By Danielle K. Roberts, a Medicare insurance expert and co-founder, Boomer Benefits.
The telehealth revolution gives health providers the opportunity to assist patients in remote or rural areas; the same kind of care that they give to patients in person. It saves money on travel and improves efficiency in healthcare as well.
While telehealth options in healthcare are helpful to individuals at any stage in life, they can be particularly helpful in treating older adults with chronic illnesses. The Centers for Medicare and Medicaid Services have recognized this and have put together guidelines for primary care physicians who treat patients in geographical areas where it may be difficult for those beneficiaries to otherwise gain access to certain specialists and medical experts.
Telehealth services are made available to these Medicare beneficiaries who have signed up for Medicare Part B. Here’s how Medicare covers telemedicine for these people.
Medicare outpatient coverage for telemedicine
Medicare has two original parts: Part A hospital coverage and Part B outpatient coverage. Telehealth services fall under Part B. Medicare Part B will cover a telehealth consultation whenever a consultation is medically necessary, and your Medicare doctor follows the guidelines in arranging the consultation.
The specialist must conduct your teleconsultation using two-way interactive communication that must include both live audio and video feeds. Fortunately, with the prevalence of digital technologies and telehealth platforms, this has become common practice for most healthcare organizations.
The Medicare beneficiary needs to live within designated rural areas, and the video conferencing call must be held at a designated originating site. Approved originating sites include your physician’s office or rural health clinic. Calls can also be conducted from within a federally qualified health center, a skilled nursing facility, inpatient hospital, critical access hospital or community mental health facility.
By George Mathew, M.D., chief medical officer for the North American Healthcare organization, DXC Technology.
In mid-February, nearly 45,000 health information and technology professionals, clinicians, executives and suppliers gathered to explore healthcare’s latest innovations at the annual Health Information and Management Systems Society (HIMSS) conference in Orlando, Florida.
These “champions of healthcare” examined the greatest challenges facing the industry — including an aging population, chronic disease, a lack of actionable information and increasingly demanding consumers. They also explored how new solutions are being enabled by technologies such as predictive analytics, artificial intelligence (AI), machine learning and telemedicine.
The following four trends drove much of the conversation at HIMSS19 and will continue to shape the next wave of healthcare transformation.
Organizing and innovating around patients
As patients gain access to more information about their health and new technologies empower them to be proactive consumers of healthcare, the industry is focusing on how patients as consumers will drive new models of care. Topics such as patient engagement, patient-centric health information exchanges, personalized care and the consumerization of health were prominent during HIMSS19 learning sessions and conversations around the expo hall.
Primary care physicians are at the frontlines of our nation’s health. The average family doctor cares for 2,300 patients with visits varying from acute conditions to chronic diseases. Treating patients with the highest quality of care is a fundamental goal of every physician. However, with a very high volume of patients, limited in-office time and space, and restricted patient availability, doctors actively seek innovative alternatives to meet patient needs. More and more physicians see telemedicine as the solution and are now offering consultations through virtual devices, such as smartphones, tablets and laptops, to their patients.
Our primary care practice, the Kaufmann Clinic that has been around in Atlanta since 1954 and has multiple locations and multiple providers, recognized the need to incorporate telemedicine into our traditional, brick-and-mortar practice. Here are the ways telemedicine has benefited our practice:
Telemedicine optimizes our practice’s capabilities. A physician can only examine a limited number of patients in office due to administrative time, severity of cases, and number of exam rooms. By using telemedicine our practitioners can now increase the number of patients they see in a given day. Seeing less acute patients virtually enables us to be more efficient and effective overall. Not only remote visits, but also in-clinic visits are optimized.
How do you provide care to underserved patients who have difficulty getting to the office? This was the challenge we were trying to solve at the Clark Clinic. Some of our patients don’t have access to a vehicle or are physically restricted and unable to travel far. But, as most of our community is underserved, we needed to collectively identify a solution to ensure we can serve all our patients.
I knew from conversations with other healthcare executives that telemedicine was the solution. I recently learned of a pediatrics office in Jacksonville that uses telemedicine to serve its ADHD patients better. Like the Clark Clinic, its patients found it difficult to comply with required visits. Telemedicine allowed ADHD patients to conduct their appointments remotely. Rates of visit compliance skyrocketed. We realized then that telemedicine technology would be ideal for a rural community.
We have experienced seismic shifts in the popularity of telemedicine. Technology has largely influenced every aspect of our society. With instant access to every component of life, people are developing a dependence on technology. In healthcare, patients want easy and efficient access to healthcare, without having to wait for hours in the office. After a telemedicine visit, they are convinced of its value. The process is simple — download the healow TeleVisits app and schedule an appointment. There is no doubt patient satisfaction has improved.
At the Clark Clinic, our slogan is “We are wherever you are” and telehealth allows us to provide the same level of care no matter where our patients are located. With multiple clinics across central Florida, our doctors are often on the road. There have been various situations where patients had urgent visits but couldn’t be seen because our doctor was miles away. But with telemedicine, the doctor can schedule a remote appointment and conduct and treat patients in need while maintaining the established provider-patient relationship. Amazingly, our physicians have even noted that in most cases they are able to make accurate judgments, all from observing a patient’s speech, breathing, motions, and mood.
Our patients who reside at local assisted living facilities also love the convenience of telemedicine. These individuals appreciate the ability to download the app directly onto their phone or tablet and schedule an appointment with their doctor. Typically, they take the call in their room, and all their health questions are quickly answered. We’ve also heard from their families and loved ones, who enjoy the reassurance that, with telehealth, the level of care never wavers and access to quality care is not limited.
While you may think of technology in terms of the CT scanner, the advancements made in recent years in cardiac monitors, portable x-ray equipment, sonography, bedside lab testing, even IV needles are all part of how tech is improving healthcare.
Just ask the medical staff of inpatient and outpatient rehab centers. Point of care testing allows blood testing to be done at the bedside. Results for electrolytes, hemoglobin and hematocrit, glucose, blood gases and several other essential blood tests can be in the doctor’s hands in the time it used to take to run the blood to the lab.
Every discipline of medicine is evolving because of the changes in technology. First, there were x-rays then CT scans and MRIs. Now PET scans routinely diagnose very early cancers because they scan the body at a cellular level, often finding tiny areas of increased activity that wouldn’t show up on a CT scan or MRI. Speaking of pets, tech has helped improve the health of our dogs and cats. Whether simply treating a constipated dog or detecting cancer in a cat, the same image scans that serve to help people are being used to help their pets. Robotic surgery sounds like science fiction, but the discipline is gaining acceptance everywhere. Very small incisions have replaced long scars as surgeons control miniaturized instruments from a monitor with magnification that enables very precise work.
Even common health problems, such as diabetes and asthma, are affected by improved technology. Advanced diabetic pumps and monitors help to control blood sugars more exactly as well as improving the quality of life for many diabetics. The newer asthma inhalers deliver a more accurate dose and are easier to use, especially for elderly and young patients.
Computers connect health care agencies and allow researchers to gather data in real time. The diagnosis of a case of influenza or meningitis can be reported to the CDC within minutes to hours, helping to stop the spread of epidemics.
It began in the 1980s with those wonderful word processors. Electric typewriters bit the dust, and health records could be entered and saved on floppy discs. This was only the beginning.
We’ve come along way, baby. As technology came to disrupt every sector of the economy, healthcare was no exception. Consider all that has happened in this sector and where we are today.
Consolidated health records in the cloud
Anyone who has been to a doctor recently understands this. That doctor may have your entire health history, from multiple providers, all in one place. This technology allows any provider to provide better care protocols according to each individual’s unique history and make recommendations for testing, etc. that will not be duplicating those already done.
Patients can also access their full health histories and provide access to family members as well. This allows more control of patients over their own healthcare and allows them to make better decisions for future care.
Use of big data for treatment protocol decisions
Now that providers have access to health data from all over the globe, they can review research studies, identify effectiveness based on specific symptoms, DNA makeups, and more. The net effect is this: research from all over the world is now available through tools that gather data, churn it, categorize it, and provide reports based on specific queries. Ultimately, better care for all can occur because of this shared data. Amy Castello, a healthcare writer for Trust My Paper, says this: “I conduct a lot of research on a number of healthcare topics. One of the most interesting is the strides that have been made in the use of big data. I see a future of customized care solutions that
Use of AI and machine learning to identify and predict disease outbreaks
When artificial intelligence is applied to bag data gathering, environmental conditions can be analyzed for their contributions to disease outbreaks. Likewise, when there are higher than average disease conditions among certain demographics or in certain geographical areas, AI can analyze data and report common characteristics that may be contributing to those outbreaks.
Development of vaccines
Every year, a number of medical reporting organizations isolate the specific viruses that have resulted in flu outbreaks. All of this information is then physically reported during a consolidated meeting, and decisions are made for the next vaccine composition. Now, all of the data can be digitally reported, and the recommended vaccine compositions determined by the use of artificial intelligence. Ultimately, this can serve to reduce some of the human “guesswork” that now occurs.
A decade ago, patients had to travel to their doctors’ offices for regular checks on chronic conditions. Now, wearable devices provide ongoing data electronically, so that patients are monitored from home, with alerts to their doctors when conditions change that they might warrant an office visit or hospitalization. Getting real-time data of this sort not only increase efficiency of care but results in lower costs for both providers and patients.
By Brooke Faulkner, freelance writer; @faulknercreek.
Up to a fifth of patients with serious conditions are first misdiagnosed, and that leaves tremendous consequences. With the help of healthcare technology, doctors are able to diagnosis patients more effectively and easier. For example, migrating patient data from paper to online, known as electronic health records (EHRs), has greatly aided the medical world. Technology, especially using artificial intelligence and predictive analytics, has enabled doctors to make faster, more accurate diagnoses, and thus provide better care.
The volume of big data
Duquesne University estimated there to be 150 exabytes of healthcare data collected in 2011. Four years later, they reported about 83 percent of doctors had transitioned from using paper to electronic records. By now, with the ubiquity of the cloud, these numbers have assuredly gone up.
Massive amounts of data make predictive analytics possible, as trends can be spotted and analyzed. By spotting patterns, diagnosis of a disease becomes easier even for doctors unfamiliar with a specific disease or symptom. Uploading symptoms allows a computer to compare records and identify symptoms comorbid of other problems. This allows even specialized doctors to recognize issues outside of their field. Medical mistakes lead to the death of some 440,000 people each year; while misdiagnosis is only a part of this number, correct diagnosis and treatment will reduce it.
Big data can even be collected in the form of PDFs as part of telemedicine. A doctor can send PDFs to patients as part of a poll or survey or simply to collect symptom information from the patient. From there, data entered in the PDF can be collected and analyzed, generating patient data or feedback for the doctor.
Google flu trends
Google ran what can best be called an experiment from 2008 to 2014. Using artificial intelligence, the search engine recorded flu-related searches in an attempt to predict the severity of an outbreak, as well as the affected geographical area.
It was a flawed model, and tried to use big data as a replacement, rather than a supplement, for traditional data collection and analysis. It completely missed a flu outbreak in 2013, the data off by a massive 140 percent, and Google Flu Trends ended its public version in 2014. The algorithm monitoring flu-related search terms was simply not sophisticated enough to provide accurate results. While new data is no longer available to the public, historical data remains available to the Centers for Disease Control and other research groups. It’s possible that once the algorithm and predictive analysis is capable, the program will continue.
There are many uses of information technology in healthcare. In the previous years, these implementations have developed more than anyone could anticipate. They boost efficiency, improve the quality of care and security and control costs. These advancements have created many benefits for the patients and medical facilities in both the public and the private sector. When asked, experts say that these are some of the biggest health IT issues that should be considered:
Interoperability, when it comes to healthcare is one of the processes that make it easier for medical services to share information on patients. It makes the healthcare more efficient — it prevents doing the same tests multiple times on one patient and it helps specialists communicate quickly through the system.
This is why it’s so crucial that this technology continues advancing and moving further while making the job of doctors all over the world as simple and as focused on the problem as possible.
Of course, with so much data which exists in healthcare field, security of that data is one of the top priorities. In recent years we have come across so many examples of how not to handle patient data but now that we are dealing with population Healthcare, we need to be even more careful. That’s why cyber security of the data became an imperative at so many companies.
“Security is something that you should definitely keep an eye on. Whenever you see that there is a new update, make sure that your healthcare organization has it. People are getting more and more skilled at hacking and obtaining data that this has to be a priority,” said Gina Petrelli, a data analyst from OriginWritings and WriteMyX
Because there is such a shortage of trained medical personnel in the world, big data will have to become the main source for point-of-care information. This can improve the current state of health in certain groups as well as establish customization so that every technology can be unique to each culture. It will also help develop safer and more efficient systems across the world.
Big data means that there are many sources and a lot of data to be taken from them — medical professionals will have the kind of information that they usually can’t easily get.
Over the years, there have been some big investments made towards the healthcare technology industry. However, those investments are noticeable now more than ever — technologies are advancing fast and this progress is visible in many areas.
Investments in healthcare information technology has mostly been aimed at technologies that improve efficiency, technology that supports decision making and personalized medicine, technology that empowers patients, technology that protects against cyber attacks and technology that enables remote health monitoring.
Why most investments are made towards these areas is understandable — they contribute to the overall health and safety of populations.
Improvements of EHR
Electronic health records are something that is already in place and has been for some time now. While there are many benefits to this, it can sometimes be a nuisance and a burden to medical professionals. They are often not inter-operable and that causes a lot headaches to doctors across the world. Any technology that allows for easier use and interoperability is going to be well-accepted.
“While we’ve had these technologies for years now, you’ll have to notice that they caused many troubles – security, operating, transitioning from paper to digital. New improvements could change that,” said Dennis Marks, a communication manager at 1Day2Write.
Growth of telemedicine has been steady over the years but the growth will speed up in the future years. This will enable doctors to examine patients using wearables and use that data to assist them in diagnostics, management and prevention later. This is all thanks to MACRA, value-based demands placed upon the providers and so on.
McKinley County, New Mexico, is the namesake of the assassinated 25 U.S. President William McKinley. Many locals, particularly those Native Americans of Navajo decent living on reservations, have also been the victim of assassination, but in character in addition to physical attacks. Three decades ago Gallup, New Mexico, which borders on the Navajo Reservation, was known as “Drunk Town, USA.”
For many years Northwest New Mexico’s Gallup ranked number one nationally in the number of alcohol-related deaths. This reputation also killed many resident’s spirits, contributing to addiction, joblessness and homelessness, further highlighting the need for behavioral health care in this region. Native American youth have the highest rates of alcoholism of any racial group in the country, according to the National Institutes of Health.
McKinley County Is One of Poorest in U.S.
There are many stories like this. Addiction’s partner is the adjunct poverty of McKinley County, one of the poorest counties in the U.S. In Gallup there is a large population of Navajo and Na’nizhoozhi Indians. It is the most populous city in the county with 22,670 residents and is situated between Albuquerque and Flagstaff with 61 percent living below the federal poverty line and unemployment at 8.4 percent.
The Indian Health Service (IHS), an operating division within the U.S. Department of Health and Human Services (HHS) is the principal federal health care provider for Indians. Its mission is to raise their health status to the highest possible level. However, there are still issues such as the life expectancy for Indians being approximately 4.5 years less than the general population of the United States, 73.7 years versus 78.1 years.
Data from a 2014 National Emergency Department Inventory survey also showed that only 85% of the 34 IHS respondents had continuous physician coverage. Of these 34 sites surveyed, only four sites utilized telemedicine while a median of just 13 percent of physicians were board certified in emergency medicine. Another behavioral health related disease afflicting the territory is diabetes. In 2016, diabetes was the sixth leading cause of death for New Mexicans and the seventh leading cause in the U.S.
RMCHCS Hospital Fights Addiction with Behavioral Health Apps
Despite the drumbeat of bad news and discouraging statistics, organizations such as Gallup’s Na’ Nihzhoozhi Center Inc.’s (NCI) has 26,000 admissions every year and is the nation’s busiest treatment center with many repeat customers. The detox center was the result of an effort 30 years ago which began when more than 5,000 people marched from Gallup to Santa Fe to demand assistance from state lawmakers and received a $400,000 for a study to build a detoxification center. The hospital then received two-million-dollar ongoing yearly federal grant out of which NCI was born.
When he became CEO of RMCHS a few years ago, he took a financially failing hospital and turned it around with the help of William Kiefer, Ph. D who is the hospital’s chief operating officer. Recognizing the root cause of the region’s health problem was addiction, Conejo revitalized a former rehab building on the hospital’s grounds and with some fundraising he launched the Behavioral Health Treatment Center.
The center is operated by Ophelia Reeder, a long-time healthcare advocate for the Navajo Nation and a board member of the Gallup Indian Medical Center. Bill Camorata, a former addict, is the behavioral special projects director. He opened “Bill’s Place,” an outdoor facility where he and hospital volunteers treated the homeless with meals, clothing and medical triage as part of Gallup’s Immediate Action Group that he founded and serves as president. The center has treated more than 200 addicted residents since the center opened in 2015 and has a staff of 30 who manage resident’s case work, provide behavioral health services and are certified in peer support.
Medical innovators can’t come up with ways to implement 3D printing into categories of healthcare fast enough. With so many practical applications, 3D printing is quickly becoming a technology realized for its untapped potential and seemingly limitless possibility to transform healthcare.
3D printing alone has many applications across a wide range of industries — for one example, advancements in health data are benefiting nursing and patient care. As 3D printing continues to be combined with the innovations in health data, it will further revolutionize patient care, lower healthcare costs, expand the field of nursing, and improve modern medicine as we know it. How will 3D printing and health data do this?
Below is an extensive look at how innovations in health data are changing healthcare fields, and how 3D printing will further reform these sectors, allowing for advancements in both medical practice and patient care.
Home healthcare benefits patients who would like personal care in the comfort of their own home. Elderly and disabled patients don’t have to travel to have minor care done, and patients who have such diseases as HIV and are worried about discrimination or bias can have their privacy. Home-based care allows for specialized care for the patient, rehabilitation, and the close monitoring of vital signs for health and wellness, without the trouble of an in-person office visit. This convenient transfer of data through new technology makes it increasingly easier for caregivers, whether it be family members or professionals, to care for patients on their terms.
ASU reports, “75.2 percent of nurses agree that telemedicine makes their job easier.” Telemedicine is another sector of healthcare made possible by the accessibility of telecommunication technologies such as videoconferencing. Through videoconferencing, a professional is able to listen to a patient’s concerns and diagnose illness or injury from a remote location. This gives the patient another level of privacy and both parties freedom and independence. Telemedicine cuts healthcare costs, as a physician doesn’t need to physically travel to a patient every time a minor checkup is needed.
EHRs and CPOEs
Electronic health records, or EHRs, are just that: electronic patient health documents that provide real-time information. Medical history, treatments, and diagnoses can be constantly updated along with other details such as allergies and current medications. An infographic by Duquesne University highlights the increased reliance on EHRs while illustrating patient data in the age of technology.
CPOEs, or computerized provider/physician order entries, are a better way to order medication and control the dosage and frequency at which the medication is administered. This efficient method of ordering pharmaceuticals reduces error and abuse, and therefore diminishes illness and injury. As Scott Rupp writes, CPOEs are “foundational for meaningful use. Make sure it’s easy to use and intuitive.”
Involvement of 3D Printing
In its infant stages, 3D printing is being utilized to make hearing aids, prosthesis, skin for burn victim patients, heart and airway splints, and much more. Showing potential for almost every aspect of healthcare, 3D printing, combined with the innovations in health data above, will transform these fields for even more accessible, affordable, and convenient healthcare.
3D printing can be applied to home health care, telecommunications, EHRs and CPOE in a number of ways. A professional can diagnose the atrophy of a leg, order the rehabilitation of walking, 3D print a prosthetic, and monitor the progress all while a patient is at home. In another instance, home healthcare and telemedicine can diagnose that a patient is ill, EHRs and CPOEs will allow for a better determination of what medication to order, and 3D printing can be used to print the medication for a patient
More accessible healthcare means more easily affordable healthcare, and with the involvement of 3D printing home-based care, telemedicine, EHRs, and CPOEs, healthcare will be transformed and turned on its ear. Patients who desire privacy, or are not mobile, will be able to get the care they need at home, while professionals will be able to stay in the office to help people with more immediate and urgent matters.
As mentioned above, 3D printing is in its infancy stages for many of these processes. An argument can be made that 3D printing will make home care, telemedicine, EHRs, and CPOEs more expensive — and that’s true, but only for now. As 3D printing becomes more of a norm in the medical field, and it will with its promising applications, the cost will decrease. As 3D printing becomes a normal process in these fields, it will increase patient care and make healthcare more accessible and more easily affordable.