Archive for the ‘Telehealth & Telemedicine’ Category

Infographic: Is the Average Patient Ready for Telehealth?

October 15th, 2014 by Melanie Matthews

The telehealth industry is poised for significant growth, with some 350,000 users today expected to grow to 7 million by the year 2018, according to a new infographic by iTriage.

The iTriage infographic looks at who's likely to use telehealth -- by gender and by age group; the average cost for a telehealth visit and some predictions for the future of telehealth.

Are Patients Ready for Telehealth

Creating a Virtual Multi-Specialty Physician Network: A Payor-Provider Telehealth CollaborativeA collaboration between Adventist Health and Blue Shield of California is improving access to specialist care and reducing inefficiencies through virtual telehealth visits. The nine-site program, which launched in March and includes 13 specialties, will expand to an additional 16 sites by the end of this year.

During Creating a Virtual Multi-Specialty Physician Network: A Payor-Provider Telehealth Collaborative, an October 15th webinar at 1:00 p.m. Eastern, Robert Marchuk, vice president of ancillary services, Adventist Health, Christine Martin, director of operations, Adventist Health, and Lisa Williams, senior director of strategic integration and execution, healthcare quality and affordability, Blue Shield of California, will share the inside details on the collaboration and the shared mission and values of the organizations that is leading to the program's success.

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Yale Online Forum Helps Teens with Diabetes “Not Look Like a Jerk”

August 14th, 2014 by Cheryl Miller

Being a teenager is hard enough; when it’s complicated by a chronic disease like type 1 diabetes, it’s even harder.

Enter telehealth, in the form of a monitored discussion board for teens with the disease.

Margaret Grey, DrPH, RN, FAAN, Dean and Annie Goodrich Professor at the Yale School of Nursing, has spent the majority of her career helping patients and families manage chronic conditions, and helping kids — teenagers in particular — manage their diabetes through their teen years so they can reduce their risk of long-term complications.

“I’ve been studying these kids for 30 years,” says the pediatric nurse practitioner, who, prior to assuming the deanship in 2005, served as associate dean for scholarly affairs and was the founding director of the school's doctoral program and the NIH-funded Center for Self and Family Management and a related pre- and post-doctoral training program. “Kids have black and white thinking — and have to manage how to 'not look like a jerk' by being given the skills to manage their disease, to think about it in a different way.”

Grey and other researchers conducted several clinical trials: an advanced diabetic education project and a life skills program, which showed that teens with diabetes' overall health and quality of life were better after going through both programs. Results showed that intensive therapy and better metabolic control reduced the incidence and progression of microvascular and neuropathic complications from diabetes from 27 percent to 76 percent.

But how to maintain those results? According to researchers, "Metabolic control tends to deteriorate as a combined result of insulin resistance that accompanies the hormonal changes of adolescence and lower adherence to the treatment regimen often associated with the desire for autonomy.”

“So we took those interventions and developed an online program kids could do at their leisure," Grey says. It incorporated a monitored discussion board that allowed kids to communicate with others like them. Teens with diabetes overcome their fear of being stigmatized by logging onto the Web site,­ called TeenCope, ­with other teens with diabetes and engaging in self-management exercises. The online program simulates situations teenagers with diabetes might encounter by using graphic novel animations that illustrate coping skills lessons from the animated characters. “As kids transition to adolescence, they require more effort and thought,” Grey says.

Peer support is an important component of maintaining a healthy lifestyle, as adolescents face pressures such as not wanting to reveal medical equipment in a social setting, or reveal their medical conditions in a social situation.

In addition, the program will also integrate an online educational program aimed at problem-solving for teens with diabetes. Adolescence is a time when patients neglect self-monitoring, dietary recommendations, and pharmacologic treatments — not because of a lack of knowledge, but due to the decision-making difficulties characteristic of this life stage. Studies show that poor metabolic control in the teen years correlates to reduced self-management in adulthood, making adolescence a key period for developing healthy behaviors. And once teenagers can get a handle on their diabetes, they improve not only their own health, but their families’ quality of life.

“This is a way to give them the skills to think about their condition in a different way,” Grey says.

Infographic: Telehealth Benefits, Delivery and Outcomes

August 13th, 2014 by Melanie Matthews

Deficiencies in access to healthcare, combined with physician shortages is driving growth in telehealth, according to a new infographic from Excalibur Healthcare.

The infographic examines predicted physician shortages and demand over the coming years, along with how telehealth can improve care coordination and telehealth delivery models and benefits.

Telehealth Benefits, Delivery, and Outcomes

Recent market data on telehealth in general and the patient-centered medical home in particular identified remote monitoring as a key care coordination strategy for individuals with complex illnesses as well as a host of vulnerable populations.

Implementing Evidence Based Practices in Behavioral Health

2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

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Guest Post: With Rise of Remote Healthcare, Are Physicians Equipped for Engaged Patients?

August 13th, 2014 by Scott Zimmerman

More engaged patients will expect more responsive healthcare professionals.

Thanks to a proliferation of wireless health monitoring tools, healthcare providers must prepare for a new breed of patient who is more tech-savvy and engaged in the management of their own health, advises guest blogger Scott Zimmerman, president of TeleVox Software.

Is your healthcare organization ready for a new breed of patient? Individuals who want or need to play a more active part in their health, and who expect their physicians to do the same?

If it’s not, it may be time to start prepping. Think about consumers’ growing interest in smart devices, sensors and mobile apps for tracking fitness levels. IHS Technology has predicted that global market revenue for sports, fitness and activity monitors will rise by 46 percent, to $2.8 billion, from 2013 through 2019.

That trend is accompanied by employers’ trying to lower their own healthcare costs, by having employees take on higher deductibles or paying only fixed amounts for certain tests or procedures. That’s creating a consumer class more conscious of securing the best health services at the best prices. Increasing personal responsibility in this area may well have a spillover effect, motivating people to become better overall managers of their own health. We may see the same result, too, as more businesses offer wellness incentives that give employees rebates for engaging in better health practices.

Also taking on greater healthcare accountability are individuals with chronic conditions, especially those using wireless home health monitoring tools to track and even transmit EKG, sugar levels and other health statistics to their providers’ systems. IHS Technology has studied this area, too, finding that worldwide revenue for telehealth devices and services used for monitoring diseases and conditions will grow to $4.5 billion in 2018, up from $440.6 million in 2013.

What Have You Done For Me Lately?

As consumers become more savvy and more engaged participants in their healthcare, they may have increased expectations about how providers will respond to their efforts. As they become better equipped to remotely transmit healthcare data to their doctors, for example, they may naturally assume providers are equally well-equipped to provide feedback on that information in real-time—or at least something close to it.

After all, while it’s nice to have direct feedback from a wireless activity wristband on daily calorie intake, that data may be even more useful if a physician can analyze it in context with other patient data—such as information in the EMR that the individual has Type 2 diabetes and blood glucose levels recorded by a home health monitoring device. The healthcare practitioner may conclude from all these measurements that calorie intake should actually be reduced now that blood glucose control has improved, in order to avoid weight gain. It’s understandable if the patient would like to be informed of that as soon as the conclusion is reached, rather than waiting for the next scheduled appointment.

Just-in-time patient engagement, then, is the direction in which healthcare providers must move. Consider that three in ten U.S. consumers responding to TeleVox’s Healthy World Research Survey said that receiving text messages, voicemails or e-mails that provide patient care between visits would increase feelings of trust in their provider. Of those who have received such communications, 51 percent reported feeling more valued as a patient, and 34 percent reported feeling more certain about visiting that healthcare provider again.

An Eye Toward the Future

Today, tens of thousands of healthcare providers already have started down that road of between-visit engagement, with automated appointment, prescription and treatment notification and reminder systems that use the patient’s medium of choice—e-mail, text or voice. In fact, TeleVox’s survey showed that more than 35 percent of patients who don’t follow exact treatment plans said they would be more likely to adhere to directions if they received reminders from their doctors via these methods. Though the outreach is automated and one-to-many, the systems feel one-to-one, as they are personalized with the patient’s name and other details drawn from providers’ practice management systems.

Ochsner Health System in Louisiana is among healthcare providers who have successfully leveraged this technology. It deployed an automated phone campaign to 3,000-plus patients who had been ordered to have colonoscopies and upper endoscopies, but had not scheduled the exams. The phone messages even offered patients the option to book the appointment by pressing a key while on the line. Of the patients reached, close to 20 percent made the appointment.

This was a win-win for patients and providers. Colon cancer detected and treated early has a nearly 100 percent success rate. These patients told Ochsner that without the automated notification, they never would have completed the test. As for the health system, Ochsner generated more than $600,000 in revenue from conducting the exams.

Today, the industry is just scratching the surface of how it can use communications technology to help healthcare providers better engage with patients between visits. The future holds the promise for more providers to obtain more data from EMRs, sensors, wearable medical devices, and home health monitoring tools; feed this data into patient engagement systems, and use business rules to trigger just-in-time customized patient engagement communications. A worrisome remote ECG reading transmitted from a heart disease patient’s home monitoring device, for example, can drive a follow-up action such as a time-sensitive outbound call to the first available specialist.

While getting to this level might sound a little daunting, it doesn’t have to be. Providers can take on the project in stages, moving from general reminders about preventive tests to follow-up messages aimed at those with chronic conditions, before they tackle real-time or near real-time responses to data submissions generated via remote healthcare devices. For instance, daily text messages could be scheduled to go out to obese patients querying them about whether they have met their daily walking goal. Or, treatment protocol compliance reminders, such as retinal and foot exams for diabetic patients, could be scheduled at regular intervals.

All that said, I suspect most providers are looking to this future less with trepidation than with excitement. They’re in the healthcare business, after all, because they want to help people. Now, the doors are open for them to have more regular and proactive contact with their patients, as well as respond more quickly to potentially dangerous situations.

About the Author: Scott Zimmerman is a regularly published authority on utilizing technology to engage and activate patients. He also spearheads TeleVox’s Healthy World initiative, which leverages ethnographic research to uncover, understand and interpret both patient and provider points of view with the end goal of creating a healthy world, one person at a time. Healthier World promotes the idea that touching the hearts and minds of patients by engaging with them between healthcare appointments will encourage and inspire them to follow and embrace treatment plans, and that activating these positive behaviors leads to healthier lives. Zimmerman possesses 20 years of proven performance in the healthcare industry, and currently serves as the president of TeleVox Software, Inc, a high-tech engagement communications company that provides automated voice, e-mail, SMS and web solutions that activate positive patient behaviors by applying technology to deliver a human touch. www.televox.com

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

NYCHHC Telehealth Success Strategy: One Hand on Heart, the Other on Phone

July 31st, 2014 by Patricia Donovan

"We transform a conversation of chronic disease into something patients can look forward to." Susan Lehrer, RN, CDE, NYCHHC House Calls.

Guided by the philosophy, "Be real to your patients, and let them be real to you," the New York City Health and Hospitals Corporation (NYCHHC) House Calls telehealth program is as committed to participants' "life bottom line" as it is to its own program ROI.

In the House Calls telehealth program for diabetics, patients' blood sugar, blood pressure and weight are transmitted via hand-size wireless modems to a team of specially trained nurses who provide feedback and education during pleasant telephone conversations at scheduled intervals.

"We transform a conversation of chronic disease into something patients can look forward to," explained Susan Lehrer, RN, CDE, associate executive director of telehealth care management. "If they're not looking forward to the call, they won't pick up."

A digital dashboard provides the telehealth nurses with a quick view of patients' vitals and individuals who may be alerting. The telehealth technology enables immediate feedback that prevents overcorrection on the part of patients, Ms. Lehrer notes, while facilitating dramatic clinical outcomes.

The telephonic exchanges augment regular patient visits and enhanced by the nurses' use of motivational interviewing. The telephonic communications are "templated" to avoid long narratives.

"Establishing that trust with patients over the phone is essential, because information received from people they believe care about them, and from people they trust, is information that is remembered," said Ms. Lehrer. "It's information that influences behavior."

Ms. Lehrer presented some of House Calls' clinical outcomes for the 2,500 patients it has serviced since the program's inception during a July 2014 webinar, Diabetic Telehealth Monitoring: The Impact of Real-Time Data on High-Risk Patients sponsored by the Healthcare Intelligence Network.

Most House Calls participants are diabetics who spend an average of two years in the program, she explained. Of a random sampling of 769 participants, 76 percent improved their A1C almost every three months. Additionally, of patients in that sampling with A1Cs between 11 and 13, 91 percent improved A1Cs by an average of 2.9 percent.

House Calls, which has experienced a side benefit of fewer appointment cancellations on the part of participants, has been so successful the program already has been rolled out for patients with heart disease; its use for the chronic obstructive pulmonary disorder (COPD) population is being discussed.

However, Ms. Lehrer is quick to point out barriers to telehealth still exist. Physicians who treat a patient with diabetes for years without seeing any real change can develop "clinical inertia," she says, although this quickly dissipates once the doctor sees a patient engaged in House Calls.

There is also the occasional patient resistant to change, and the frustration of being unable to integrate patient data into an electronic medical record (EMR).

Still, despite the program's focus on technology and results, the nurses remind themselves that at its core, House Calls is about the person at the other end of the line.

"The staff always talks about keeping our hands on our hearts so that when we speak to people, they don’t become the numbers."

Listen to an interview with Susan Lehrer here.

Replicating Home Care Telehealth for Non-Homebound Curbs Readmissions

July 15th, 2014 by Patricia Donovan

Community Health Network considers it a failure of the system if a patient with chronic illness has to go to the hospital. Deborah Lyons, Community Health Network's disease management executive director, describes how the integration of telehealth into care of heart failure patients is helping to keep hospital readmission rates down for this population.

It’s all part of Community’s network strategy. That’s really a failure of the system if a patient has to go to the hospital—at least for those with chronic diseases. Our strategy has been to keep patients out of the hospital regardless of disease type. We want to keep patients out of the hospital.

As part of an integrated strategy, we’ve used our experts in home care to do high-risk home visits rather than creating a siloed entity to do this. Home care was doing telehealth for their homebound patients in home care, and we didn’t want to recreate this functionality. We chose to work with our home care telehealth experts and expand this to the non-homebound population.

This network strategy helps us to better manage the health of patients by looking at what expertise exists and then expanding it to meet the population needs.

When we first started developing the strategy, we also started with heart failure originally because we have a lot of heart failure patients and an issue with readmissions.

When we looked at the heart failure patients, we found that first, about 43 percent of our patients that were readmitted were patients that were discharged home to self-care, meaning they didn’t qualify for traditional home care. They weren’t going into a facility. These were people that were going home alone. And this group was driving 43 percent of our readmissions.

When we looked at what was occurring in our own network, we also found that our home care agency was doing telehealth with their home care patients and had a national best readmission rate. We asked ourselves how we could replicate this for our non-homebound patients. There are experts there that are getting great results. Now we want to apply this to our non-homebound population. And that’s where we decided to do this with IVR, the automated telephonic system that calls the patients at home.

Excerpted from: New Horizons in Healthcare Home Visits

Infographic: Healthcare Embraces the Cloud

June 27th, 2014 by Jackie Lyons

Eighty-three percent of healthcare organizations use cloud services. The top reasons healthcare organizations adopt cloud services is a reduction in maintenance costs, increased speed of deployment and addressing staffing challenges, according to a new infographic from HIMSS.

This infographic also identifies the challenges, barriers and successes healthcare organizations are having with cloud services.

Remote monitoring is another crucial healthcare technology utilized by organizations to obtain patient information and reduce costs. 2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

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Infographic: Public Opinion of the Affordable Care Act

June 20th, 2014 by Jackie Lyons

Nearly 60 percent of individuals want Congress to improve the Affordable Care Act (ACA) rather than repeal it, according to a new infographic produced by the Journal of the American Medical Association.

This infographic also illustrates the barriers to obtaining health insurance, and the effects of the ACA since its rollout in 2010.

Want to know more about healthcare trends and effects of reform? Plunkett's Health Care Industry Almanac 2014 provides a complete market research report, including forecasts and market estimates, technologies analysis and developments at innovative firms. This resource provides vital insights into how the healthcare industry is evolving and effects of healthcare reform.

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Infographic: Healthcare in the Cloud

June 9th, 2014 by Jackie Lyons

Security, agility and accessibility are among the top healthcare benefits of cloud computing. Furthermore, cloud storage could potentially reduce health IT costs by $11 billion, according to a new infographic from MBAHealthcareManagement.org.

This infographic also identifies the three types of cloud computing, additional benefits of cloud storage, types of information that can be stored in the 'cloud,' and more.

Remote monitoring is another crucial healthcare technology utilized by organizations to obtain patient information and reduce costs. 2014 Healthcare Benchmarks: Remote Patient Monitoring delivers a comprehensive set of metrics from more than 100 healthcare organizations on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

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Remote Care Management Improvements As Close As Telephone

June 3rd, 2014 by Patricia Donovan

Telephonic care management leads the list of remote patient monitoring strategies.

Remote patient monitoring in all its embodiments is here to stay, as results from our 2014 survey validate, with everything from interactive voice response (IVR) to video visits to home sensors driving results in population health management, particularly for the frail elderly.

Even CMS shows signs of softening its stance toward telemedicine. A key provision of a May 2014 rule issued by the Centers for Medicare and Medicaid services removed some barriers surrounding the umbrella issue of telehealth. In particular, this rule reduced the burden on very small critical access hospitals, rural health clinics and federally qualified health centers (FQHCs) by no longer holding physicians hostage to a prescriptive onsite schedule. This provision addresses the geographic barriers and remoteness of many rural facilities, and recognizes telemedicine improvements and expansions that allow physicians to provide many types of care at lower costs, while maintaining high-quality care.

More of these concessions are likely to come as the industry embraces value-based care and the market for devices to track home-based biometrics and activity continues to explode.

But sometimes, it's not the clinical emergency averted by the use of remote monitoring but the assurance provided by a simple phone call. Analytics by naviHealth, a convener in the CMS Bundled Payments pilot, identified healthcare utilization patterns by the elderly that might benefit from telephonic care management.

“Often we found that some of our beneficiaries re-admit [to the hospital] because they simply want social interaction with someone else. A telephone call can sometimes be gratifying enough for that beneficiary so that they’re not seeking social engagement back at the hospital again,” notes Kelsey Mellard, vice president of partnership marketing and policy with naviHealth.

“If you think about how you target your population, you have high risk, low risk and maybe medium risk, depending on your analytics and clinical team. This is not rocket science,” Ms. Mellard continues. “It is a lot of work. It’s a lot of use of analytics against a target, but once you’ve identified that target population, it’s a question of how to turn up the engagement or turn down the engagement based on where that patient is. "

"It can be very simple telephonic care management in the form of brief conversations,” she concludes.

Excerpted from 2014 Healthcare Benchmarks: Remote Patient Monitoring