Archive for the ‘Telehealth & Telemedicine’ Category

Overcoming ‘Clinical Inertia’ and 7 Other Barriers to Remote Patient Monitoring

February 26th, 2015 by Cheryl Miller

It's important to identify potential barriers from both patients and providers before implementing a telehealth program, says Susan Lehrer, RN, CDE, associate executive director of the telehealth office for the New York City Health and Hospitals Corporation (NYCHHC), because both groups need to change behaviors. Resistance to change is universal, and if you’re changing any kind of work flow or communication, there will be initial resistance.

  • Slow buy-in and some resistance by clinicians (referrals).
  • Clinicians concerned with appearance of decreased productivity.
  • Resistance to change in clinic work flow.
  • Inability to “integrate” Web site data and electronic medical records (EMRs).
  • Language and literacy.
  • Complexity of chronic disease management.
  • Lack of protocols for use of email in coordination of care.
  • Not all clinicians utilize secure email system.
  • Source: Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management

    http://hin.3dcartstores.com/Remote-Monitoring-of-High-Risk-Patients-Telehealth-Protocols-for-Chronic-Care-Management_p_5008.html

    Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation's (NYCHHC) House Calls Telehealth Program that significantly lowered patients' A1C blood glucose levels. Susan Lehrer, RN, BSN, CDE, associate executive director of the telehealth office for NYCHHC, shares key aspects of the real-time monitoring program, including how the program blends telehealth, electronic medical records, electronic communication with providers and direct communication with patients by nurse case managers, and much more.

    Infographic: Telemedicine Market Growth

    February 20th, 2015 by Melanie Matthews

    Telemedicine is one of the fastest growing sectors in healthcare, according to a new infographic by MANA. With increased pressure for healthcare cost efficiency and cost reduction, this growth is expected to accelerate.

    The MANA infographic compares the telehealth market in 2010 and expectations for 2016, along with expected growth rates for home-based and hospital-based telehealth technology.

    Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care ManagementReal-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

    Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation's (NYCHHC) House Calls Telehealth Program that significantly lowered patients' A1C blood glucose levels.

    Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

    Have an infographic you'd like featured on our site? Click here for submission guidelines.

    6 Health Plan Trends in Remote Patient Monitoring

    February 12th, 2015 by Patricia Donovan

    CHF and COPD are the health conditions most frequently targeted by health plan remote monitoring programs.

    Frequent emergency room users, individuals with chronic comorbidities and members recently discharged from the hospital are the populations most often monitored remotely by health plans, according to 2014 market data.

    Payors comprised 16 percent of respondents to the Healthcare Intelligence Network's 2014 survey on remote patient monitoring.

    The survey identified the following payor trends in remote care management:

    • Forty percent of health plans said they had a remote monitoring program in place, versus a high of 64 percent for case management and a low of 24 percent for hospital/health systems.
    • Health plans principally rely on case management assessments to identify remote monitoring candidates (80 percent) a fraction more than case management organizations themselves (78 percent). They were also most likely to depend upon direct member/patient referrals—a high of 44 percent versus a low of 0 percent for health plans and a median of 25 percent for hospital/health systems.
    • Health plans were most likely to monitor frequent hospital/ER utilizers remotely (100 percent) versus a low of 55 percent for case management and a median of 75 percent for hospital/health systems. They were also most likely to monitor those patients recently discharged (80 percent) versus a low of 44 percent for case management and a median of 50 percent for hospital/health systems.
    • Of the top five chronic diseases monitored by remote technologies (CHF, COPD, asthma, hypertension, and stroke), health plans were most likely to monitor CHF (100 percent versus a low of 25 percent for hospital/health systems and a median of 89 percent for case management); COPD (100 percent versus a low of 50 percent for hospital/health systems and a median of 67 percent for case management); and asthma (80 percent versus a low of 44 percent for case management and a median of 50 percent for hospital/health systems.
    • In terms of payor challenges associated with remote monitoring, patient education was a strong concern (60 percent) versus a low of 25 percent for hospitals/health systems and a median of 56 percent for case management, as was reliability of self-reported data (60 percent) versus a low of 25 percent for hospitals/health systems and a median of 44 percent for case management.
    • Across the board, all three sectors (100 percent) said telephonic case management was key to remote monitoring.

    Source: 2014 Healthcare Benchmarks: Remote Patient Monitoring

    Infographic: Telehealth Index

    January 28th, 2015 by Melanie Matthews

    Sixty-four percent of Americans would be willing to have a physician visit over a video platform, according to a new survey conducted by Harris on behalf of American Well.

    An infographic by American Well drills down into the survey results, including details on consumer perceptions of telehealth.

    Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care ManagementReal-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

    Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation's (NYCHHC) House Calls Telehealth Program that significantly lowered patients' A1C blood glucose levels.

    Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

    Have an infographic you'd like featured on our site? Click here for submission guidelines.

    14 Protocols to Enhance Healthcare Home Visits

    January 20th, 2015 by Cheryl Miller

    Use of telemonitoring equipment, electronic medical records (EMRs), a staff dedicated to monitoring home visits and engaged caregivers are just some of the protocols used to enhance home visits, according to 155 respondents to the Healthcare Intelligence Network’s most recent industry survey on home visits.

    Following are 10 more protocols used to improve the home visit process:

    • Inclusion of home visiting physician in hospital rounds; and the collaboration of home visit physician with primary care physician (PCP) and complex case managers.
    • Using our medication management machines with skilled nursing follow-up to increase medication compliance.
    • Proactive phone calls to determine if a patient's condition is worsening and in need of home visits.
    • Daily workflow management algorithms with prioritization and mobile access to electronic case management records.
    • Using teach-back to assure comprehension.
    • Easy to use/wear multimodal, advanced diagnostics telemonitoring allowing patients total mobility and continuous real-time monitoring.
    • Medication reconciliation is crucial in eliminating confusion for the patient, and our electronic medical record (EMR) accurately reflects what the patient is taking, including over-the-counter (OTC) and supplements.
    • Hospital coach gathers information and prepares the patient for discharge, coordinates with home visit staff, home visit team (coach and mobile physician) and completes home visit.
    • Portable EMR to document and review medical information on the spot.
    • EHR-generated lists, community-based team, community Web-based tracking tool, telehome monitoring devices, preferred provider network with skilled nursing facility/long-term acute care (SNF/LTAC), home health and infusion therapy.

    Source: 2013 Healthcare Benchmarks: Home Visits

    http://hin.3dcartstores.com/2013-Healthcare-Benchmarks-Home-Visits_p_4713.html

    2013 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from the populations visited to top health tasks performed in the home to results and ROI from home interventions.

    Remote Diabetes Monitoring: Magic is in the Phone Call, Not the Technology

    January 8th, 2015 by Patricia Donovan

    Using a blend of telehealth, access to electronic medical records, electronic communication with providers and direct communication with patients, nurse care managers with the New York City Health and Hospitals Corporation's (NYCHHC) House Calls Telehealth Program significantly improved patient clinical outcomes and impacted healthcare costs for enrollees with diabetes. Here, Susan Lehrer, RN, BSN, CDE, associate executive director of the telehealth office for NYCHHC, shares some lessons learned from the eight-year-old program.

    We can achieve really significant clinical and financial outcomes with available simple technology. I want to say 'simple' because this is not rocket science. It’s a glucometer that transmits over a modem, a blood pressure cuff that transmits the information of blood pressure via Bluetooth® to us that we see on a Web site within seconds.

    That information is the first step, but providing the case management and communication back to providers is where the magic happens. Conducting effective patient interactions utilizing motivational interviewing can be done over the phone. We were all disbelievers in the beginning. “How can I do the same thing that I did face-to-face over the phone?” we asked ourselves.

    You can’t do the same thing, but over time, you can achieve the same outcomes, as long as you have providers seeing the patients and patients keeping their appointments.

    Technology enables us to give the feedback at the moment that the patient needs it. If somebody’s blood sugar is 58, and they don’t feel very well, calling them at that moment, which we do every day, prevents them from overcorrecting. Eventually, they learn how to treat their hypoglycemia. Giving that immediate feedback to a patient is where the dramatic clinical outcomes occur. Patients can learn self-management with very targeted interventions and support.

    To recap, it’s not about the technology, because the data comes to us every day, but it’s the magic that happens in the phone call back to the patient.

    remote diabetes management
    Susan Lehrer RN, BSN, CDE is the Associate Executive Director for the House Calls Telehealth program for the New York City Health and Hospitals Corporation. Ms. Lehrer joined HHC in 2006 to design and implement the Telehealth program to provide expert care management for Diabetics with poor control.

    Source: Diabetic Telehealth Monitoring: The Impact of Real-Time Data on High-Risk Patients (webinar available for replay)

    The Year in Healthcare Intelligence: Reimbursement, Value-Based Results Resonate with Readers

    December 29th, 2014 by Patricia Donovan

    Newswise, fee-for-value healthcare initiatives eclipsed fee-for-service models.

    When survival of healthcare providers hinges on payment for services rendered, it's not surprising our 2014 readers closely tracked news of emerging payment models and results from patient-centered, quality-based initiatives.

    Here is a retrospective of stories that dominated our readers' news feeds over the last 12 months:

    • We reported on results from many accountable care organizations (ACO) over the last year, but few generated interest like the Anthem Blue Cross-Healthcare Partners accountable care collaboration that saved more than $4 million. The program succeeded by sharpening its focus to those with two or more chronic diseases—the population that research shows can most effectively be helped by coordinated care, officials state. A dedicated staff of care managers and care coordinators identify hospitalized ACO patients, coordinate transitions of care, and ensure patient care and healthcare resources are accessible.

    • Heads also turned when the Centers for Medicare and Medicaid Services (CMS) proposed updated penalties and incentives for its Medicare Shared Savings Program (MSSP), an accountable care initiative for Medicare beneficiaries. The proposed rules are designed to strengthen MSSP by placing greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. CMS is also suggesting a third ACO model," track 3," which integrates some elements from the Pioneer ACO model.

    • The patient-centered medical home (PCMH) model, a stepping stone to an ACO, garnered its share of readership, especially when the National Committee for Quality Assurance (NCQA) added five measures to its medical home criteria, the gold standard for patient-centered measurement.

      In its third iteration of PCMH standards since 2008, the NCQA added behavioral health integration and care management for high-need populations, among other new criteria.

    • The patient-centered model suffered a setback, however, when one of the first, largest, and longest-running multipayor trials of PCMHs in the United States was associated with limited improvements in quality and was not associated with reductions in use of hospital, emergency department (ED), or ambulatory care services or total costs of care over three years. Research by Rand Corporation and colleagues centered on patient-centered activities in the Southeastern Pennsylvania Chronic Care Initiative.

    • There was good news on the medical home front, however: A study published in September, 2014 attributed reductions in emergency room visits, principally by patients with chronic illness, to the PCMH approach. Research by Independence Blue Cross (Independence) and CTI Clinical Trial and Consulting Services (CTI), and published by Health Services Research, found that transitions to a medical home were associated with a 5 to 8 percent reduction in ED utilization. This finding is specific to patients with chronic illness(es) having one or more ED visits in any given year. These reductions were most evident among patients with diabetes.

    • Readers also paid attention when Geisinger Health System, an early adoptor of care coordination for chronic illness, announced that its all-or-none or “bundled” approach to primary care for patients with diabetes produced better health outcomes, and the benefits happened quickly for the more than 4,000 patients in the study. The system-wide approach was not easy, warned Geisinger: the model requires constant evaluation, and must be scalable across a variety of practice settings.

    • Also raising the bar for physician practices was Highmark, which shared six requirements for the "best practices" element of its successful pay-for-performance initiative. Physician practices can earn additional rewards for completion of an office-based best practice project, essentially a small pilot, that involves measurement and reporting.

    • On the flip side, reporting of some questionable hospital pricing strategies rated some page views as well. Data released early in 2014 by National Nurses United (NNU) and the Institute for Health and Socio-Economic Policy (IHSP) found that some U.S. hospitals charge more than 10 times their cost, or nearly $1200 for every $100 of their total costs. Public oversight or regulation seems to help constrain excessive pricing, researchers found; Maryland, probably the most regulated state in the United States, has the lowest average charges of all the states among its 10 most expensive hospitals.

    • Cost savings aside, readers seemed especially attuned to new approaches or technologies designed to streamline healthcare delivery and enhance the patient experience, such as an uptick in remote monitoring.

      One hundred percent of respondents to the Telehealth in 2013 Survey by the Healthcare Intelligence Network monitor weight and vital signs, up from a respective 79 and 77 percent in 2010. The health conditions monitored remotely remain the same from 2010, the top three being heart failure, COPD and diabetes.

    • And finally, as all eyes focus on care management interventions that span the healthcare continuum, many readers responded to a story on a CMS pilot that would give hospice patients more options in the type of care they wish to receive at the end of life. Under the Medicare Care Choices Model, individuals who meet Medicare hospice eligibility requirements could receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.

    Were these stories on your news radar in 2014? Stay up-to-date in 2015 with the latest healthcare news, trends and benchmarks with a free subscription to the Healthcare Business Weekly Update.

    11 Statistics About Remote Patient Monitoring

    December 23rd, 2014 by Cheryl Miller

    Remote monitoring of individuals with multiple chronic conditions reduced hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted disease self-management for nearly all of these monitored patients, according to the 119 respondents who participated in the Healthcare Intelligence Network's inaugural survey on Remote Patient Monitoring in March 2014. Other targets of a remote monitoring strategy included frequent utilizers of hospitals and emergency rooms (ERs) (62 percent) and the recently discharged (52 percent).

    Following are seven more statistics from the Remote Patient Monitoring survey:

    • Fifty percent of respondents rely on specific diagnoses sets to identify candidates for remote monitoring.
    • More than a quarter of respondents (27 percent) target the frail and/or home-bound with remote monitoring programs.
    • Reimbursement for remote monitoring, followed by the education of patients in this technology, were identified by respondents as the chief challenges of these remote care management efforts.
    • Two-thirds of respondents said remote monitoring reduced bed days.
    • Telephonic case management is a component of remote monitoring efforts for 71 percent of 2014 respondents.
    • About a third of respondents report the use of either a Web interface or a dedicated mHealth app to supplement remote monitoring.
    • A patient-centered touch, such as a follow-up phone reminder to use a monitoring device or a personal coaching session, was frequently cited as a noteworthy supplement to remote monitoring technology.

    Source: 2014 Healthcare Benchmarks: Remote Patient Monitoring

    http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Remote-Patient-Monitoring_p_4868.html

    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.

    Humana Remote Monitoring Tools Assess Frail Elderly with Functional Limitations

    November 18th, 2014 by Patricia Donovan

    In nine separate pilots of remote patient monitoring, Humana is testing technologies to keep the frail elderly safe and healthy within their homes for as long as possible. Here, Gail Miller, vice president of telephonic clinical operations in Humana's care management organization, Humana Cares/SeniorBridge, reviews some of the tools and challenges of remote care management of individuals experiencing difficulties with activities of daily living (ADL).

    Question: What assessment tools do you use to measure functional limitations and ADLs?

    (Gail Miller): Besides the Charleston Frailty Index, we have a proprietarily developed tool that was started with Green Ribbon Health that manages all of the functional capabilities. That is the one that we use to help scale people. We also use the PH12 and the Subjective Global Assessment (SGA), as well as a couple of other assessment tools. It will often depend on how the person is presenting, but our primary assessment tool for functionality is the mDAT, which we developed internally.

    Question: How does Humana define ‘frail’?

    (Gail Miller): We use the clinical definition of frail — people more likely to fall, unable to keep their balance, on various medications, etc.

    Question: How do you coordinate care for the functionally challenged?

    (Gail Miller): If someone is having problems falling in their home, we will send our care managers into the home to do a fall and safety assessment, and then we will work with that member to complete the actions on the plan and to try and make their home safer for them to be able to move around in. If the person is having issues with their balance for example, and it isn’t due to the construction of their home or the way items are placed there, then we will get them to the appropriate provider so that they can be assessed, and see if there are things that we can do to improve on that.

    In that case, we would not only be taking them to one of our providers, but also getting them enrolled in one of our Silver Sneakers classes, which is a class we offer that focuses specifically on balance and core strengths.

    remote patient monitoring
    Gail Miller is vice president of clinical telephonic operations for Humana Cares, the complex care and chronic management arm of Humana, Inc. Her responsibilities include the oversight of the complex and chronic care programs provided telephonically to members of Humana.

    Source: Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population

    Infographic: Telemedicine Enhances Health Care Delivery

    October 27th, 2014 by Melanie Matthews

    Telemedicine is becoming a mainstay in the healthcare delivery system, according to a new infographic by Accenture. While in its early stages, telemedicine is expected to grow rapidly and could provide alternatives for some physician office visits and urgent care and ER visits.

    Accenture released an infographic on the topic that looks at the potential of telemedicine, the role of employers in telemedicine adoption and where telemedicine fits into the telehealth spectrum.

    Telemedicine Enhances Health Care Delivery

    2013 Healthcare Benchmarks: Telehealth & Telemedicine More than 10 million Americans directly benefited from a telemedicine service during the past year, according to American Telemedicine Association estimates. Telehealth's broad reach encompasses telemedicine -- the use of telecommunications technology to deliver clinical diagnosis, services and patient consultations -- as well as the exploding field of mobile health.

    2013 Healthcare Benchmarks: Telehealth & Telemedicine is packed with actionable new information from more than 125 healthcare organizations on their utilization of telehealth & telemedicine. This 60-page report, now in its third year, documents trends and metrics on current and planned telehealth and telemedicine initiatives and includes a year-over-year comparison of telehealth trends from 2009 to present.

    Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today. Have an infographic you'd like featured on our site? Click here for submission guidelines.