Wednesday, September 10, 2008

Telehealth Report Released

AHRQ’s National Resource Center has just released a report summarizing key findings from grantees implementing telehealth technology as part of AHRQ’s health IT portfolio. The technologies include the use of electronic information and telecommunications technologies to support clinical healthcare, health related education, public health, and health administration all delivered from a distance.

The grants were awarded in 10 states that included Arkansas, California, Minnesota, Montana, New Mexico, New York, Oklahoma, Pennsylvania, Tennessee, and Texas. These states were chosen since these states serve primarily low income rural areas with high rates of chronic illnesses.

The grantees found that telehealth can improve patient safety and the quality of care. One project demonstrated that remote pharmacy services provided to rural hospitals during irregular hours can more effectively detect and prevent dangerous medication errors. This is attributed to pharmacists manually reviewing night and weekend orders first thing in the morning before turning to day shift activities.

Other grants have demonstrated that pediatricians can easily remotely treat common childhood illnesses from schools and child care centers. This helps working parents who cannot leave their jobs and also reduces unnecessary visits to the emergency room.

However, the grantees found that implementing telehealth is not always easy. Several problems arose such as some vendor supplied home monitoring devices failed to work on a regular basis, and as a result, one-third of the patients became frustrated with the devices and stopped using them. Also, two projects reported that the video cameras used to transmit video and still images did not provide adequate resolution to yield clear images of small pills and wound areas.

The grantees found that technical support must be available 24/7. While large healthcare organizations have internal IT department to provide support, smaller organizations must rely on vendor technical support. This support can vary and is not always available 24/7.

Telehealth systems should be integrated with EHR systems so that patient data is captured and transmitted to clinicians at the point-of-care. Integrating the systems is particularly valuable when managing medications with home patients and when medications are dispensed by hospitals after hours. Telehealth systems can support team-based care and has created online communities among clinicians, specialists, and community providers.

Although CMS and some third party payers have created telehealth reimbursement guidelines, widespread acceptance of telehealth as a cost category for reimbursement has been slow to develop. One project developed a framework for reimbursement that was generally agreed upon by regional payers. They agreed to measure component healthcare costs and demonstrate to regional payers the cost savings for telehealth over traditional in person care. The project also looked at the impact of early diagnosis when treating patients, and the ability to manage chronic illness via telehealth versus emergency care.

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