Telehealth Makes Gains Out West

At the American Telemedicine Association’s annual meeting in Baltimore in May, the buzz was about health systems increasingly incorporating virtual visits into their operations and how mobile technologies could play a role in enhancing telehealth’s value. That conversation will continue July 22-23 at the Health IT Summit in Denver, sponsored by the Institute for Health Technology Transformation, or iHT2. (Since December 2013, iHT2 has been in partnership with Healthcare Informatics, through its parent company, Vendome Group LLC.)

At the Denver conference, three leaders in the field of telemedicine will come together for a panel entitled “The Convergence of Telehealth, Telemedicine and mHealth: Improving Quality and Access while Reducing Cost.” They are James Marcin, M.D., M.P.H., director of the pediatric telemedicine program, and a professor of pediatric critical care, at UC Davis Children’s Hospital in California; Doris Barta, MHA, director of telehealth services, at the Partners in Health Telemedicine Network (PHTN), St. Vincent Healthcare, Billings, Mont.; and John F. “Fred” Thomas, Ph.D., Director of Telemedicine at Children’s Hospital Colorado (Denver).

To preview their panel discussion, Healthcare Informatics Senior Contributing Editor David Raths spoke recently with Dr. Marcin and Dr. Thomas and asked them to share their perspectives on the evolution of telemedicine, its integration into clinical workflow and how mobile convergence is starting to have an impact.

HCI: Could you start by describing a little about your telemedicine program’s area of focus and geographical reach?

Marcin: Because we serve a lot of rural areas in Northern California, UC Davis has invested in the use of this technology to address disparities to access for people living in rural communities. We use the technology in a variety of ways, including in pediatrics. We help sick children in rural hospitals and clinics with any specialty needs, whether it involves cancer, trauma, pulmonary health or immunology.

Thomas: At Children’s Hospital Colorado, many of our specialists are the only people who do what they do in the whole Rocky Mountain region. In so far as outreach, we would like to expand these unique services across the region and improve access. And overall, our efforts are aimed at how telemedicine opportunities apply to our strategic initiatives to improve outcomes, reduce costs, and improve access.

HCI: What are some ways that mobile technology and telemedicine might be converging? And what are some of the benefits?

Marcin: A few years ago, telemedicine was typically a $15,000 telemedicine unit on one end and a $15,000 telemedicine unit on the other end, and some telecommunications in between. But advances in technology make solutions more mobile and lightweight. As a hub site, we still have a clinic, but now physicians are doing consultations from their offices. I used to have to go to the clinic where the equipment was. Now I can do a consultation remotely on my laptop or iPad. And on the other end, the consultation might take place at the patient’s home. Whether they use videoconferencing or not, many programs are starting to incorporate more remote patient monitoring for things such as palliative care or glucose monitoring for diabetic patients.

Thomas: Platforms [with HIPAA-compliant desktop videoconferencing] are much more nimble for supporting primary care providers in rural settings. They are enabling organizations to start working on integrating behavioral health into primary care settings, doing specialty care follow-ups, or even home-based follow-ups with patients and their caregivers to assure coordination of care after discharge and possibly prevent unnecessary re-hospitalizations.

HCI: Is telemedicine technology getting better and easier to incorporate into clinicians’ workflow?

Marcin: I think that it depends. If you are a tech-savvy person, you don’t consider the technology a limiting factor. But the technology is far ahead of the rules and regulations and the way health care is reimbursed. We are not able to take a fraction of the advantage we could if the way we are paid as clinicians took account of efficiency. We are not paid to keep people healthy; we are paid to see patients in clinics. In my opinion, the biggest barrier is the lack of alignment between reimbursement and providing quality of care. We know that mobile technologies can keep people out of the hospital. You can monitor all of your diabetic or hypertension or renal failure patients a lot better with mobile health and home monitoring, but doctors and hospitals are not paid to do that.

Thomas: In the past, our telemedicine system was not integrated into the clinical workflow and thus our physicians would have to go to specific tele-enabled clinics for consultations. This required really motivated people and resulted in low usage. Our new platform allows for seamless integration into clinical workflows and results in a much more efficient process.

HCI: Do you think the shift toward value-based purchasing in healthcare will make telehealth more attractive to payers, including the federal government?

Marcin: I hope so. In health systems where the incentives are more aligned, such as the Veteran Health Administration and Kaiser, they do lots of mobile and home health. As doctors and hospitals take on more risk with capitated or managed care models, you would expect the pendulum to swing, but we still have a long way to go in terms of moving from volume to value.

Thomas: We are working on population health-oriented pilots with our eye on what we hope will happen with global responsibility for care. They involve doing patient intake and discharge more efficiently, transitions from hospital to home, as well as how we handle specialist consults in rural places, so that all providers in a medical home are on the same page about the responsibilities of the patient, primary care doctor and specialist. I think telehealth plays a role in all of those areas.

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