Intro: Expansion of Telehealth

“[Telehealth] will be the way health care is provided.  I don’t think we’ll call it anything.  It will just be health care.” 

Adam Darkins, VA chief consultant for telehealth services in reference to the future of telehealth (Calgary Scientific, n.d.)

I grew up in rural South Dakota. I couldn’t wait to move away, though ironically enough, I now find myself excited to return to my Midwestern roots. I will be moving to Nebraska this summer to work with a hospitalist team at Nebraska Medicine.

One of my passions is improving access to healthcare. In the Midwest, barriers to care include any of the common socioeconomical barriers, but can also include the mere distance to providers, battling weather conditions, or limited transportation options. Telehealth offers great promise in addressing many of these barriers. Much of healthcare involves conversation and education. These valuable discussions do not necessarily require a face-to-face visit to be effective.

“[Telehealth] has the same standards and the same outcomes as in person care delivery.”

Kyle Hall, Telehealth Coordinator at Nebraska Medicine (Calgary Scientific, n.d.)

Telehealth is defined as “the delivery of healthcare services at a distance using information and communication technology” (Calgary Scientific, n.d., p. 3). Telehealth and its necessary technology advancements are continually expanding across the nation, though many barriers still exist to its widespread and most effective use. Some of these barriers include widely varied regulation (currently different in all 50 states), reimbursement practices, eligible geographic locations, eligible services, and ability to practice across state lines (Calgary Scientific, n.d.).

However, telehealth, which was once just a subcategory of Health Information Technology (HIT), has beckoned attention from healthcare policy makers. The advisory board for Bloomberg Bureau of National Affairs (BNA) Health Law Reporter voted the topic as one of the Top Ten Health Law Issues for 2016 (Loughran, 2016).

In April 2014, Nebraska approved Legislation LB 1076 to expand the definition of telehealth to include synchronous and asynchronous, as well as remote patient telemonitoring (CCHP, 2014). The bill also declared that the reimbursement rate for telehealth is not dependent upon the distance between the healthcare provider and the patient (CCHP, 2014). These changes make Nebraska more progressive on the issue of telehealth expansion than many other states.

Later in 2014, Nebraska Medicine, formerly University of Nebraska Medical Center, received a $10 million telehealth grant from Centers for Medicare/Medicaid Innovation. This grant is being used to enroll patients in a remote patient monitoring program that will follow their care for 90 days post discharge and offer nurse coaching (Wilson, 2014). Remote patient monitoring allows a patient to use a mobile medical device to perform routine testing, such as check a blood glucose level, and send the results to a healthcare professional in real-time (Calgary Scientific, n.d.). The goal is to help patients stay healthy and out of the hospital rather than only treating them when they are sick (Wilson, 2014). Acting on these goals is necessary for quality, value-based, sustainable healthcare.

Over the coming months, this blog will explore many of the issues surrounding telehealth with consideration of existing health policy, technology advancements, impact of public and private sector institutions, ethics, and financing. A specific focus will lie on the advancements and future of telehealth at Nebraska Medicine.

 

References:

Calgary Scientific. (n.d.). The road to telehealth 2.0 is mobile. Retrieved from http://cdn2.hubspot.net/hub/211730/file-2073190158-pdf/pdf/Telehealth-whitepaper.pdf?t=1452755174000&utm_campaign=Telehealth+Whitepaper&utm_source=hs_automation&utm_medium=email&utm_content=14892602&_hsenc=p2ANqtz-93M91Kw6w5okHfT-ebT4nWoiY2NC-o-EqhI_IsslNRG5olGUwbPP8TkFJv68LMhcVvL6bnFzvq-noBQFbo8Dy6t-qabQ&_hsmi=14892807

Center for Connected Health Policy (CCHP). (2014).NE approved legislation LB 1076. Retrieved from http://cchpca.org/ne-approved-legislation-lb-1076

Loughran, M. (2016). Telemedicine cracks top ten health law issue list for 2016. Bloomberg BNA. Retrieved from http://www.bna.com/telemedicine-cracks-top-b57982066002/
Wilson, T. (2014). $10 million telehealth grant awarded to med center. Retrieved from http://www.unmc.edu/news.cfm?match=15411.

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4 thoughts on “Intro: Expansion of Telehealth

  1. Telehealth has the potential to enhance patient care tremendously, especially for those who live in rural areas. It is interesting how this concept is interpreted differently throughout the country. I look forward to watching this blog unfold and learning more about telehealth policy and implementation.

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  2. Hi Megan, Great post about tele-health. I can also really sympathize with you in regards to access to healthcare in rural areas. The closest hospital, or even a doctors office, is 70 miles away from my parents home. There were a number of times they had to drive one of us kids all that way with broken extremities… painful. However, now the concern is more related to my parents, and other elderly folks in the community that are aging. Not only is it a concern for events such as a stroke or MI, but also as they age they stop driving and have to rely on others as a mode of transportation. I was taken back by the large financial contribution of CMS for the study of tele-health, thats a great investment. I appreciate the focus on the 90 period post discharge. I wonder how much chronic medicine they will be monitoring with this study set up, as well as, post d/c care. Maybe this is something you can get involved in with your new job! Regards, J

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  3. Since I am working in Telehealth and cover one of the community hospitals at Ogallala in Nebraska, I am really interested in following your blog. Telehealth is very critical to expand the access for services of healthcare to patients who live in rural and undeserved regions. It becomes a trouble when healthcare access is unavailable to those who are geographically disadvantaged, such as those who live in the rural side of America. They are isolated from health care centers, physicians and several nurse specialists. If we check the history, it shows how there is an asymmetrical distribution of physicians and healthcare specialists that mainly focus on their jobs in the metropolitan areas (Bentley, Powell, Orrell & Mountain, 2014).
    Hospital telehealth adoption rates differ from other states and their policies. The greater chances of telehealth adoption are the policies that support private reimbursements. Unlike, other policies that have the lesser chance of telehealth adoption are the ones who require out-of-state providers to have a special license to provide telehealth services (Adler-Milstein, Kvedar, & Bates, 2014). When it comes to telehealth programs, there are several cost-efficient and bureaucratic conflicts that one needs to overcome. Not all laws are equal, even though several states have passed and enforced telehealth enabling laws. Since all laws are not uniformed, implementing telehealth across state lines is difficult. One conflict is economic feasibility because of its expensive costs. State agencies, private sector organizations and university and medical institutions are pushed to gather resources and create networks for telehealth across states and regions (Schmeida, 2007). I look forward to reading your ideas and to seeing how your blog progresses.

    References:

    Adler-Milstein, J., Kvedar, J., & Bates, D. W. (2014). Telehealth Among US Hospitals: Several Factors, Including State Reimbursement And Licensure Policies, Influence Adoption. Health Affairs, 33(2), 207-215 9p. doi:10.1377/hlthaff.2013.1054
    Bentley, C. L., Powell, L. A., Orrell, A., & Mountain, G. A. (2014). Addressing design and suitability barriers to Telecare use: Has anything changed?. Technology & Disability, 26(4), 221-235 15p. doi:10.3233/TAD-150421
    Schmeida, M. (2007). Rural health policy: telehealth to bridge the rural-urban health care divide. AAACN Viewpoint, 29(5), 18-8 3p.

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  4. This topic is cutting edge and ready to impact the rural community. I do feel it has permeated urban populations also. For example, when I was working in a 12 bed ICU in Mesa, we did not have intensivists in the unit to assist us for immediate needs. Often the hospitalists were not present on that unit or had left for the day. We started ICare. It was a telehealth program where the nurses could access a veteran ICU RN and an intensivist 24/7. It was so interesting, I would just push the ICare button on the wall and over the camera came the team. They would even run codes from the camera. Another interesting aspect was the resource for new ICU nurses to be able to consult with a seasoned ICU nurse with just a push of a button. In addition to this, the ICare team would monitor our patients all day long and in turn call us if they noted a problem or if an alarm was going off. In your post you discussed the bill that allowed asynchronous health care. I am curious to hear what policies come from this and how your blog outlines the seemingly endless policy that could come in to play with telehealth. I see a parallel forming with Telehealth and electronic health records. As you stated in your post, telehealth was initially part of HIT (health information technology). With everything that is going on with telehealth, patient portals and electronic medical records, I can see a strong need for policy adherence, overlapping electronic needs and special requirements for privacy.

    Along with this, one investigating policy should consider frameworks and theoretical models that guide policymaking and the acquisition of evidence on the specific topic for which the policy is meant (Longest, 2016). One such interesting theoretical model is the Information Technology Adoption Model (ITAM). It is used to understand end users perceptions of a particular technology, in this case, telehealth programs, and allows for modification of application to increase adoption of the technology. I have read an application of this theory to assist physicians when they were first learning how to e-scribe medications. I look forward to reading the rest of your blog and find your topic very relevant and interesting.

    References

    Devine, E. B., Williams, E. C., Martin, D. P., Sittig, D. F., Tarczy-Hornoch, P., Payne, T. H.,
    Sullivan, S. D. (2010). Prescriber and staff perceptions of an electronic prescribing
    system in primary care: A qualitative assessment. BMC Medical Informatics & Decision Making, 10, 72-87. doi:10.1186/1472-6947-10-72

    Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL:
    Health Administration Press

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