By Eric Wicklund

Created 2011-08-18 10:48

From the July/August issue
of Government Health IT.When the Ford Motor Company announced plans in mid-May to partner with at
least three companies to develop healthcare apps for the company’s car-based
platform, telemedicine experts around the country offered a hesitant smile.
Could this be the big break they’ve been waiting for?Could telemedicine finally gain mainstream attention?Long thought to be stuck in the realm of academic medical universities and
small-scale pilot projects, telemedicine – and telehealth, and mHealth, and all
the other names being used for this wide-ranging healthcare field – may be
turning a corner, thanks to some high-profile implementations.

Everybody’s Talking

Telehealth has become a favorite topic of conversation for, among others, the
nation’s chief technology officer, Aneesh Chopra, who spoke at last year’s
American Telemedicine Association (ATA) conference. This year, ATA’s 16th
international meeting and exposition, held May 1-3 in Tampa, Fla., drew close to
5,000 attendees, placing it among the top 10 healthcare-related conferences in
the nation. And telehealth has attracted the attention of the Centers for
Medicare & Medicaid Services (CMS), which recently relaxed its rules on
credentialing to allow hospitals to engage in telemedicine-based consults with
physicians in other parts of the country.

“CMS’ new rules will truly help patients receive the care they need, no
matter where they live or where their doctor is located,” said Dale Alverson,
MD, former ATA president and medical director of the Center for Telehealth and
Cybermedicine Research at the University of New Mexico’s Health Sciences Center.
“By eliminating the overly-burdensome credentialing and privileging rules in
Medicare, CMS has shown its growing support of telemedicine.”

The CMS ruling is expected to boost a program overseen by the Department of
Health and Human Services’ Health Resources and Service Administration, which
has awarded grants to the Federation of State Medical Boards to help states set
criteria to allow physicians to practice across state lines. According to an
HRSA report issued to Congress, cross-state licensing “is seen as one element in
the panoply of strategies needed to improve access to quality care services
through the deployment of telehealth and other electronic practice strategies.”
To date, eight states have established licensing criteria.

Add to that separate projects by UPMC, Kaiser Permanente, the Mayo Clinic,
the University of Miami and the Ford announcement (Toyota and GM are expected to
announce similar projects soon), and telemedicine may finally be finding the
spotlight.
Maybe.

Missing: Monetary Incentive

Ironically, while the ATA was trumpeting CMS’ decision, a panel discussion at
the May conference was taking the federal government to task for not including
telemedicine or telehealth in the meaningful use program – thus depriving
healthcare providers of valuable financial incentives contained in the HITECH
Act.

There’s “no real inclusion for telemedicine and telehealth” in the incentives
designated by the American Recovery and Reinvestment Act for adoption of
healthcare IT, said Neal Neuberger, executive director of the Institute for
e-Health Policy and president of Health Tech Strategies.

Neuberger called on the Office of the National Coordinator for Health IT
(ONC), headed by Farzad Mostashari, MD, to set the stage for increased
acceptance of telemedicine.

“I think we need a grand vision that takes the long view as far as
transforming healthcare outcomes, quality, efficiency, cost, and access,” he
said.

To be fair, the HITECH Act did include some consideration for telemedicine in
the Beacon Community Program. According to Yael Harris, director of the HRSA’s
Office of Health IT and Quality, four community-based collaboratives in San
Diego, Indiana, Utah and North Carolina, have received funding to incorporate
telemedicine technology into programs.

The question of cost – not only of paying for telemedicine projects, but
finding the reimbursement value – continues to plague the industry. Some
vendors, like Arizona’s Stat Health, are targeting businesses with an online
doctor service in hopes of convincing them that paying a telemedicine fee will
reduce employee health insurance and lost productivity costs over the long run.
Others are exploring “pay-per-consult” plans, in which physicians set a price
for their services, whether they’re delivered online, by text message, or in
person.

Care Without Technological Borders

Telemedicine might be the next version of the electronic health record. In a
nation moving toward accountable care and outcomes-based reimbursement, the
pressure may be on the providers to adopt telemedicine, Joseph Kvedar, of the
Massachusetts-based Partners HealthCare System and director of the Center for
Connected Health, told attendees at the “Health IT: Improving Healthcare and the
Economy” conference, held May 10 in Worcester, Mass.

“There are ways to look globally at economics around this,” he said. “One is,
as we prepare for a world where we’re paid for outcomes and quality, it will be
up to us to interact with patients in whatever way we think will add the most
value. That could be via e-mail, or via Skype. It doesn’t have to be in the
office.”

The issue isn’t specific to the United States. European healthcare leaders at
the recent eHealth Week 2011 conference in Budapest, Hungary, urged government
leaders to invest in telemedicine even as they wondered where the ROI would be
found.

“Telemedicine is part of a complex healthcare process with different actors,
factors and devices,” said Francisca Garcia Lizana, policy officer at Spain’s DG
Infso and a spokesperson for the European Commission. “The change of any
parameter in the process affects the total outcome. It is therefore difficult to
measure the benefits of telemedicine on its own.”

World leaders need to “evaluate the process and not the technology,” she
said. “We need more research but we should learn from the past and not repeat
the same mistakes.”

More Than Physician-to-Patient

Kaveh Safavi, vice president and global leader for Cisco’s healthcare
business, sees an immediate benefit to telehealth in linking physicians to each
other to foster better collaboration and problem-solving, rather than linking
patients to the physicians. And at a time when reimbursement for telemedicine
services is murky, the effort to gain physician buy-in may be better served by
focusing on the improvement in clinical outcomes through access to
resources.

While Cisco is advancing the telemedicine platform on the West Coast, working
with Kaiser Permanente and other providers, UPMC is taking the reins on the East
Coast. The Pittsburgh-based healthcare network recently announced a partnership
with Alcatel-Lucent to create a virtual “exam room” linking real-time audio and
video communications with mobile devices.

“The challenge involved in creating this next-generation telemedicine system
is designing a true multi-point communication platform that allows everyone
involved in the medical case to securely view the same data and medical records
at the same time regardless of the communication device used,” said Sid Ahuja,
vice president of Alcatel-Lucent Ventures/Bell Labs, who will co-manage the
initiative. “With cloud-based technologies, services and software
applications are delivered from the Internet rather than a dedicated enterprise
network in a single location, enabling a new level of medical collaboration and
information sharing via secure real-time audio, video, and data links.”

The Department of Veterans Affairs, which cares for more than 43,000
servicemen and –women through its home telehealth program, is also taking a step
forward. In April, the VA awarded contracts to six vendors: Authentidate,
American Telecare, cardiocom, HealthHero Network, Visual Telecommunication
Network/ViTelCare and Viterion TeleHealthcare. The contracts run between $150
million and $372 million and could cumulatively total $1.38 billion if all the
contracts are renewed for the full five years.

Remarkable Implications

Meanwhile, surveys continue to paint a rosy picture for the future of
telemedicine.

Recently, Manhattan Research reported that 7 percent of physicians in a
recent study (2,041 U.S.-based physicians answered the call) use online video
conferencing to communicate with patients.

“Telemedicine has the potential to open up consultations with top
specialists, regardless of your location,” said Meredith Ressi, Manhattan’s
president. “Combined with the impending shortage of primary care physicians, the
implications of these technologies for how healthcare is delivered in our
country are remarkable.”

In addition, a recent study conducted by the University of Massachusetts
Medical School in Worcester, Mass., and reported in the Journal of the American
Medical Association reported that intensive care units that implemented a
telemedicine program saw lower mortality rates, lower rates of preventable
complications, and shorter hospital and ICU stays.

So while the Ford announcement is certain to spur a new round of mobile
healthcare interest, only time will tell if it makes any headway on the
long-standing issue of federal support.

Sidebar: The 4 Pillars of Telemedicine

Telemedicine’s potential to improve care delivery and outcomes stands to
benefit doctors and patients alike. The advantages have been called remarkable,
and a number of requisite technologies are already in place. Questions linger,
however, most notably about funding and incentives. Nonetheless, the push to
make telemedicine a part of accepted mainstream healthcare seems to focus on
four areas:

(1)    Chronic disease management – With diabetes,
high blood pressure and heart disease (among many conditions) on the increase,
the ability to monitor people in their homes – or anywhere outside the doctor’s
office or hospital – is seen as an important step in reducing unnecessary
healthcare costs.
(2)    Wellness/preventive health – Health plans are
pushing telehealth resources on such issues as smoking cessation, exercise and
weight loss programs, while psychiatrists, schools and prisons are all exploring
the benefits of remote consults.
(3)    Replacing the ER trip or
non-acute visit to the doctor’s office – Hospital emergency rooms are closing
down, and those left open are often overcrowded. Providing online contact
between a physician and a patient is seen as a way of reducing unnecessary trips
to the ER, as well as giving busy families an easy alternative to the
time-consuming trip to the doctor.
(4)    Emergency care – Accident
victims, as well as those suffering a stroke or heart attack, need quick access
to healthcare. Giving physicians a means to diagnose a patient in the field –
either through a video connection or by receiving vital signs – could mean the
difference between life and death.

 Source URL: http://www.govhealthit.com/news/telehealth-heads-toward-mainstream-julyaugust-2011