Archive for the ‘Web 2.0’ Category

Two-Thirds of Healthcare Organizations Use Telehealth

February 4th, 2010 by Melanie Matthews

Two-thirds of healthcare organizations use telehealth for clinical or non-clinical purposes, according to a 2009 Healthcare Intelligence Network survey. The September 2009 survey also identified the most common applications for telehealth, the prevalence of remote monitoring, benefits and ROI, the greatest barriers to implementation and other telehealth trends among survey respondents.

Conducted online in September 2009, the survey’s goal was to document metrics in the use of telehealth and telemedicine and identify emerging applications of these technologies. Through responses provided by 139 healthcare organizations to 19 multiple choice and open-ended questions, the survey results offer a glimpse into a healthcare future where no patient is left behind because of a lack of access.

Survey Highlights

— Almost three-quarters of respondents — 66.9 percent — are using telehealth for clinical or non-clinical purposes.

— Specialist real-time remote diagnostic consultations was the most common application of telehealth by respondents (14.7 percent).

— Almost half of respondents — 49.3 percent — monitor the health conditions of some patients or members remotely.

— The telephone is the technology most often utilized in the telehealth initiatives of respondents (72.1 percent).

— Healthcare efficiency is the area most impacted by the introduction of telehealth, report 73.3 percent of respondents.

— Reimbursement has been the greatest barrier to implementation of telehealth, report 19.6 percent of respondents.

Key Findings

Prevalence of Telehealth and Telemedicine:

— Of the remaining 33.1 percent of respondents that do not engage in telehealth, 21.3 percent plan to do so in the next year.

— Private payors are the most common funding source for telehealth efforts, say 40 percent of respondents.

— More than half — 57.7 percent — do not know whether their state has passed legislation regarding reimbursement for telehealth.

Telehealth Targets and Delivery:

— A majority of respondents (61.9 percent) direct telehealth programs at their entire population, while 17.5 percent focus only on the chronically ill.

— After remote specialist consults, health information by telephone was the second most frequent application of telehealth (13.2 percent) followed by equal use of telehealth for distance education of patients and providers, EHRs, patient and caregiver e-mails and automated message reminders for appointments and medications (all reported by 10.3 percent).

— Heart failure was the condition most frequently tracked via remote monitoring, said 83.9 percent of respondents.

— Almost two fifths — 39.7 percent — deliver telehealth via a broadband connection.

Reality TV: Delivering Specialty Care via $100 Webcam

June 19th, 2009 by Melanie Matthews

Telemedicine is one way to address specialty care needs of safety net populations, says Dr. Kim Dunn, a Texas physician who has practiced telemedicine since the ‘90s. Then, as now, she notes, compensation for telemedicine is an issue. “The problem is that nobody pays for it. It’s starting to be paid for, but this trend is not very widespread.”

Dr. Dunn is director of the HealthQuilt initiative, a pilot health information exchange, and founder and CEO of the Your Doctor Program L.P. HealthQuilt launched its telemedicine feature with depression management — the number one behavioral health problem identified in the safety net community. “The Your Doctor Program, L.P. took the national guidelines for depression and put them into a base protocol in HealthQuilt’s Quality Health Record (QHR).

Academics-based telespecialists provide the base protocols for the project’s teleconsults, explains Dr. Dunn. “The medical doctors who will participate in the HealthQuilt pilot will look at the protocol and customize it to their practice, which takes about two minutes per protocol. That training, provided by the Your Doctor Program, L.P., overcomes the traditional provider barrier of, “I practice differently,” which often prevents physicians from participating in quality initiatives, she says, and also overcomes the reluctance of specialists who often have big concerns about telemedicine source locations.

“Let’s say I’ve seen a patient, and I’m diagnosing him with depression,” says Dr. Dunn. “There are about five medications I feel comfortable using for depression. Or let’s say the patient’s case is really complicated — they’re elderly or have major problems and I’m feeling out of my league. We have two ways to use telemedicine to access specialty care in this case. First, via the QHR, I can go to our telepsychiatrist’s cell phone. [As part of the pilot, that specialist] is contractually obligated to answer his cell phone and speak with me. I ask the psychiatrist to look at this patient because he’s already cued up to look at the QHR when he gets the cell phone call. We have a one- or two-minute conversation, and then he messages me with his recommendation. The whole “curbside consult” takes about four minutes. Since I as a medical home physician manage the care plan, we automatically follow up on the outcomes of care.

“Through this collaborative practice model we’ve been able to impact that patient’s care through that process, and the patient hasn’t had to have an additional appointment. There hasn’t been a delay in their treatment,” says Dr. Dunn.

But in some cases, the psychiatrist may say, ‘I don’t really know what to do with the patient.’ HealthQuilt’s second option is its embedded live interactive telemedicine inside the QHR via a $100 webcam that enables the team to do acceptable quality video so there can be specialist-to-patient interaction, Dr. Dunn explains. The project is now piloting payment to physicians for this service.

Live interactive consults can also be scheduled, she adds. “Often, you really just need to talk about the problem and get a few questions answered, and then you can schedule either a live interactive follow-up via telemedicine or an in-person exam.”

Four-Story Medical Home Wired with Telemedicine Outreach

June 2nd, 2009 by Melanie Matthews

Kathy Scher, program manager for the Center for Clinical Care Design at Henry Ford Health System, describes how her organization designed a four-story medical home and identified patients for telemedicine outreach in this model.

When we designed our medical home model, we conceptually built it with a four-story house in mind. On the first and second floors of our home, we have designed the services for a relatively healthy patient population. The patient profile for level two and level one floors is that they’re healthy, but they may have acute episodic illnesses. These illnesses are treated by nurse practitioners, mid-level physician assistants and clinical pharmacists. But the physician is the coordinator of this care. We also provide them with different ways to reach their clinician team — e-visits, shared medical appointments, shared goal-setting and routine screenings.

On the third and fourth floors of our home, the patient profile is a bit different. We have patients with multiple chronic conditions. Usually one or more of these conditions is dangerously out of control or the patients have shown some evidence that they’re not good self-managers. The team has been expanded on this level of care to include complex case managers, clinical pharmacists to address polypharmacy issues and also palliative care services.

The case managers focus on treating the patients with chronic disease. For our particular model, we have case managers who focus on heart failure, diabetes and depression screenings. They handle the needs of the patients who can’t pay for the medications, who don’t have transportation or who need additional services that will help improve their care. Initially, when we started focusing on heart failure as one of the conditions we wanted to build a program around, we started in cardiology. We had a nurse practitioner heart failure program built in our cardiology clinic and those nurse practitioners had access to telemedicine services. We found that it didn’t work out. We built a program that didn’t meet the needs of the patients and we didn’t get enough referrals. Going back and looking at how we could do this differently was part of our next step.

We wanted to look at the data to identify the appropriate populations — have the physicians that we work with in internal medicine look at all of the patients we identified using the administrative data and use that as the first swipe to try to trim the population. Then, we looked at those patients who had high ER visit rates and high inpatient utilization. The physicians collaborated with us and went through each of their patients to determine who would benefit from the telemedicine outreach. They removed patients that wouldn’t be good for this service; perhaps they had a language barrier, had dementia or were being admitted to a nursing home. The collaboration with our physicians was key to our success in identifying the appropriate population of patients.

We started by explaining the value and benefit of the telemonitoring that the case managers would use as one of their tools to help them manage their population, but the physician endorsement was key.

Social Networking Can Send Prevention Message to Adolescents

April 14th, 2009 by Melanie Matthews

As the parent of an adolescent and a 20-year-old, I was heartened last week to read that more parents are having substance-abuse related conversations with their adolescents, a practice associated with reduced substance abuse in this age group. Unfortunately, this SAMHSA report (a featured story in this week’s Healthcare Business Weekly Update) also found that adolescents are receiving fewer prevention messages through media sources.

Could it be that these messages are being placed in all the wrong places? According to a recent article in Archives of Pediatrics & Adolescence, more than 90 percent of adolescents have Internet access and approximately 50 percent use social networking sites. In my unscientific opinion, they’re also watching less TV — recording what they want to watch and then fast-forwarding through the commercials. Instead, public service organizations should create a presence on Facebook, YouTube, Twitter and other social networking sites to deliver prevention messages where this vulnerable age group is — and rely on them to spread the word virally, which is what they do best. You can create special interest groups, pages, quizzes, videos, applications and more to get their attention and that of their friends and followers.

If you haven’t yet tried these sites, you can start by following us on Facebook, Twitter and LinkedIn. In time, your organization may “Like This.”

High Hopes for High-Tech Healthcare

January 12th, 2009 by Melanie Matthews

There’s much debate about whether an injection of health IT can heal the healthcare industry. However, few would dispute the nationwide need for broadband Internet access called for by HHS Secretary-designate Tom Daschle during his confirmation hearing last week — especially for providers serving rural populations. And with bad healthcare debt on the rise, strategists suggest that Web access to appointment scheduling, insurance forms and payment data can improve patient collections.

However, a recent survey by Oneupweb found that 63 percent of America’s top hospitals have little online presence. Oneupweb analyzed the online marketing initiatives of the 19 healthcare organizations recognized by U.S. News & World Report as the Best Hospitals Honor Roll.

Meanwhile, according to a story in this week’s Healthcare Business Weekly Update, health-monitoring technology helps seniors live at home longer. Also gaining ground on the self-management front are personal health records (PHRs). This week’s featured download, PHRs for Healthcare Consumers, describes how more than 200 health plans, hospitals and health systems, healthcare providers, employers and healthcare IT vendors use PHRs to benefit their populations.

New uses 4 ur cell phone: DM and Medication Adherence

November 18th, 2008 by Melanie Matthews

Phone calls, pictures, video, Web surfing, IM-ing…now add disease management to the list of cell phone capabilities. A study from the University of North Carolina at Chapel Hill suggests that text messaging could be used to reduce children’s chances of becoming overweight or obese later in life by helping them monitor and modify their own behaviors.

And the Pill Phone from Vocel enables wireless customers to personalize and schedule audio and visual alerts reminding them to take their prescribed medications at the right time, whether they are at home or traveling. The company says the Pill Phone is expected to help improve therapeutic results and medication adherence rates while helping to control healthcare costs.

Health Coaching 3.0: Coaching the Whole Self in a Multi-Platform World

November 12th, 2008 by Melanie Matthews

As the moderator during today’s HIN sponsored-webinar Health and
Wellness Coaching in 2009
, I thought you’d appreciate some of the
insight from today’s presenters on trends and developments in the
health coaching field.

Roger Reed from Gordian Health Solutions likened the developments in
health coaching to the developments of the Internet from Web 1.0
through to Web 2.0 and now into Web 3.0. The cornerstones of Health
Coaching 3.0, which is starting to emerge in the industry, is
individual-centric and relationship driven utilizing a multi-platform
world, including PDAs, telephones and home monitoring services.

Jennifer Hidding with OptumHealth described how health coaches need to
address the “whole” self, while recognizing barriers and the
likelihood of lapses. She also described how to incent behavior at key
junctures, making it personal and aspirational, utilizing social
networking, plugins with Microsoft Outlook and other calendar

You can hear interviews with Hidding and Reed on these and other health and
wellness coaching trends.

HHS Funds Healthcare Technology for Health Centers

October 20th, 2008 by Melanie Matthews

In a featured Healthcare Business Weekly Update story this week, HHS is making $18.9 million available to health centers to adopt EHRs and other HIT innovations, including e-prescribing, health information exchanges, data warehouses and interoperability with outside partners such as state immunization registries and hospitals.

Providers not ready to adopt an EHR might consider using a population-based registry as a start. In a recent HIN e-survey, more than half of 159 responding healthcare organizations told us they use registries to improve quality and efficiency of care and boost prevention efforts. UnitedHealthcare Senior Vice President of Clinical Innovations Dawn Bazarko, who spoke with us recently about UnitedHealthcare’s medical home initiative, said that an EHR is not required at this time for the most basic medical home. However, she added, “We also believe that the presence of a high-functioning well-utilized registry is very critical and oftentimes is not a component of an EHR, so we reinforce our practice sites to first start with a good population-based registry.”

Details on how survey respondents are using paper, spreadsheet and electronic registries to better the health status of their populations are available in a complimentary white paper, Patient Registries: The Track to Better Quality Healthcare.

Injecting Web 2.0 into Healthcare

September 9th, 2008 by Melanie Matthews

For many of us, back-to-school also means lessons in computer literacy to access our children’s online textbooks, e-mailed status reports and teachers’ Web sites. Web 2.0 is everywhere — co-workers and children are friending, tweeting and texting away as these social networking tools become de facto communication modes. The healthcare industry isn’t immune. A featured story this week chronicles how blogs, podcasts and wikis are changing the face of information exchange at the Cleveland Clinic.

We’re no strangers to user-generated content (UGC) ourselves. HIN ventured into the Web video realm earlier this year, and this month are raising our virtual profile even higher. You can now friend HIN VP and COO Melanie Matthews on Facebook and join the Healthcare Intelligence Network group.

You can also follow HIN on Twitter.

Join us there, and we’ll figure out together whether Health 2.0 is helping or hindering our industry’s information flow. And share your Web 2.0 experiences at the HIN blog.

We also offer you one final way to communicate — by taking our fourth annual Healthcare Trends survey. Tell us about your year in healthcare and what’s ahead for your organization in 2009, and we’ll send you an e-summary of the results at the conclusion of the survey.

Video: Health Coaching Scores Big Gains in Disease Management, Behavior Change

September 5th, 2008 by Melanie Matthews

Learn how health coaching for chronic illness helps employers and health plans save millions in healthcare costs and motivates individuals to change unhealthy behaviors in this new video from HIN: