Wednesday, April 29, 2009

Telemedicine/Telehealth Update

Reimbursement for telemedicine is vital for the technology to move forward at a rapid pace. Policy, costs, standards, infrastructure, and human dimension issues also must be solved before this country can move into a technology enabled healthcare environment, according to Neal Neuberger, Executive Director, Institute for e-Health Policy moderator for the April 22nd Steering Committee on Telehealth and Healthcare Informatics lunch briefing held on Capitol Hill.

This is an amazing time and we are at the center of the storm with everyone ready to see telemedicine and telehealth move forward said Jonathan Linkous, CEO, of the American Telemedicine Association. He continued to say that telemedicine has been growing with 200 networks, at 300 sites, and 100,000 units in homes treating individuals with chronic conditions. Yet we are behind the rest of the world.

Linkous is concerned about CMS rules for telemedicine reimbursement and how their rules can differ from the private sector. CMS will reimburse at times for using interactive video for consults, but this only results in 17% coverage in the U.S. Most of the people in this country are not reimbursed by CMS.

As a notable leader in the telemedicine field, Jay H. Sanders, M.D., President and CEO, the Global Telemedicine Group, discussed how effectively telemedicine can function in the 21st century. In today’s world, telemedicine technologies have brought the exam room, doctors, and specialists to the patient especially patients with chronic diseases. Trauma surgeons, neurologists, ophthalmologists, and many other specialists located at academic centers can now be seen routinely via video at rural hospitals.

As Dr. Sanders pointed out, we are all telemedicine experts since we use cell phones. Using telemedicine in the work place can save a great deal of time and money for employers. Today, cell phones are brought into the worksite making it much easier and more cost effective for employees to be tested where they work. Asthma tests can now be done at work with sensors transmitting the information to cell phones with embedded diagnostics in place. This is just one way for bringing healthcare delivery to the patient.

In addition, EMR systems need to provide intelligent dynamic electronic medical records. For example if the patient has a complaint that is difficult to diagnose, then the EMR intelligent dynamic system would start helping the physician. A dynamic EMR would search records, find essential information, scan the literature, incorporate this new information into the EMR, and then alert the doctor to changes or new therapies.

Both, Stuart Ferguson, Ph.D., Director of Telehealth Alaska Native Tribal Health Consortium, and John Kokesh, M.D., Chairman Department of Otolaryngology, Alaska Native Medical Center in Anchorage Alaska traveled from their state to describe how the Alaska Federal Health Care Access Network (AFHCAN) is improving healthcare. The network supports beneficiaries of IHS and tribal organizations, the Department of Defense, U.S. Coast Guard, and the VA.

As the speakers explained, during the early years, there was overwhelming need to create a store-and-forward telemedicine system. Clinical needs assessments indicated that primary care, otolaryngology and cardiology were the most needed services and amendable to store-and-forward applications.

Today in Alaska, telehealth has had had a huge impact and is used to identify many health issues much earlier. The network handles 12,000 cases per year, has 248 sites with care not only being delivered in Alaska but also delivered to other places such as Greenland, Panamanian prisons, and schools in Ohio.

Both speakers emphasized that much has been accomplished and now telehealth provides care for many health issues including post surgical follow-ups, wound closure examinations, and post cochlear implant assistance. In addition, travel time is greatly saved since 8% of specialty consults are prevented with 20% travel time reduced for primary cases. This has saved AFHCAN $3.5 million in treating 43,800 patients. For every dollar spent by Medicaid on reimbursement, $7.95 is saved on travel costs.

According to both speakers, better healthcare can be provided with multi-providers providing care in multiple regions and with patient participation. But it does require using a system approach when initiating the technology, developing the workflow process efficiently, establishing the relationships needed to maintain the system, and providing for adequate training and support. All of these factors are the key to cost savings since it has been found that telehealth is more cost effective and operates more efficiently when done at higher volumes at many sites.

On the state legislative front, the Alaska State Senate recently passed Senate Bill 233 to create an electronic health network that would enable Alaskans to have their own personal health record and the bill would authorize their healthcare providers to exchange electronic medical records.

Today, 23% of Medicare emergency room visits are due to the elderly and others mismanaging their medications. To help cope with prescription mismanagement problems, a few years back INRange Systems Inc. developed a medication management system called EMMA ®.

Walt Grant, Director of Government Affairs and IT Integration for INRange Systems Inc, discussed how medication management systems can be effective since the system operates as the arm of the caregiver in the patient’s home and greatly helps control medication.

EMMA ® consists of a Medication Delivery Unit (MDU), and wireless two-way web-based communications software that enables a physician, pharmacist, or other licensed practitioners to remotely manage prescriptions stored and released by the patient 24/7.

EMMA ® has proven to be invaluable since it can control narcotics, provide for inventory control, schedule medications or change dosing schedules, provide reminders for other medications, suspend and add medications, provides both visual and audible alarms, and automatic phone notifications.

The Congressional Luncheon Seminar ar Series is a project managed by the Institute for e-Health Policy, a subsidiary of the HIMSS Foundation. For more information, go to