April 2017

Wireless World: Telehealth — Betting the Minimum or All In?
By Daniel Theobald and Amanda Baldi
For The Record
Vol. 29 No. 4 P. 30

Telehealth is gaining momentum. Patients prefer it, physicians need it, the market demands it, insurers reimburse for it, and the technology is proven and ready to scale. Typically, telehealth adoption is driven by physicians with a finite amount of time who view the solution as a way to either see more patients or to see patients in treatment when needed, not when dictated by rounding schedules.

However, as effective as these remote care consultations can be, health care organizations are not yet fully on board. As a result, they're failing to take advantage of the technology's financial benefits. Leaders at health care systems must support end users and scale up their telehealth programs to start deriving value for the entire organization.

Extending Physician Reach
Reports indicate a shortfall of 130,600 physicians by 2025, a development that would intensify the shortage of specialists and health care facilities in rural areas. Physicians will need to build in travel time for clinical or surgical rotations for the catchment areas of health care systems that are often spread out over large geographic areas.

Telepresence solutions have a positive impact in emergency departments (EDs) and ICUs, where specialists are often required on short notice. For example, physicians at Vanderbilt University Medical Center (VUMC) in Nashville can remotely monitor a patient with sepsis at a small community hospital via teleICU and order a timely treatment, preventing further clinical deterioration and avoiding a transfer to VUMC. A virtual intensivist uses a VGo, a small mobile robot that provides two-way audiovisual communication, at the patient's bedside to discuss care plans with the nurse and family, while placing orders into the partner hospital's EMR to facilitate immediate care.

Working in Elder Care
The squeeze on clinical resources can be attributed in part to demographic trends. An aging population is creating a larger number of high-acuity, high-risk patients with a high incidence of chronic diseases who require more frequent attention from specialists.

The University of Cincinnati College of Nursing is using telepresence robots at its partner retirement communities and skilled nursing facilities to address the care needs of a changing demographic. Initial results indicate more resident-reported "well days" per month. Thus, the standard of care can be maintained without in-person visits, allowing the organization to be more efficient with its limited resources.

Improving Outcomes
One of the most important benefits of telehealth is its ability to lower costs by reducing hospitalizations, readmissions, and lengths of stay. Because approximately 100 million Americans with chronic disease account for 75% of all health care expenditures, better management of these conditions can lead to significant financial savings.

El Camino Hospital in Mountain View, California, has implemented the VGo as part of its telehealth initiative to improve quality of care and patient experiences. In an effort to reduce readmissions, patients take a VGo with them when they are discharged. The VGo then connects patients in the nursing home with their physician.

Making the Most of Reimbursements
The Centers for Medicare & Medicaid Services has created a structure to guide the adoption of telehealth. Forty-eight states and Washington, D.C. provide reimbursement for some form of live video in Medicaid fee-for-service; more than one-third of these reimburse for remote patient monitoring.

While many of these states still have restrictions on telehealth reimbursement policies, such as patient setting, origination site, technology type, geography, and provider type, the stage is set for greater adoption of telehealth services, especially in the private sector. Private insurers are actually promoting their telemedicine services and using the technology as a competitive advantage.

Patient Satisfaction
Providers already using telehealth are discovering that the technology can improve patient satisfaction. For example, at Children's Specialized Hospital in New Jersey, parents use VGo to virtually visit their children at any time during their stay.

Physicians also gain critical access—at any time and from anywhere—ensuring continuity of care for children with complex conditions. As a result, patient satisfaction and the standard of care have improved, while overall costs, including those associated with readmissions, have been reduced. Not only is this significant for reimbursements related to patient satisfaction, which account for more than 30% of a hospital's total, but it also provides a competitive advantage.

Best Practices in Implementing Telehealth
Patients and physicians are ready for telehealth, and improved outcomes are being realized by health care facilities around the country. So what's holding health care leaders back from mass adoption of telehealth solutions?

As with any new technology, the most important thing may be simply to get started. The following are eight best practices that can help lower barriers to taking that first step:

• Start small. Choose an area that will have the biggest impact, and then scale to other areas of the practice. Identify the biggest areas of constrained resources, with the largest proponents of live video consult. Application areas may include video rounding for traveling physicians or remote specialists, rural hospital consultations, skilled nursing care, and rapid second opinions in the ICU or ED.

• Identify critical features. Find a simple and affordable solution that offers the ability for physicians to move around, zoom in, and snap photos that can be uploaded to a patient's health record. Some telepresence solutions are also equipped with a USB port for high-powered cameras for remote dermatological or wound care consultations. This solution should allow a physician to log in without requiring a resource at the other end to receive the call.

• Account for all costs. To ensure the best return on investment, ensure that the solution includes the cost of the device, subscriptions, warranties, and support. This will prevent any future surprises.

• Make good on reimbursements. Start with a small application covered by reimbursements, and then use that income to scale up and purchase additional devices or licenses.

• Minimize reliance on IT staff. Reduce the workload for the IT department by using an encrypted solution that connects over preexisting Wi-Fi networks.

• Turn clinical early adopters into solution champions. The key here is making sure the solution is easy to learn, easy to use, and device agnostic. Once those features are secured, physicians who are already using telehealth technologies will be your best advocates for scaling up the telehealth program.

• Increase patient adoption through marketing. Studies indicate that public awareness of telehealth technologies may lag behind availability. A return on investment can be achieved only if the technology is used and accepted by physicians and patients. As is often the case with patient self-service solutions, any technology that's used for patient-facing communication must be well marketed. Use digital signage in waiting rooms, e-mails, and patient portals to educate patients about telehealth.

• Appoint a telehealth expert. To take their telehealth programs to scale, some early adopters are creating a position for a telehealth expert and advocate. By committing a resource to coordinating telehealth services, an organization is making a value statement and demonstrating to patients and physicians that it's serious about supporting improved patient satisfaction, reducing physician fatigue, and improving outcomes.

The Winning Hand: Compassionate Care
The methods by which organizations engage with HIT infrastructures are still being refined. Nevertheless, telehealth is one way to use HIT to improve the patient-provider relationship.

While the value of telehealth can be quantified by patient satisfaction scores, competitive edge, reimbursement, and improved outcomes, there are human factors at play as well. Scaling up the adoption of telehealth can build trust between patients and providers, reduce clinician burnout, and make health care a little bit more human. Call it care and compassion on the go.

— Daniel Theobald is chief innovation officer at Vecna.

— Amanda Baldi is director of marketing at Vecna.