Tuesday, July 22, 2014

Telehealth

Telehealth
What does that word even mean? To many today, it means virtual visits – being able to see your doctor on a computer screen, avoiding the drive to the office.  There are even companies creating special rooms to allow you to see a specialist remotely.  Also, you may hear about “store and forward” telehealth, which means taking a picture/video, and it gets sent to your care provider securely at an appropriate time, basically fancy email.  But the part of telehealth I really want to talk about is tele-monitoring.

Tele-monitoring (or remote patient monitoring) is using devices to gather health information, usually vital signs, and sending them to a centralized system so they can be monitored.  Many of the systems that gather that information can also provide reminders and education to the patient.  The beauty of these systems is that they require no scheduling between patient and provider, and they let the patient feel in control.

Why is now the time to build a program around RPM?

RPM no longer costs extra
Coverage of tele-monitoring is still rare under fee for service, but value based reimbursement allows users to recoup the investment.  Watch the documentary “Escape Fire”.  US medicine is finally beginning to move toward incentives for health care.  The old model of simply paying for doctors to do more can’t be sustained.  And once the provider’s reimbursement is tied to keeping the patient well and avoiding expensive hospital care, Remote Patient Monitoring essentially becomes reimbursed, because it saves more money than it costs.  Study after study has shown patients stay healthier and avoid re-admissions while on a tele-monitoring program.

The technology is better
It’s finally time.  Apple’s iWatch may make the technology even better, but it is already good enough to have working, inexpensive, unobtrusive equipment in the patient’s home.  We’ve come a long way since I was part of a company that tried to do this in 1994.  Back then, we were desperate for workable equipment.  We tried to use the Apple Newton.
We used a PC from an Atlanta company that made an all-in-one for < $1000, back when that was cheap and special.  Eventually we contracted with a device manufacturer in Boston create a special device.  It was still a little bulky and cumbersome; we even had to build a box to hide all the wires.  But even with that, we had success in the patient's home. Nowadays, devices use Bluetooth connectivity to send measurements to a hub.  The Hub connects over a cellular network to send data to server.  The server data is accessible via web.  Systems are less expensive, more reliable, and there is a lot of competition.


Medication compliance
The CDC measures that 20-30% of prescriptions are never filled.  And 50% are not taken correctly.  This imposes tremendous costs on the health care system, estimated at between $100 Million and $289 Million.  In-home reminder systems, text alerts and other mechanisms are available to improve medication compliance.

People (patients) like it
We are beyond the point where only gadget lovers are interested in tele-monitoring.  Systems have been proven to work, and patient satisfaction with programs is high.  As an added bonus, having telemonitoring in the home increases patient engagement, which can help satisfy Meaningful Use.

So, we finally have payment systems starting which align the desire for better, lower cost care with the revenue coming in.  And we have the technology to monitor vital signs in the home and intervene as necessary.  We can improve health care and improve the bottom line.  If you are involved in a health system that isn’t talking about Remote Patient Monitoring, I’d love to talk to you and help you get there. The time for telehealth is now.

Friday, July 18, 2014