Many healthcare organizations refer to the at-home, at-risk patients as the “sickest of the sick.” Unfortunately, these patients may receive inadequate care and attention after being discharged and often rely on emergency medical services and/or the ED to answer questions and provide care in non-emergency situations. The model for treating these patients and attempting to keep them at-home (and not back in the hospital) has not changed substantially in decades. In an attempt to minimize re-admissions, hospitals may schedule case managers and/or nurses to physically visit these patients at-home in an effort to help the patients stay on track with their adherence.
However, this continuum of care model is not sustainable. The budget and resourcing implications are significant when most of the staff’s time is spent behind the wheel vs. in front of the patient. Significant opportunities exist for telehealth solutions to bring the care closer to the patient — at a more convenient and cost-effective manner for all involved.
Why Reducing Readmissions Matters From the patients’ perspective, returning to the ED and potentially being re-admitted is disruptive and stressful for patients and family. Patients may be put at an additional risk for hospital-acquired infections and complication. Returning to the hospital can also lower the rate of patient satisfaction and weaken overall outcomes.
From the perspectives of health systems and health plans, readmissions are costly. Since the introduction of HRRP (Hospital Readmission Reduction Program), hospitals that exceeded the national average of readmissions for specific conditions (within the 30-day window) have been penalized by a reduction of payments across all of their Medicare admissions. More than half of hospitals in the HRRP program were penalized the past five years, resulting in $528 million in withheld Medicare payments. Re-admissions can also negatively impact measures in Hospital Compare data, levels of provider satisfaction and the health system’s overall reputation in the community it serves. Re-admissions cost more than $26 billion annually but $17 billion is considered avoidable.
What Happens Today Keeping at-risk patients at-home is critical to reducing re-admissions and the associated consequences. Typical discharge programs with in-person appointment schedules often fail the at-home, at-risk patient, the providers, and the healthcare system by insufficiently engaging the patient at the point of discharge and upon returning home. The rates of patients being readmitted are significant:
Nearly 20 percent Medicare patients are readmitted within 30 days.
34 percent of Medicare patients are readmitted within 90 days and 56 percent within 1 year.
64 percent received no post-hospital care between discharge and readmission.
What happens in-hospital and at-home which leads to this situation? In-hospital experiences can adversely affect health and contribute to substantial impairments during the early recovery period, an inability to fend off disease, and simple mental error. As a result, patients may leave the hospital deprived of sleep, experiencing pain and discomfort, without sufficient nourishment, and with medications which may alter cognition and physical function.
When a patient is discharged, the patient may continue to face physical, emotional and even financial issues, depending on one’s condition, health history and home environment. A patient may be discharged without adequate instructions and information for self-care and follow-up. The patient may be provided with comprehensive verbal instructions but quickly forget the detailed instruction. Written instructions may be provided to the patient but the patient may fail to keep the information handy and/or share the information with family/friends serving as caregivers. Internalizing the discharge program and being able to practice self-care may also be negatively impacted by a patient’s level of English proficiency, health literacy, socio-economic status, gender and cultural background.
Sherlock Holmes famously captured the popular imagination with his uncanny ability to make wild, but accurate, leaps of logic to solve mysteries. By observing Dr. Watson’s suit jacket sleeve, upon their first encounter, he was able to deduce that Watson was in fact a surgeon, in the British Army, and had recently returned from Afghanistan, where he had sustained an injury.
When he slowed down to explain his reasoning, it was easy to follow; what made his deductions impressive was how quickly he would skip from observation to conclusion. I’m no Sherlock Holmes, but it seems to me that chatbots are poised to take over much of modern healthcare.
As more data is moved to portals through EHRs and digital documentation, there is increased patient interest in and demand for other digital and remote encounters and health resources. This, along with improving technology and competitive solutions, is helping increase adoption of telehealth. So, patient portals lead to increased telehealth adoption.
Finally, although part of the premise and value of telehealth is enabling face-to-face encounters between caregivers and patients without respect to geography, hospital waiting rooms, or other physical barriers, it changes certain expectations. Like all mobile and web-based services, telehealth feeds a consumer mindset that expects everything on-demand, all but instantaneously, and highly customized at that.
While portable patient records facilitated by EHRs and interoperability can help this, customization and on-demand healthcare doesn’t just put pressure on records and data. Patients want fast and personalized answers. As customer service centers, tech support, banks and virtually every other consumer-facing industry has learned, a lot of the on-demand load can be pushed onto increasingly sophisticated chatbots.
So, telehealth leads to growing expectations for on-demand clinical encounters and chat, which is provided by chatbots.
The Case for Chatbots
Retail has previewed much for healthcare: See how customer service upgrades have turned everyone into “The Most Important Person Here” wherever they go, in person or online. Consumers demand personalization, expedition, authenticity and they want it all exactly when and where they want it. And now, see how AI is not yet taking over the world, but is making FAQs and other routine customer service interactions painless for those answering, and interactive enough for those asking.
Retail is even making inroads to healthcare, as consumer-facing devices promise to measure and track all manner of health metrics. Statistics-loving sports fans witness the increasing digitization and quantification of athletes, games, injuries and training, and they want a similar level of insight and precision for their own care. Mobile technology is redefining and disrupting even the oldest and most stable of markets and industries, bit by literal bit.
So how long until the dry, repetitive questions doctors routinely must answer in check-ups and physicals are ethically and effectively offloaded onto chatbots programmed to triage and educate patients without wasting valuable human resources? How long until using telehealth to keep nonemergency patients out of the emergency room merges with using chat and AI — the basic recipe for chatbots — to keep healthy but curious or concerned patients from wasting time and money going through full encounters simply to get their general questions answered?
It doesn’t take a lot of sophistication to realize the benefits of AI at scale. Google has all but taken over the modern world by connecting searchers with answers to their questions; Wikipedia has all but bankrupted the encyclopedia industry with free, accessible, general knowledge. In a world where health literacy is so lacking in the majority of the population, some interactive resources could go a long way to chipping away at ER overuse and healthcare overconsumption, just by giving people an alternative to seeing the doctor.
Automation of Care, Automation of Crime
As quickly as potential benefits can scale, very real risks and both moral and financial hazards scale even quicker.
The growing popularity and implementation of chatbots has given hackers and cybercriminals a new way to scam, defraud, and generally abuse unwitting consumers. Sometimes that means hackers take over a company’s chat system with their own bot and solicit data. Sometimes fraudsters attract visitors with a spoof website, then use a bot to similarly extract volunteered data at scale from misled visitors. However it is done, it scales almost as well as a more conventional data breach, and can be harder to detect or track.
The need of Telemedicine AHA Report shows that 20 percent of US citizens are located in the rural areas and do not have access to the healthcare professionals and their services. The industry, though, has found a way out in form of telemedicine.
Telemedicineis defined by American Telemedicine Association as the process of medical data exchange from one site to another via electronic devices in order to improve patient clinical health status, electronic devices meaning emali, applications, video, wireless gadgets, smartphones, etc.
Telemedicine notion includes three main modalities: real-time, store-and-forward, and remote patient monitoring. The first modality means doctor-patient interaction with the help of audiovisual technology. The second — transmission of patient data and her history via secured electronic channels to a healthcare specialist. The third — collection of the patient data with the help of special devices (like wearables) and its transmission to a healthcare provider.
Foley predicts that by 2020, telemedicine will grow to 36.2 billion US dollars at CAGR (compound annual growth rate) of 14.3 percent. In 2014, it was 14.3 billion US dollars. Currently, there are around 200 healthcare academic centers in the US that provide video consultations worldwide, according to American Telemedicine Association.
Foley has also reported that 90 percent of healthcare top minders have already begun telemedicine integration. Nearly 70 percent of employers are going to offer telemedicine services as perks for their employees. 42 states in the US have already created more than 200 legislative acts about telemedicine.
US patients are not opposed to the idea of telemedicine, too. According to American Well, 64 percent of them would attend a meeting with their doctor via telecommunication means; forecasts that there will be 7 billion telemedicine users worldwide.
Types of Telemedicine
Telemedicine deals with many spheres of healthcare: telestroke (remote data transferred to the emergency specialists on site), teleradiology (images and media transfer), tele-ICU (systems and networks connected to the critical medical specialists), telemental health (distant mental health treatment), cybersurgery (operations held by surgeons remotely with the help of telecommunication and robotic instruments), and telepharmacy.
Importance of Telepharmacy
As stated by Centers for Disease Control and Prevention, 74.2 percent of physician visits involve drug therapy. During hospital outpatient department visits, there were 329.2 million drugs ordered or provided. These numbers demonstrate the potential hidden in the telepharmacy. Moreover, the number of independent pharmacies is steadily decreasing from 2011.
Telepharmacy was originally introduced for the rural areas that lack the resources to supply existing demands in the pharmacy. However, it’s now being actively used by healthcare systems, regardless of the location, due to its ability to meet medication needs 24/7.
A vivid example of telepharmacy success, Comprehensive Pharmacy Services, has launched telepharmacy project, CPS Telepharmacy, that works 24/7 the whole year round. It has been reported to detect and improve 1,300 medical errors per year and to have reduced around 45 percent of costs, with improved quality.
CPS Telepharmacy can process nearly 3 million medication events a year and involves with 200 medication orders a day (73,000 cases a year). Averagely, errors occur 3.6 times per day. Those can be wrong patient, wrong dose, or wrong medication.
CPS Telepharmacy has brought substantial improvements in form of reduced costs, lowered adverse drug events, and improved clinical outcomes.
PiplineRX, another leader in the industry, has recently announced its round funding at $9.1 million U.S. dollars by McKesson Ventures, Mitsui & Co Inc., and AMN Healthcare. Currently, the system is available in around 200 hospitals.
Many reports have been issued emphasizing the importance of the control of antibiotics prescription, namely ASP (antimicrobial stewardship program) to prevent emerging antibiotic resistance. Advanced technologies are to help reduce costs on drug by finding cheaper alternatives or preventing over prescribing of medications.
To sum up, telemedicine, as well as telepharmacy, have great perspectives. The number of their supporters in the healthcare industry is increasing from day to day and is not going to stop.
Mobile technology is impacting every element of American healthcare–from insurance and billing to documentation and caregiving, the impacts are being felt. The truly transformative element of the mobile revolution is not the technology itself, or the way it changes the look and feel of the tasks it affects. Despite complaints of the depersonalizing effect of technology, the ultimate value of mobile in the sector will be how it enhances and encourages communication.
Providers are Going Mobile
Already, flexibility and functionality have already drawn providers to mobile devices and solutions. Voice-to-text technology and similar automated solutions are in the offing to relieve the documentation burden that has dampered some amount of enthusiasm toward digitization. Bolstered by these advancements, caregivers will go from subjects of their EHRs to masters of patient encounters.
One of the huge benefits of mobility — as opposed to simply being networked on desktop computers or having a digital health records solution — is the capacity for greater native customization and app development. Native apps are like the currency of the mobile, smart device world providers are entering. Developers can deliver personal, branded interfaces that allow doctors to choose precisely how they want their dashboards to look, giving their EHRs a custom touch that has been sorely lacking throughout their implementation.
App-centric development will further reduce the friction of adoption and utilization, giving doctors a sense of empowerment and investment, rather than the bland inertia that has carried digitization thus far.
The personalization of the technology through app development will help boost adoption, and return the focus to what the technology enables, rather than how it looks or what it has replaced. Mobile technology’s strength will be in reconnecting doctors and patients, and creating bridges of data and communication across the continuum of care.
Patients are Going Mobile
Patient-facing health apps and mobile point of access to care combine convenience and cost-saving with a learning curve. Increasing the visibility of EHRs through mobile portals gives patients greater reason to develop some basic health literacy, and levels the playing field during doctor encounters. The more providers use mobile solutions, the more incentive patients will have to do the same.
When apps are connected to prescription management and can monitor adherence to treatment plans, mobile devices provide a two-way mirror enabling doctor and patient to remain connected long after the encounter is over. This can allow providers to better anticipate and intervene where drug abuse is at risk, as well as to prevent ED admissions and re-admissions beyond what telehealth has been able to achieve.
Even without connecting providers, mobile health apps will also support personal health management, with an eye to prevention as well as education. From diet-planning to workout tracking and even disease management, patients have more ways than ever to study their bodies and better understand their unique wellness needs. As providers and their EHRs evolve to integrate mobile patient-generated data, the potential for customization will make each encounter more conversation-driven, using data as a platform to educate, engage, and advance communication.
All these personal, data-rich conversations will help push prevention and population health into front of mind for a generation.
Guest post by Torben Nielsen, senior vice president of product at HealthSparq.
Significant policy changes are inevitably on the horizon for health care in 2017. Though the question marks about what is next for our industry seem endless, Americans are wondering how health care costs will change, and if their insurance carrier will continue to provide them with the coverage they need. One thing we know for certain is that health care industry disruptors will continue to innovate in a way that we can’t ignore. That’s why it’s important for health plans and hospitals alike to embrace the technology that could simplify the way people interact with the health care industry.
To that, here are my five predictions for the industry in 2017:
Artificial intelligence innovations will help people navigate the healthcare system.
From robots and chat bots, to increasing telehealth options, we’re expecting significant innovations in 2017 for both doctors and patients. On the hospital side, chat bots have the potential to streamline the processes that people often get caught up in when visiting their practitioner, or when dealing with insurance protocol. The chat bots of the future will be able to have meaningful conversation that will help people navigate the system, instead of confusing them. A member could say to their health plan, “I’m looking for a cheaper MRI,” and artificial intelligence can help with a more guided search.
Virtual reality will continue moving into the hospital side of healthcare.
With technology like Oculus Rift and HTC Vibe on the market, people around the world are getting used to the idea of virtual reality in health care, too, and we don’t expect that interest to die down anytime soon. Surgeons are already utilizing virtual reality to practice upcoming surgeries, and patients are beginning to see the benefits of this technology, too. For example, at the University of Southern California combat veterans experiencing PTSD are being treated using virtual reality gaming as a healing mechanism to help process trauma. As these tools continue to get smarter, both hospitals and patients will continue to see virtual reality extend into their care practices more regularly in the coming year.
Personalization of healthcare technology will help data transfers happen easier.
Block chain technology has potential to help secure EHR data and health plan member information in a way that streamlines the health care journey for both the patient and the provider. Healthcare processes and experiences can feel very stifled and complicated to all parties in the system (that’s why HealthSparq created #WhatTheHealthCare!) because hospitals and health systems are sitting on so much data that is not connected or easily shared. Data fluidity is a goal for the industry, and with new applications of block chain technology, the health care ecosystem may now see data transfers and fluidity happen much more simply, giving everyone a more holistic view of health care status, options and improvement opportunities.
Lee Horner serves as Stratus Video’s president of telemedicine, bringing more than 25 years of experience in enterprise software and healthcare IT industry. Most recently, Horner served as the president of CareCloud, a health care technology company specializing in practice management and EHR software. During that time, his core focus was setting the direction and strategy of the company while managing the top- and bottom-line revenues. He also drove both technology excellence and platform growth to meet CareCloud’s clients’ goals. Prior to CareCloud, Lee also held executive roles at Vitera Healthcare (formerly Sage Healthcare, where I worked with him; now Greenway Health) and Eliza Corporation.
You recently joined Stratus as president of telehealth – what motivated your decision and why is this such an important field nowadays?
In today’s mobile and fast-paced world, telehealth is a necessity. Telehealth is healthcare 2.0 – it can cut wait times, costs for both the provider and the patient, inefficiencies. At the same time it can elevate the kind of expertise and quality of the care patients receive, as well as give new opportunities to connect doctors to the patients who need them most. Telehealth is the future of health. It’s not only preserving that face-to-face connection between patients and providers – which is essential to great healthcare – it’s making that connection available to so many more people in so many different contexts. By enabling these essential connections, telehealth expands the probability of people getting the care they need, and is inevitably helping to save lives.
What is your background in health IT?
I have been involved in healthcare IT for the past 10 years. I have experience operating businesses in the payer, ambulatory and health system markets. It is a great field to be in. It’s very progressive and always changing.
Why is health IT where it’s at today? What do you feel has made this industry successful?
This market is expanding rapidly and technological advancement is at the forefront of that expansion. Smart people with extreme passion for improving patient quality care are really what is making this industry successful.
What are some of the things that most inspire you about the space and it’s work?
I am inspired every time I see the changes we are making improve a patient’s quality of care. It is incredible to see our work start to make a difference.
What are the most important areas in telehealth nowadays?
One important area is how telehealth is opening opportunities for more health industry professionals – and this is in turn, leading to a more robust patient experience. Predictable disruption is a huge theme in telehealth. You saw unpredictable disruption with industries like car ride service – when Uber and other apps came out, people who weren’t taxi drivers were suddenly entering that industry. In healthcare, it’s different – apps are creating opportunities for people already within the industry, allowing more providers to help the patients who need them most and more patients to connect with the providers best suited to their needs.
A couple of other important areas are readmissions and urgent care:
The Affordable Care Act penalizes hospital readmissions, because it’s important to incentivize successful treatment. Unfortunately, the nature of healthcare and the nature of life is that you sometimes need to go back in for continued treatment or to inquire about something. But maybe you moved or you’re too sick to keep going back to your treating physician. Discharge solutions are allowing people to reconnect and get the follow-up care they need without the hassle.
Urgent and emergency care solutions are also becoming really important. Imagine a burn victim walks into an ER at 4 a.m. and needs to see a specialist – but the staff is all tied up or there isn’t a specialist working in that particular facility. Without an urgent care app, the patient would be waiting and suffering, while the provider would be struggling to give them the care they need. With an app, they’d be able to pull up a tablet and connect that patient face-to-face with the doctor they need almost immediately.
In the age of the digital hospital and the connected patient, security will likely improve the less it depends on providers.
Everything from HIPAA to patient engagement treats physicians as the white hot sun of the healthcare universe, holding everything together and keeping it all in stable orbit. They are accountable for health outcomes, for patient satisfaction, for guiding patients to online portals, and for coordinating with care teams to keep data secure — even as mobility and EHR dominance complicates every node in the connectivity chain. All this digital chaos brings more diminished security.
Only as Strong as the Weakest Link
Every business out there has learned — usually the hard way, or by watching someone else learn the hard way — that whatever the security infrastructure, users are the weakest link. More devices means more users, and more connectivity and data-sharing means more weak spots all along the chain. By design, the EHR system adds vulnerability to healthcare data security through a long chain of users.
Patients don’t have a systemic, accountable role in all of this. Our whole approach fosters passivity on the part of the patient and paternalistic assumptions on the parts of caregivers and policymakers. We give tacit acknowledgement of this imbalance whenever malpractice law or tort reform is mentioned — and promptly left behind in the face of other, patient-exculpatory programs and initiatives.
Patients are a part of this. Clearly they are invested in their own security — the costs of health data breaches contribute to the rising costs of care, besides exposing personal financial and medical information that can carry its own universe of costs.
Patients are implicated, but they must also be accountable for security in the new high tech healthcare system.
An Old Problem with New Importance
Getting patients included in the evolution and delivery of healthcare requires engagement. The same goes for digital security. The ethical and financial dilemmas of the security situation is an expensive distraction for administrators and caregivers, but it is a learning opportunity that could empower patients. A new emphasis on digital security and privacy could be the start of a cascade of engagement with further questions of use and responsibility for outcomes.
Already, patients are key players in making telemedicine effective. Access is on the shoulders of the patients, and utilization depends on their technical literacy. The incentives–time and money savings, improved access to care–are powerful, but come with the obligation to learn the platform through which remote care is delivered. Utilizing any telehealth solutions requires patients to think about what information they want to share, whether they trust the new platform, communicating effectively with their provider, and gaining confidence for the new medium.
This same model can be applied more broadly to EHRs, and the patient role in the digital healthcare system.
There are exciting developments with telehealth reimbursement thanks to the progress in moving towards Patient Centered Care, and a focus on Prevention and Wellness. Early in 2016 we saw the introduction of Senate bill 2484 and with it a proposed path to remove many of the obstacles to providing access to patient centered care and telehealth. Now we are seeing the Comprehensive Primary Care Plus model take shape that further supports telehealth adoption and reimbursements. Imagine a connected care team, in collaboration with patient and family members, the relevant data is available as needed, and an empowered healthcare provider who is able to ‘do the right thing’ with respect to each patient.
Wouldn’t it be great if care was accessible independent of the patient’s or doctor’s location, whether they are rural or urban, whether they are in their home or in a clinic? Well, Senate bill 2484 may do just that. It is looking at removing obstacles to delivering telehealth services and opening the door to the delivery of care where and when it is needed.
Additionally, wouldn’t it be great if the primary care practitioner were free to utilize the right delivery of care at the right time?
To date it has been difficult to find a model that empowers the primary care provider and provides the freedom to do what they know is best for their patients including telehealth as appropriate. This year, a change is kicking off that may go a long way toward enabling the primary care practitioner. It comes in the form of the recent announcement from CMS in an interview with Joyce Freidon from Medpage Today published in article on 4-11-16: “The 5-year initiative, known as the Comprehensive Primary Care Plus model, will give doctors the freedom and flexibility to practice medicine the best way they know how, to return to what matters most to doctors and their patients,” said Patrick Conway, MD, CMS chief medical officer, on a phone call with reporters.
And Dr. Conway states “If telehealth makes sense, they can do that.” As the program kicks off this summer and goes into action January 2017, look for more details to unfold.
The article further quotes Dr. Patrick Conway:
“Doctors will be given more freedom to design the type and amount of care that best meets the needs of their patients,” said Conway. “If telehealth makes sense, they can do that … This initiative will also make it easier for doctors to communicate with each other and have all the information they need … to get better support from nurses, specialists, and others on the patient’s care team.”
Guest post by Michael Leonard, director of product management, healthcare, Commvault.
Once a year, the healthcare community gathers to discuss the hottest healthcare trends. This year, the event took place in Sin City, and the turnout was staggering. Topics of choice at the show ranged from EHR best practices to the rising need for telehealth services.
Now that I’ve had a chance to step back and digest, there are a few key moments that jumped out from the event. Here are my top two:
The HIMSS survey showed healthcare organizations are ready for telehealth.
During the show, HIMSS released a survey that had some exciting results around connected technology in the healthcare field. The results showed that 52 percent of hospitals are currently using three or more connected health technologies. Technologies being used by that group that stood out to me include mobile optimized patient portals (58 percent), remote patient monitoring (37 percent) and patient generated health data (32 percent). It’s fascinating to see these results, and important for healthcare and health IT professionals to know that the telehealth wave is here to stay.
The U.S. Department of Health and Human Services’ (HHS) made a key interoperability announcement.
At the show, the HHS Secretary Sylvia M. Burwell made a major announcement around interoperability that was backed by the majority of the top electronic health record (EHR) vendors and is supported by many of the leading providers. This news will enhance healthcare services and allow doctors and patients to make better informed decisions. It certainly has the potential to catapult the industry forward, allowing healthcare partners to increase accessibility by improving their clinical data management solutions.
As always, the conversation at HIMSS was engaging and educational and I left with some great takeaways and predictions for the future of health IT including:
Guest post by Charlotte Hovet, MD, MMM, and Joseph Kim, MD, MPH.
Remember a few years ago, when online shopping was first getting started, and everyone used words like “e-tailer” to refer to companies that sold stuff on line? When was the last time you heard that used? It has become an anachronism, because almost every company is now an e-tailer. And “online shopping” has become merely shopping, because no one thinks twice about buying via the Internet.
The phrase mobile health will soon be headed for extinction in the same way as “e-tailer” because it is becoming a routine way to consult your medical practitioner. Over the next couple of years, it will become a major force in healthcare, and in five years no one will think twice about using remote communications to get medical help. We predict there will soon come a time when young people will wrinkle their noses and ask “Really? You had to drive to the doctor’s office, and sit in a waiting room and infect a bunch of other people just to get some Tamiflu? That’s insane!”
Both public and private health plans are rapidly adding coverage for e-visits. Not only are they cheaper, they are also more effective for some types of care and consumers greatly appreciate this trend. While the baby boom generation may still have some holdouts who don’t like mobile communications, the majority of people across all age groups have not only adopted mobile technology, they’ve melded with it.
So the question for physicians and hospitals is not whether to adopt e-visits and mobile technology, but how to use them most effectively.
We co-hosted a webinar on the topic recently, in which we looked at mobile technology from the perspective of patients and caregivers. Both sets of stakeholders have a shared need: simplicity and ease of use. Merely making an application or function mobile isn’t enough. How mobility is integrated and used makes a big difference in the value derived.
During the webinar, we polled attendees on which mobility trends will have the biggest impact in the coming year:
47 percent think a greater use of digital communication between patients and healthcare providers will have the biggest impact.
5 percent voted for Telehealth replacing more in-person visits with healthcare providers
While 14.7 percent see increased use of medical-grade disease management mobile apps and growing adoption of health/fitness wearable devices and apps by consumers.