthcare services are growing as aging Americans want to stay in their homes as long as possible. Pharmacists are making home visits to the most at-risk patients to manage medication therapy. Doctors are making house calls to help improve care and decrease hospital readmissions. Nurses are performing all types of infusion therapy in patients’ homes.
In 2013, while searching for a telemedicine solution, Brandon Welch thought that his only options were expensive and complicated telemedicine systems or video conferencing solutions that were not HIPAA compliant. He wondered where he would find simple and free telemedicine solutions. He said he felt, “The world needed a simple and secure telemedicine solution that was freely available to all healthcare providers.”
So he created Doxy.me.
Telemedicine will revolutionize the delivery of healthcare by making it more convenient and accessible for patients to access qualified healthcare professionals, and reducing unnecessary expenses. Unfortunately, current telemedicine technologies are expensive and complicated to use, limiting its widespread impact on healthcare.
For telemedicine to change the world, we believe that telemedicine technologies must be simple and free to use. That’s why we developed Doxy.me — the simple, free, and secure telemedicine solution.
Doxy.me is a simple, secure, HIPAA-compliant and free telemedicine available to an clinician in the world. They can use the platform to provide care to their patients, or use it for clinical research or clinical trials.
Origin Story/Founder’s Story
Doxy.me was founded at the University of Utah by then Biomedical Informatics PhD student Brandon Welch while working on a research project within Department of Obstetrics and Gynecology. The goal of the study was to develop and evaluate a novel prenatal care delivery model that replaced several in-person prenatal care visits with telemedicine visits with pregnant moms from home or work. Initially, he wanted to use Skype or FaceTime for the technology, but the institution wouldn’t allow it because these popular and free conferencing solutions were not deemed to be HIPAA-compliant. So he set out to find a good, simple and free telemedicine solution. However, he was surprised upon reviewing HIPAA-compliant telemedicine technologies that the only options available were complicated and expensive; none were deemed practical to be used by patients at home. Being familiar with the technology, he set out to build a simple and free telemedicine solution. He first submitted the idea to a medical invention competition at the university and won the “Consumer’s Choice” award, and he used the winnings from the competition to build the first prototype of Doxy.me (which was used in the prenatal care study). Over the next year, he continued to improve the Doxy.me features based on clinician and patient feedback, but with a guiding principle of simplicity and ease of use.
Since it was officially released to the public, it has grown exceptionally over the past year with little marketing efforts. Networking with organizations and word of mouth has been the largest marketing tool.
Competitors include snap.md, telehealth.org and vsee.com. Market opportunity really focused on the fact there were no telemedicine solutions that were HIPAA-compliant, free and easy to use. This gave us a leg up on our competitors, as most other solutions require downloads, plug-ins, or are expensive.
Beverly Glass Buchman, senior vice president of marketing, TouchCare.
Numerous studies show that patient involvement in their own healthcare leads to reduced costs and better outcomes. It is especially beneficial for managing chronic diseases, such as diabetes, asthma and heart disease, and it will become even more vital as the industry continues to move from volume-based care to a value-based care system.
Still, in a recent CommonWealth Fund study, 86 percent of providers said patient engagement has been challenging, specifically when it comes to adopting healthy behaviors and being compliant with treatment protocols and standard care recommendations. The challenge lies in continuing the doctor-patient conversation between office visits. Many physicians struggle to stay connected with patients and follow up between office visits, while balancing their ever-demanding schedules and precious time off.
Mobile technology can help. It can serve as a key component for improving engagement simply by adapting to a patient’s lifestyle. Nearly every American owns a smartphone today and daily usage time continues to skyrocket.
Look at the numbers for American smartphone usage:
64 percent own a smartphone (PewResearch Center)
3 hours each day using their smartphones (ExactTarget)
People download three apps per month on average (comScore)
57 percent of smartphone owners use apps every single day (comScore)
Leveraging text messages, digital portals, and telemedicine video consults can engage your patients between appointments in a way that’s both convenient and familiar. For example, a remote video appointment allows a physician to check in between office visits to ensure medication adherence, discuss recent test results or receive patient feedback to help in shared decision making as treatment progresses. And it can be as easy as Skype or Facetime.
Scheduled virtual video consults can provide valuable data that will help tailor delivery of care to improve outcomes, all while saving money for both the provider and the patient.
Guest post by Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Telemedicine is about reaching out to patients in remote locations, but limited to videoconferencing between patients and health providers. It is similar to a face-to-face service with the exception that the patient and primary care provider are not physically together. Such efficiency is limited in term of scope and only addresses the geographical challenge and scarcity of physician availability, a far cry from what CMS wanted for its Chronic Care Management Services (CMS), which would fundamentally change telemedicine as it is practiced.
CCM services bring the telemedicine definition to the next level – a quiet continuous monitoring and collaboration from all care services to the patient, given the ability to anticipate and engage in care issues. Such ability not only curbs care costs, it would also increase care provider bandwidth, giving them the ability to cover more patients with better efficiency. The challenge is not on the requirements part of CCM services, but the lack of an IT solution to really address all CMS guidelines, including its intent to enforce the concepts through the healthcare industry.
The New England Journal of Medicine has covered the major challenges from the new CCM guidelines, touching on all the major shortcomings in today healthcare IT offerings. Healthcare providers recognized that the fee-for-service system, which restricts payments for primary care to office-based visits, is poorly designed to support the core activities of primary care, which involve substantial time outside office visits for tasks such as care coordination, patient communication, medication refills, and care provided electronically or by telephone.
The time has come for a paradigm shift to re-engineer how we deliver care and manage our patients. To arrive at a new plateau requires rethinking the needs of our patients and how to meet these needs in an already resource constrained, proprietary, inoperable systems. Unless we develop solutions that both integrate with and enhance the technologies currently available and those yet to be realized, we will not realize a return on health IT investment. That has now changed since one Healthcare 2.0 innovator has been able to connect the CMS guideline dots.
Huge Market Opportunity
According to the 2010 Census, the number of people older than 65 years was 40 million with increasing trends to 56 million in 2020 and not reaching a plateau until 2050 at 83.7 million. With two-thirds of Medicare beneficiaries having two or more chronic conditions while one-third has more than three chronic conditions according to CMS data, putting the number of patients who qualify for CCM services at 15 million. This number is predicted to continue on an upward trend until 2050.
The World Health Organization (WHO) recognized the growing burden this trend in chronic disease places on the healthcare system and addressed the need for innovative solutions in their 2002 report. While the potential market is huge, in the billions of dollars yearly, healthcare organizations have been struggled to address the CMS guidelines with key requirements from CMS. We can no longer afford not to address the needs of patient with chronic medical conditions along with engaging them in their healthcare decisions.
The CMS guidelines are as follows:
24×7 access to clinical staff
Patient care continuum
Collaboration, coordination between primary care providers and other care services
Electronic management of care transition among care providers
Coordination between home and community care services
Here is how these guidelines are now being addressed:
Guest post by Christina Richards, vice president, AOptix.
In recent years, the healthcare industry has experienced a Renaissance of sorts with the development and adoption of mobile and connected technologies. As a result, healthcare facilities the world over are increasingly making use of smart technologies to drive better patient outcomes, track equipment, and support overall operations. In addition, the developing practice of telemedicine is becoming increasingly commonplace for doctors in healthcare settings across the United States, which is raising new concerns about the infrastructure needed to support these real-time doctor-patient experiences.
Although the development of these digital technologies for healthcare applications is only in its infancy, we are already beginning to see their wide range of benefits, including the potential to help organizations achieve the Institute for Healthcare Improvement’s (IHI) Triple Aim of bettering the patient experience, improving population health standings and reducing the cost of healthcare. For instance, a 2014 study by Dale H. Yamamoto of Red Quill Consulting, Inc. found that that the average estimated cost of a telehealth patient consultation was $40 to $50 per visit, compared to the average estimated cost of $136 to $176 for in-person acute care.
With the widespread adoption of any new technology however, there is a learning curve to ensure that they can be effectively integrated into existing operations to capture the greatest benefit without compromising the level of care. But what does this entail?
As healthcare facilities become more connected through the Internet of Things, adoption will continue across a broad spectrum of devices and sensors—from wearable tech that monitors patient location and vital signs to analytics platforms that track staff movements and create more efficient workflows. While these devices span a variety of applications, they all share a universal purpose, which is the constant collection and analysis of data.
Likewise, video conferencing and other mobile approaches to telehealth are highly data-intensive, requiring the transmission and processing of large amounts of information. As a result, many healthcare administrators have encountered the need for far more robust mobile networks in their facilities to support the massive amounts of data traveling across their systems.
In considering other data requirements on the horizon, take the case of rapid genomic sequencing. While the new technology allows researchers to quickly determine the complete DNA sequence of an organism to predict disease susceptibility and drug response, the process requires the transfer of massive amounts of data. To make this information more widely accessible, one company, NantHealth, is looking into a method of compressing the data into a more manageable size so it can be shared with other facilities through high-capacity wireless connections, rather than strictly relying on fiber. With ever-growing levels of data becoming necessary in the healthcare system, new technologies and methods for managing it across various networks will become even more important.
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.”
Today’s physicians face an increasing array of non-clinical demands on their time, from filling out paperwork to sorting through insurance denials. As a result, the amount of time doctors have to actually see patients has been reduced.
The combination of decreasing number of physicians, increasing demand for quality care, and rising costs of healthcare has created a challenging environment for both patients and healthcare professionals.
Nearly all of us have experienced long wait times at a physician’s office, often for minor ailments or routine follow-ups. These lengthy wait times are causing more and more patients to skip follow-up visits or turn to unreliable online medical services and websites for information. This not only erodes the doctor-patient relationship, but it puts patient health at risk. Furthermore, the information is not properly shared with the patient’s actual physician.
Today’s ultra-connected world has a solution that can bring the doctor-patient relationship into the 21st century: telemedicine.
Telemedicine is a suite of technology solutions that enables doctors to communicate with and treat patients via text, video and audio – and it can be used by physicians, nurses, office staff, any healthcare professional and, of course, patients. Telemedicine allows physicians to provide more convenient, real-time interactions with their own patients, for triaging acute issues and for quick follow up visits that can save the entire health system time and money.
And it’s far from the latest medical fad. Telemedicine is already one of the fastest growing segments in healthcare. According to the American Telemedicine Association, half of all U.S. hospitals now use some form of telemedicine. Similarly, Health Affairs has predicted an increase in domestic telehealth revenue by almost 20 percent per year, to $1.9 billion by 2018.
Connecting to patients, anywhere and anytime
Clearly, these solutions have ushered in a new age of medicine. Technology can also provide real-time data on patient vital signs, blood sugars and other information to improve the monitoring of chronic conditions, reducing readmission rates and keeping our patients healthier outside of the hospital.
Factors fueling the growth of telemedicine are as follows: a shortage of physicians in rural and remote areas, the high prevalence of chronic diseases, growing elderly populations, increasing numbers of smartphone users and the need for improved quality of care.
Telemedicine solutions fall into two broad categories: remote patient monitoring and online/digital communications. Remote patient monitoring links home healthcare equipment (heart monitors, dialysis equipment, etc.) to the internet and then securely reports patient data back to a healthcare provider.