Electronic Health Reporter

Guest post by Jack Plotkin, CTO, Virtual Health.

As a concept, telehealth has always impressed physicians with its potential. The ability to capture time-critical health information regardless of a patient’s location empowers a level of preventive care and early diagnosis never before possible. A physician can only observe the symptoms exhibited by a patient during a visit, but what of the symptoms exhibited in the course of the hours, days, weeks and months between visits? Each day, patients are subject to changes in their health as a result of lifestyle choices, treatment compliance decisions and physiological processes. Telehealth makes it possible to continually monitor these changes and take immediate remediation measures rather than waiting until the disease has progressed to a point of no return.

The advent of wireless devices that may be unobtrusively worn or placed in the home to track everything from pulse rate to frequency of night-time bathroom usage has made the real-time collection of a broad range of biometric data a reality. Moreover, the cost of such devices has dropped significantly over the past several years while their convenience and capabilities have grown. Despite this progress, the healthcare industry has yet to fully adopt telehealth or realize its enormous potential.

Some point to the lack of reimbursement as the culprit. Although device costs may have dropped, the overall expense of initiating and maintaining a telehealth program, including the associated device, data, personnel and training costs, is significant. However, two trends are chipping away at the economic side of the equation. First, state Medicaid programs are continually increasing the scope of reimbursement for tele-visits and remote monitoring, and both Medicare and private insurers have also started to move in the same direction. Second, the shift from fee-for-service to capitation models are providing compelling financial incentives for managed care organizations to fund telehealth programs.

Arguably a more critical obstacle to the mainstream adoption of telehealth is the challenge of data integration. Telehealth systems have developed along a separate track from electronic medical record systems. As a result, the telehealth data resides in a separate, landlocked silo from the patient’s medical history. Thus, even though data is being captured regarding the patient between physician visits, the physician still only sees and records the data accessible during the visit. At the same time, the telehealth program nurse is only seeing the biometric data without the context of the patient’s overall health profile that is accessible to the physician. With the data in landlocked silos, different members of the patient’s care team are unable to see the entire picture or effectively collaborate.

For telehealth data to be truly useful, it must be integrated into a 360 degree view of the patient which can then be shared collaboratively by the entire care team. This way, causal linkages between the real-time readings made possible by telehealth and the patient’s diagnoses, medications and therapies can be clearly identified and properly addressed. Such functionality is being implemented by a new class of software known as population management or care coordination systems. These solutions combine telehealth data with other data streams, such as health records, claims and care planning, to create a comprehensive view. More advanced solutions also provide real-time triggers to support clinical decision making and collaboration tools that enable the various healthcare professionals involved in a patient’s care to share information and work cooperatively.

The challenge is that population management and care coordination solutions are very new and only select systems can currently work with telehealth data. Many of these systems were developed to address the broader needs of managed care organizations to appropriately stratify and coordinate their patient populations. However, the advent of these technologies has the potential to fill the missing piece of the telehealth puzzle.

Going forward, the challenge of telehealth will be less about capturing the data and more about making sense of the data. By intelligently incorporating telehealth data into the overall patient record, population management and care coordination platforms will make it possible for both payers and providers to ensure a higher standard of care at a lower overall cost.

Jack Plotkin is the CTO of Virtual Health and the architect of the company’s transformational population management and care coordination platform. After completing studies in both computer science and economics at Harvard University, Jack spent the next two decades spearheading technology design, development and deployment on behalf of both Fortune 500 companies and early ventures across finance, consumer products and healthcare. He is considered a leading expert on enterprise solutions for large-scale organizations that manage complex consumer populations.