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Seven Ways Telemedicine is Changing Healthcare

Forbes recently published an article surrounding innovation in telemedicine and the way it is changing our nation's healthcare field. With countless problems facing the structure of healthcare itself, a Journal of Patient Safety study from 2013 shows that 210,000 to 440,000 US patients die each year from accidental practice (such as lack of quality mental healthcare) while around 600,000 patients per year die from heart disease. This “puts healthcare incompetence as the third leading cause of death in the United States,” the article states.

Telemedicine not only gives patients much more accessibility than in-person visits, but it also gives a piece of mind to patients who can easily reach a doctor with the push of a button. The article outlines seven ways in which telehealth is continuing to “change the healthcare landscape – for the better,”:

1. Building strong relationships. Online consultations allow patients to develop individual relationships with their doctors through remote accessibility. This eliminates wait times, frustration, and potentially being exposed to other airborne illnesses by visiting an office.

2. Making care more convenient. Patients never have to leave the comfort of home to consult with their doctor. This not only helps patients emotionally, but also helps financially for travel costs.

3. Makes care less complex. “Complexity is defined by the speed at which industries change and the interdependence of relationships therein,” the article says, “telemedicine reduces both.”

4. Providers are more aware. Technology applications create ways in which pop-ups and alarms can alert doctors of certain side-effects, drug information, or anything that their patient may need to know.

5. Focusing on quality and quantity. “The focus of care today appears to be more towards earning a profit rather than serving its purpose of patient care,” the article states, “the purpose of an organization is (ideally) to serve as a value differentiator to its customers because of what they (the company) stand for. Whatever a company's flavor, its purpose is defined by a certifiable element that distinguishes it from all else, and that element is what attains and retains customers and fulfills a societal need.”

6. Competence and efficiency. Regulations and legislation are put in place for telehealth companies and doctors to follow guidelines insuring that patients are being taken care of in the most efficient way possible.

7. More flexibility for doctors. Remote consultations allows the patient to be able to directly share secure information with their doctor at any point in time. This allows patients and providers to communicate freely without the hinderance of wait times.

Ø The Importance of HIPAA Security

The HIPAA Omnibus rule, which increases patient privacy protections and provides them with updated rights to their protected health information, has been enforced now for a year and has seen little adherence. An article by FierceHealthIT, reporting on security consultant Andrew Hicks of Coalfire Systems, Inc., states, “With the Office for Civil Rights [OCR] hinting that it will ramp up enforcement of HIPAA, Hicks says that one important thing covered entities and BAs can do to help with compliance is adopt a solid IT security framework, which then ties back to HIPAA and satisfies 90 percent of it.”

With forthcoming increased attention from OCR, organizations required to be compliant will want to improve their online security to protect patients from breaches that potentially expose personal information. Some organizations are confused about the Security Rule, the article finds, as well as many not having the resources to ensure compliance.

This makes having a HIPAA compliant online platform essential, ensuring patients can feel secure that their information will stay safe when interacting with a physician online

Ø ATA Practice Guidelines for Telemental Health

The American Telemedicine Association (ATA) has released guidelines for “Video-Based Online Mental Health Services” addressing clinical professional's needs to have a reference point for getting started with their own telemental practice. The ATA believes that with these guidelines, more clinicians will be able to set up quality treatment for potential patients, as well as help to further advance telemedicine itself. Below are important ATA clinical guidelines for video based online mental health services:

1. The first step to take beforet he online mental health treatment will begin is verifying both the professional and the patient's identities. Next, it is important to verify the patient's location. This is necessary in determining what laws do and do not take effect in both the professional's location and the patient's location. The next steps are to verify both parties contact information. As well to set expectations towards how much contact will be made between sessions. A clear informed consent should be done with the patient at the beginning of the online appointments.

2. “The professional shall be familiar with local in-person mental health resources should the professional exercise clinical judgment to make a referral for additional mental health or other appropriate services,” the guidelines state. This is also very useful in the case of emergencies and the ability to collaborate with local physicians if the patient is not in the professional's physical location.

3. Lastly for the clinical guidelines, the professional should be culturally aware of the patient's physical location for the purposes of treatment. This includes understanding the patient's “language, ethnicity, race, age, gender, sexual orientation, geographical location, and socioeconomic and cultural backgrounds,” the guidelines state.

A few technical guidelines from the ATA include:

1. Utilizing the appropriate video conferencing applications that ensure security, confidentiality, and are HIPAA compliant, as well as, making sure the latest antivirus software as well as firewall measures are installed on the professional's computer being used as well as the patient's when possible.

2. A plan should be made and discussed surrounding the possibility of a technology breakdown during a session. This may include the professional immediately calling the patient and if the issue cannot be resolved, continuing and finishing the session via telephone.

3. For mobile devices, the professional should ensure that the device they are using requires a passcode or similar security component in order to access the device. They should also ensure that there is a function enabled that will wipe all data off of the device should the device be stolen or lost.

Ø Telehealth Could Potentially Save Billions

Telehealth is clearly becoming the preferred healthcare method of the future. It is not only popular among potential patients, but a new study from Towers Watson finds that the implementation of telemedicine would save around $6 billion annually. According to the report, Allan Khoury, MD, senior consultant at Towers Watson says, “While this analysis highlights a maximum potential savings, even a significantly lower level of use could generate hundreds of millions of dollars in savings. Achieving this savings requires a shift in patient and physician mindsets, health plan willingness to integrate and reimburse such services, and regulatory support in all states.”

Based on findings from the Towers Watson's 2014 Health Care Changes Ahead Survey of United States employers, the following statistics were presented:

  • 37% of employers anticipate offering telehealth consultation options to employees by 2015 in place of in-person physician appointments as a cost-cutting alternative, while another 34% are considering to offer telemedicine by 2016-2017.
  • As of now, 22% of employers currently offer telemedicine-based options and programs for their employees.
  • The number of employers that will be offering telehealth options is expected to grow from 22% to 37%, making a 68% increase overall.

Continuing to grow, telemedicine itself will not only increase due to demand but also due to a direct result of lower-cost technology and the awaited support of insurance companies towards reimbursement policies. “With both insurance companies and employers encouraging its use, telemedicine is going to have a growing role in the spectrum of health care service delivery,” says Khoury, “We’re also likely to see that it’s just the tip of the iceberg. Telemedicine is just one piece of a broader telehealth spectrum that includes video, apps, kiosks, virtual visits, wearable devices and other advancements.”

Ø Statistics Show Opportunity for Telemedicine

Telemedicine is a quickly growing field, and the statistics of potential users show promising capacity for increased expansion. In a study conducted by Matthew

Gardner, MBA, MDes, and supported by the Center for Innovation at the Mayo Clinic, a random group of patients were surveyed, all of whom had recently been outpatients at the same institution. The participants, whose average age was 57.9, provided information about their willingness to try telemedicine.

The survey found that 84% of participants had a computer or smart device capable of video calls, implying that technology, while the obvious target when it comes to increasing the volume of telehealth appointments, is not the bottleneck. 75.5% of those surveyed said that they would be “not at all likely” to participate in telemedicine if their insurance did not cover the appointment. This indicates that making insurance coverage more ubiquitous is essential to increasing the number of patients serviced. The other key contributing factor was familiarity with the medium. 62% of those who had participated in a video call agreed or strongly agreed that they could receive the same quality of healthcare as a traditional in-person visit compared to only 34% who had not participated. As the population becomes more comfortable with video calling, we can expect a near doubling of comfortablity with telemedicine. It is important to note, however, that 61% of respondents who had not made a video call still believed they would be able to communicate what they needed to via secure video appointment.

The study found that, “Almost uniformly, participants who reported having to take an economic loss, or make work, pet, or child care arrangements, were more likely to also have indicated that they were very likely to accept a video appointment.” This suggests that those with busier schedules or long travel times to see a healthcare provider represent a substantial untapped market. Perhaps most intriguingly the survey noted that, “Nineteen percent of the sample (29% local, 7% non-local) indicated that their last visit to the local institution involved one provider and required no additional tests. This reflects the patient population for whom a video visit would potentially be feasible and most beneficial. Among the [subset] 41.7% were somewhat likely to accept a video invite and 31.3% were very likely. Therefore 74.4% of this subset are somewhat or very likely to accept.”

Ø Telemental Health's Opportunity in 2015

Telemedicine is a current policy topic that continues to gain momentum and Krista Drobac of the Alliance for Connected Care believes that telehealth’s window of opportunity is 2015. Through an article published by VentureBeat, she posits that four key factors have created the circumstances for regulatory change to open the window for telemed/Telemental Health

  • Consumer Demand for Access, Convenience, and Engagement”

The consumer of today’s services look to technology for fast and easy access. “According to a report from Research and Markets, the global telemedicine market, valued at $14.2 billion in 2012, will have a compound annual growth rate of 18.5 percent through 2018,” the article says. This rapidly expanding market will create the momentum required for increased telehealth support in the form of the addition of online medicinal services becoming eligible for reimbursement through Medicare.

  • Growing Emphasis on Value-based Care”

The value for both patients and care providers intrinsic in telemedicine has led to a desire to develop the market by health plans. Expect 2015 to lead to a renewed push for the increase in coverage for these services.

  • Broadband Infrastructure”

The massive increase over the last decade in reliable internet coverage for Americans has enabled telemedicine to become a viable option for the 70% of adults who have a high-speed internet connection at home.

  • Bipartisanship”
    Drobac says that she expects both sides of the aisle to support telemedicine. The advantage of constituent support combined with the desire to support something in the healthcare field make regulatory changes desirable for politicians. Its separation from the Affordable Care Act will give this change the bipartisanship it deserves.

She leaves us with this call to action: “The window is open; it would be a shame if we didn’t go through it.”

Ø Aging Population to Benefit from Telehealth

In a recent article published by MultiBriefs Exclusive, the Administration on Aging found a continual rise in the number of adults in America over 65 eventually reaching about 80 million by 2040. This record-breaking calculation for our nation begs the question: will our healthcare system be prepared to properly serve this growing aging population?

Being more likely to experience chronic health problems, diseases, and conditions, older adults require regular access to healthcare as well as routine appointments and checkups. In areas where care is sparse, this generation will look towards telehealth to receive the care they need.

With benefits such as doctors being able to monitor their patients from home in order to avoid potential hospital visits, keep a close eye on vital signs, and provide ongoing care for those who are not able to leave their bed, telemedicine can possibly not only solve but also prevent certain medical issues from occurring with older patients. As well as hold Telemental Health consultations to be able to provide therapy for patients that need the versatility of Telehealth.

The healthcare field is starting to take notice of these benefits as well as the cost benefits associated with telehealth. According to a report put out by HealthData Management, “37 percent of employers surveyed said that by 2015 they expect to offer their employees telemedicine consultations as a low-cost alternative to emergency room or physician office visits for non-emergency health issues, and another 34 percent are considering offering telemedicine for 2016 or 2017. Currently, 22 percent of employers offer such programs. The percentage of employers offering telemedicine is expected to rise from 22 percent to 37 percent, a 68 percent increase. These percentages are based on Towers Watson’s 2014 Health Care Changes Ahead Survey of U.S. employers with at least 1,000 employees.”

Ø Three Key Ideas for Getting Started in Telemedicine

The medical field has always utilized the highest levels of cutting-edge technology in order to achieve ground-breaking discoveries and results for both patient

s and researchers in health care. The question is, why does technology not widely play a role in the way doctors and patients interact? Entrepreneur recently published an article addressing how to seize these technological opportunities to not only better our health care system, but also improve the quantity and quality of patient care.

“According to the World Market for Telehealth (2014) report, the number of patients using telehealth services will rise from less than 350,000 people in 2013 to 7 million in 2018. Furthermore, revenue for telehealth devices and services is expected to reach $4.5 billion, up from $440.6 million in 2013,” the article says. These numbers show an immense opportunity to seize space in the growing telemedicine field. Here are three key fundamental ideas to keep in mind when getting involved in telehealth is being considered:

  • It is important to keep up-to-date with your local health regulations while also keeping up with national health regulation and legislation. “If your business operates across multiple states, you need to take into consideration both federal and state-level regulations,” the article says, “it is especially important for telehealth companies to analyze the laws and regulations regarding the use of the Internet, email and related technologies in the treatment of patients.”
  • Educate not only yourself, but potential patients as well. Telemedicine is just making its way into mainstream news and media so many patients may not yet be aware of just how convenient and budget-friendly it can be. “To build brand awareness,” the article says, “be systematic in a scalable way. When considering expansion, make sure there is demand for the business by examining population density, wellness and health index, average age, income levels and family size.”
  • Build and create relationships with your peers in the medical field. “In addition to gaining the trust of consumers, it's important to assemble a team of the best and brightest minds,” the article says, “the healthcare industry is extremely small, so never undervalue taking 15 minutes of your time to network with others and offer your valuable insight to any conversation. People will take notice and want to work with you. Pay it forward. Pass along your knowledge to other entrepreneurs in your community and beyond.”

Ø Insight into Teleneurology and the Evolution of Telehealth

Healthcare Informatics recently published an interview with Miles E. Drake, M.D., a retired professor of Psychology and Neurology at Ohio State University, focusing on his experiences and opinions regarding the future of telehealth and telepsychiatry. During his time at Duke University Medical Center, Drake utilized telehealth to provide medical consultations with Ohio state prisoners and participated in numerous medical education programs with the Ohio Medical Education Network surrounding telehealth.

When asked about the opportunities afforded by telemedicine, Drake outlined the ease of technology as a promising point. “Most things about medical practice tend to get more expensive and more complicated as we develop new technologies and train new people to do them,” says Drake, “with video and computer-assisted exchange of information, this technology is getting cheaper and easier to use. There is not much in the American health system that is getting cheaper and simpler to use than it used to be.”

Focusing on neurology, Drake's experiences with telehealth and the data he has gathered shows, “...psychiatry and mental health may actually be more effective and more efficient. Both of those are promising areas because much of the diagnostic process centers upon what the patient says, how they are describing their symptoms,” he says.

The continual evolution of telemedicine and teleneurology looks to be promising. Along with factors such as cut costs, flexibility, and availability, Drake says, “It will allow medical specialist consultation, neurological and otherwise, to be done where there isn’t always a specialist and where there is only occasionally a patient that needs those services. We may be able to get by with fewer specialists and still not have a deleterious effect on patient care. Likewise, we may be able to give the patient in the small, rural community the same kind of study and interpretation as he would get at a major teaching hospital some distance away.”

Ø Congress Focuses on Telehealth and the Medicare Parity Act

In an article published yesterday from mHealthNews, Congress is put in the spotlight for the recent efforts made to push telehealth forward. ML Strategies recently put out a report, “Telehealth and Health IT Policy: Considerations for Stakeholders”, that outlined key information and statistics regarding the ongoing telemedicine landscape in Washington. The report shows 46 telehealth-related bills introduced from 2013 to 2014 as well as continuing discussions and hearings to keep telemedicine a current topic amongst legislators.

The report also estimates the number of patients using telemedicine to jump from 350,000 in 2013 to almost 7 million in 2018, also outlining that 75% of the 100 million telehealth virtual appointments anticipated this year will be held in the United States. With so many recent breakthroughs there also comes hurdles along the way. While each state gets to decide on legislation regarding Medicaid reimbursement for telehealth services, Medicare reimbursement is still restricted under federal law. “This could be a timely moment for telehealth providers to make their voice heard in Congress,” the report says, “and develop policies that will allow the broader deployment of telemedicine.”

Last covered in March, parity law has certainly gained new ground in Washington during recent months. One bill that is doing just this called the Medicare Telehealth Parity Act of 2014 was recently introduced this summer by Representatives Mike Thompson and Gregg Harper. “As proposed, the bill would expand the use of Medicare-reimbursed video conferencing and store-and-forward technologies in rural health clinics and health centers. The use of remote patient monitoring for diabetes, congestive heart failure and chronic obstructive pulmonary disease would be included, as well as video conferencing for home health services and agencies, durable medical equipment, home dialysis and hospice services,” mHealthNews reports in a recent article, “In addition, the bill would expand services covered under Medicare to those provided by physical therapists, certified diabetes educators, speech language therapists, audiologists, respiratory therapists and occupational therapists.”

Jonthan Linkous, Chief Executive Officer of the American Telemedicine Association, says in a quote regarding the bill, "We fully support this effort to improve healthcare access and affordability using telecommunications technology. These cost-saving provisions are critical to improve telehealth coverage and extend care to millions of Americans.”