Telehealth Next Stage Evolution: What Will be Different, Important

Telehealth – Next Stage Evolution: 

What Will be Different, Important 

and Worth Looking Out For?

Mark

VanderWerf

Vice

President,

Nonin

Medical

Chairman,

Home

Telehealth

 ‐

The

data

is

In

•

Telehealth

has

shown

strong

positive

results

to

date.

These

results

have

been

repeated

in

programs

on

a

variety

of

countries

around

the

globe.

Over

1,000

studies

and

papers

have

been

published.

•

We

can

all

do

more

research

but

hundreds

or

pilots

are

now

complete

and

the

data

(with

some

exceptions)

has

been

overwhelmingly

positive

–

Improved

quality

of

life

–

Reduces

hospitalizations

/

Reduce

cost

Clinical

Telemedicine

– The

Data

is

In

•

Over

10,000

published

articles

and

papers

in

the

Library

of

Congress

alone.

–

Overwhelmingly

positive.

–

Improved

access

to

care

–

Improved

utilization

of

resources

–

Improved

outcomes

The Value of Provider‐to‐Provider Telehealth Technologies Center for Information Technology Leadership Partners HealthCare System, Inc, 2007

For the use of telemedicine to join emergency rooms ‐ the cost to equip all US emergency departments 

with hybrid telehealth technologies could easily be covered by savings from a reduction in transf ers between emergency departments. … avoid 850,000 transports with a cost savings of $537 million a year.

For the use of telemedicine in correctional facilities ‐ Correctional facilities could cover their cos ts of hybrid telehealth equipment by savings from a reduction in transporting patients to emerg ency departments and to physician offices, and by avoiding the costs of the emergency departm ent visit. … avoid 543,000 inmate transports with a cost savings of $210 million.

For the use of telemedicine in nursing homes ‐ the costs of implementing hybrid telehealth equi pment in nursing homes could be covered by savings from a reduction in transferring residents t o emergency departments and physician offices, and by avoiding the costs of the emergency de partment visit. … avoid 6.87 million transports with a cost savings of $479 million.

Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Ho me Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic

Conditions 2 ‐ Adam Darkins, et al December 2008, 14(10): 1118‐1126.

CCHT patients increased from 2,000 to 31,570 (1,500% growth) between 2003 and 2007. CCHT i s now a routine noninstitutional care(NIC) service provided by VHA to support veteran patients with chronic conditions as they age. Routine analysis of data obtained for quality and performa nce purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in n umbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisf action score rating of 86% after enrollmentinto the program. These results demonstrate

a dramatic reduction in costs and an equally dramatic increase in quality.

A Systematic Review of the Key Indicators for Assessing Telehomecare Cost‐Effectiveness Steph anie Vergara Rojas, Marie‐Pierre Gagnon. Telemedicine and e‐Health November 1, 2008, 14(9):

896‐904. doi:10.1089/tmj.2008.0009.

… review identified 5,219 reports on telehomecare published between 1997 and 2007. Of all these, 23 were appropriate for comparison of cost in various ways. Of these, 70% were in the Un ited States, 15 of 23 were randomized control trials, and 48% were published between 2003 and 2007. Teleconsultation was about equal to telemonitoring in the services. Total cost, cost per pa tient, and cost per visit were all reduced by telehomecare.

Economic Impact of eICU Implementation in an Academic Surgical ICU Benjamin A Kohl, Fran k D Sites, Jacob T Gutsche, Patrick Kim, Anesthesiology and Critical Care, University of Penns ylvania, Philadelphia, PA Crit Care Med. 2007;35(12):A26.

Introduction: We have recently shown an improvement in mortality and length of stay after implementing an eICU (VISICU, Baltimore, MD) in a large academic surgical ICU.

Results: An almost 10% reduction in ICU stay and 20% reduction in floor stay occurred after implementation of eICU. This translated into a savings of $706,272‐$941,697 for the ICU and $2,134,339‐$2,842,940 for the floor

CostUtility Analysis of Telemedicine and Ophthalmoscopy for Retinopathy of Prematurity Ma nagement Kevin M. Jackson, OD, MPH; Karen E. Scott, MD, MBA; et 

al Arch Ophthalmol. 2008;

126(4):493‐499. Conclusions Telemedicine is more cost 

effective than standard ophthalmoscopy for ROP management. Both strategies are highly co st‐effective compared with other health care interventions.

Can Telecommunications Help Solve America’s Health Care Problems? Arthur D. Little, Jan93

… concluded that the use of videoconferencing for professional training and

remote medical consultations will reduce costs by more than $200 million. While this early st udy did not include the cost associated with implementation of the applications the results ar e illustrative of the size and scope of potential for the use of telemedicine nationally.

Home‐based telehealth: a review and meta analysis Dellifraine JL, Dansky KH. J Telemed Telec are. 2008;14(2):626 Department of Health Policy and Administration, The Pennsylvania State University, Pennsylvania 16802, USA.a systematic review to identify studies on the effect of ho me telehealth on clinical care outcomes. The search yielded 154 potential articles

and dissertations. Overall, the meta‐analysis indicated that telehealth positively affects clinical outcomes of care, even in different patient populations.

Young TL, Ireson C.Effectiveness of schoolbased telehealth care in urban and rural elementary schools. Pediatrics. 2003 Nov;112(5):1088‐94.Telehealth technology was effective in deliverin g pediatric acute care to children in [these] schools. Pediatric providers, nurses, parents, and chi ldren reported primary care school‐based telehealth as an acceptable alternative to traditional

health care delivery systems.

Leggett PF, Graham L , Steele K, Gilliland A, Stevenson M, O'Reilly D, Wootton R, and Taggart A (Sep 2001) Telerheumatology: Diagnostic accuracy and acceptability to patient, specialist, a nd general practitioner. British Journal of General Practice 51(470) : 746‐8.

This study examines the diagnostic accuracy and acceptability of telemedicine in the field of rheumatology. … the televisual consultations were highly accurate (97%) and acceptable to pa tients, general practitioners, and specialists.

Loane, M.A., Corbett, R., Bloomer, S.E., Eedy, D.J., Gore, H.E., Mathews, C., Steele, K., and Wootton, R. Journal of Telemedicine and Telecare 4(2): 95‐100. Diagnostic accuracy and clinica l management by real‐time teledermatology: results from the Northern

Ireland arms of the UK Mulitcentre Teledermatology Trial (1998). …a high proportion of dermat ological conditions can be successfully managed by real‐time (tele)teledermatology

Impact

of

this

Work

•

Broadening

of

Accepted

Services

•

Commercialization

•

Integration

of

Telehealth

•

Next?

Impact

on

this

Work

•

Accelerants

–

Recognition

that

change

in

healthcare

is

needed

–

Changing

Incentives

Broadening

of

accepted

services

•

TeleRadiology

•

TelePathology

•

TeleStroke

•

TeleSepsis

•

TeleER /

TeleTrauma

•

TelePsychiatry

•

2

nd

Opinions

•

Consumer

to

Physician

Commercialization

•

Telemedicine

and

Telehealth

have

been

Provider

driven

to

date.

•

Moving

to

a

new

phase

–

From

provider

lead

to

commercial

enterprise

–

Providers

services

to

other

Providers

Commercialization

•

Providers

leveraging

new

capabilities

to

offer

services

–

Increase

utilization

of

resources,

increase

service

breadth,

leverage

investment,

increase

service

area,

Providers

Offering

Services

•

Mercy

Medical

–

Missouri

and

Iowa

Networks

•

Deaconess

Healthcare

•

Partners

Connected

Health

•

Johns

Hopkins

•

Cleveland

Clinic

•

Mayo

Clinic

•

Eastern

Maine

Medical

Center

•

Rural

Nebraska

Medical

Response

System

Partnership

Commercial

Enterprises

•

American

Well

 ‐

–

allows

consumers

to

connect

with

physicians

on

demand

whenever

they

have

a

health

need,

from

their

home

or

office

for

$49

per

visit

•

Specialists

on

Call

–

a

Joint

Commission

‐

accredited

provider

of

emergency

telemedicine

consultations

dedicated

to

solving

the

national

specialty

physician

shortage

•

PhoneDOCTORx –

–

provides

physician

coverage

services

through

audio

and

or

video

conferencing

consultation

services.

Extended

Care

Facilities

(ECFs)

are

empowered

to

provide

nurses,

patients

and

their

families

with

confidential,

real

‐

time

access

to

Board

Certified

physicians

in

non

‐

urgent,

urgent

and

emergent

care

Commercial

Operations

•

Offsitecare

http://www.offsitecare.com/

–

24/7

ICU

and

ER

coverage

for

adult

and

pediatric

critical

care,

stroke

intervention,

infectious

•

UnitedTelehealthServices

–

connects

physicians

to

patients

and

healthcare

Integration

of

Telehealth

Services

•

Programs

often

focused

on

either

clinical

telemedicine

or

home

Telehealth

•

Now

integrating.

Single

focus

offering

all

services

–

Ontario

Telemedicine

Network

(Canada)

–

Partners

Healthcare

(US)

Incentives

Are

changing

•

Population

Payment

•

Integrated

Provider/Payer

Systems

•

Acountable Care

Organizations

(ACOs)

•

Pay

‐

For

‐

Performance

•

Risk

Shift

/

Risk

Sharing

•

Outcomes

incentives

and

penalties

–

Re

‐

hospitalization

rate

penalties

Expectations

•

Expectation

of

the

Patient

are

changing

•

The

average

buyer

of

an

iPad

is

55

•

The

baby

boom

is

here

–

With

a

vengeance

Technology

Shift

•

Purpose

built

/ Proprietary

–

To

Ubiquitous

Platforms

–

Pads,

smart

phones,

Tablets

–

Standard

hubs,

shared

ecosystems

•

Sudden

drop

in

the

cost

of

technology

•

Increased

Mobility

•

Ease

of

use

•

iOS,

Android,

Windows8

–

Open

Source?

Shift

of

emphasis

•

From

the

box

to:

–

Communications,

data

integration,

quality

and

breadth

of

service

Integration

•

Integration

in

the

process

of

care

•

Ecosystem

wide

•

Integration

in

the

information

systems

of

care

•

Shared

date

– Shared

EMR

Mobility

•

Smart

Phones,

Tablets

Pads

•

Easy

integration

– Move

away

from

Bluetooth

to

Bluetooth

Smart

–

Simplified

paring

–

Simplified

logistics

and

support

–

Longer

battery

life

of

devices

•

Apps

Challenges

•

Differentiation

–

Showing

your

solution

is

better

•

Move

from

technology

to

quality/breadth

of

service

–

Results

/

Added

value

•

Documentation

•

Reporting

Outcomes

•

Measure

on

performance

Quality

•

Quality

of

the

Measurements

(the

data)

–

“We

need

to

respond

to

changes

in

the

patient

…

not

in

the

medical

or

measurement

device”

Example

 ‐

Pulse

Oximetry

•

Diverse

Population

– all

sizes,

skin

tones

•

Diagnosed

disease

•

Challenging

patients

– Low

perfusion,

motion

•

Durability

– Cost

of

Ownership

•

Ease

of

acceptance

– Ease

of

Use

•

Environmental

standards

Get

Ready

Thank

You

!

Mark

VanderWerf

Nonin

Medical