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Real time access to vital signs, improving outcomes for chronic care patients and the shift of our health system to a value-based model…. YES, it’s time to embrace telehealth.

By Eric Venn-Watson on July 30, 2015- The Goldman Sachs report referenced in the first part of this series mentions that remote patient monitoring (RPM) enables healthcare providers to better manage high risk patients, potentially decreasing healthcare spending through better chronic disease management. Further, the report notes that most chronic disease spending can be attributed to heart disease, asthma and diabetes -disease states that represent the most fertile ground for digital health.

This is one of the most promising – and limitless – opportunities in healthcare today. Current RPM devices allow us to monitor CHF patients from home, providing a real-time assessment of their heart health and decreasing their risk of readmission. In the case of an asthmatic patient, RPM devices can monitor a patient’s respiratory health and provide notifications when factors such as local air quality put them at risk for an exacerbation. For diabetic patients, RPM can measure continuous blood glucose levels and help provide a level of glucose control that was previously unachievable.

The future of RPM involves combining these tools and the patient’s entire health history with streaming analytics and clinical decision support tools that can detect when a patient’s physiologic parameters are trending outside the normal range, and send a notification to the patient and potentially the care team when appropriate. As a result, we are able to predict and track diseases before they become acute – and potentially even prevent them from ever happening. In essence, we will be able to shift the management paradigm from reactive care to proactive care, which is mission critical in an environment where caregivers are scarce.

Ultimately, clinicians want to provide the best care possible and make a positive impact on our patients’ quality of life. The digital healthcare revolution is helping us achieve that goal, improving the way we practice and provide medical care, streamlining our clinical workflow and helping us to make the vast number of patient data sources relevant and actionable. The old ways of doing business are no longer acceptable. The new financial and regulatory models won’t allow for it – and ultimately, the patients won’t stand for it.

The digital healthcare revolution has arrived.

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Remote Patient Monitoring can provide better if note equal results in the quality of care for mental health patients who either may have physical issues or live in rural areas.

By Vera Gruessner on July 30, 2015- Telehealth solutions are spreading throughout the medical care industry and affecting the lives of patients and workflow of healthcare providers. Among many patients, transportation, mobility, place of residence, and other obstacles may stand in the way of sufficient access to healthcare services. For example, some people who reside in rural areas may not have certain specialists or urgent care clinics nearby, which is why telehealth solutions are so necessary in the medical field.

Telemedicine services can be useful for a wide variety of patients with both physical and mental health conditions. Reuters Health reports on a study that found audio and video-based therapy sessions assist older veterans manage their depression as much as an in-person appointment might.

Some senior citizens are also concerned with the social stigma of obtaining mental health counseling, which is why telemedicine could be a sufficient answer to receiving the necessary treatment.

“At our facility, we have almost 40 percent of people who live in rural areas, so this is a good opportunity to be able to provide care for them without them having to drive long distances,” Dr. Leonard Egede, the Allen H. Johnson Endowed Chair and professor of medicine at the Medical University of South Carolina in Charleston, told the news source.

Older people have higher risk of depressive symptoms especially past age 65, Egede and colleagues explained in their findings, which was published in The Lancet Psychiatry. Additionally, the risk of depression is even higher among veterans, which is at least twice as much as the rest of the population.

With many in this population disabled or otherwise unable to make it to an in-person doctor’s appointment, telehealth solutions present a better option in which patients would be able to speak with mental health professionals or medical doctors about any potential issues taking place in this segment of the population.

With regard to post-traumatic stress disorder, there has been research that’s found telehealth solutions to be as favorable as in-person visits to a psychiatrist or psychologist. However, when it comes to depression, there haven’t been as many studies focused on whether telemedicine services improve the well-being of the patient.

“Our goal was really to understand whether you can actually provide good psychotherapy via telemedicine,” Egede told the source.

The research team looked at a total of 204 veteran patients who were 58 years old and up with a depression disorder. The subjects were also divided up into two groups with one experimental and one control. The control group received in-person mental health professional help while the second experimental group of patients spoke with a psychotherapist via video and audio in their own home.

“The study team measured the participants’ progress using two standard questionnaires in which patients rated their own symptoms. Participants were considered to be responding to treatment if their symptoms were reduced by at least half,” Reuters reported. “After four weeks, the questionnaires showed that only a small proportion of patients in either group had reduced their symptoms by that much, and only half as many in the telemedicine group (5 percent to 7 percent) as in the in-person therapy group (15 percent)… At the one-year mark, the groups were about even, with 19 percent to 22 percent of the telemedicine patients and 19 percent to 21 percent of in-person patients meeting the treatment-response definition based on the questionnaires.”

Clearly, telehealth solutions proved to be fruitful in treating depression in older veterans and have made an impact on patients with mobility issues or residing in rural areas across the healthcare industry as a whole. Currently, the federal policies on telemedicine may be changing with Congress considering expanding telehealth services across the country, according to Bank Rate.

At this moment in time, Medicare is covering telehealth solutions that are impacting care delivery to rural areas. The Veterans Health Administration, for example, has a system for providing video conferencing to patients who would like to speak with their doctor while at home.

As the federal government continues to focus on expanding coverage and access to telehealth solutions, new technologies will likely continue to impact the patient population and lead to better care, more positive population health outcomes and lower medical care costs.

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Healthcare leaders give their feedback to the Senate Committee members on how to improve the care management of chronic high-risk patients. The feedback being constant by all and focusing on three key areas the healthcare industry must deploy in order to have comprehensive success: EMR interoperability, improvements in patient engagement and the use of telehealth technologies and services.

By Jennifer Bresnick on June 18, 2015

The healthcare system must focus its efforts on improving health data interoperability, boosting patient engagement, and overhauling the nation’s telehealth policies if providers are to succeed with chronic disease management and better population health, say the leaders of the College of Healthcare Information Management Executives (CHIME) in a letter to Congress.

“A high degree of data fluidity” across the care continuum will provide the foundation for a number of different important activities related to chronic disease management, including care coordination, home monitoring, and the integration of patient-generated health data into the comprehensive electronic health record.

After a May 15th hearing discussing methods for improving care for Medicare patients, the Senate Committee on Finance formed a bi-partisan working group to address the growing need for more robust and cost-effective population health management for patients with chronic conditions such as diabetes, heart failure, hypertension, asthma, and COPD.

The Committee also asked for suggestions on how the healthcare industry can strengthen its chronic disease management and preventative care strategies to meet the rapidly growing needs of this large patient cohort.

“Stakeholder input is critical for the committee to work toward its goal of producing bipartisan legislation that can be introduced and marked up later this year. To aid the Finance Committee in bipartisan chronic care reform policy development, we request all interested public and private sector stakeholders submit their best ideas on ways to improve outcomes for Medicare patients with chronic conditions,” wrote Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) in a letter to the healthcare industry.

CHIME’s response to the call for feedback highlights three major areas where the industry must focus its efforts if it is to make strides with chronic disease management: health data interoperability, patient engagement, and a heavier reliance on telehealth and remote monitoring throughout the care process.

At the core of these efforts is the creation and maintenance of a longitudinal patient health record that will aid care coordination across multiple settings, write Russell Branzell, CHCIO, LCHIME, President and CEO of CHIME and Charles E. Christian, CHCIO, LCHIME, FCHIME, FHIMSS, Chair of the CHIME Board of Trustees and Vice President of Technology and Engagement at the Indiana Health Information Exchange.

“The concept of a longitudinal healthcare record should reflect the patient’s experience across episodes of care, payers, geographic locations and stages of life,” Branzell and Christian said. “It should consist of provider-, payer- and patient-generated data, and be accessible to all members of an individual’s care team, including the patient, in a single location, an invaluable resource in care coordination.”

“Foundational to coordinated care is the need to accurately match patients with their healthcare data across providers, systems and states,” the letter continues.  The industry must embrace the idea of a widely-heldpatient identification process, such as a national patient identifier, to ensure that matching and synthesis of data across different healthcare systems is conducted in a secure, accurate, and meaningful way.

“A longitudinal healthcare record, supported by widely adopted standards, also should improve a patient’s ability to manage consent privileges and diminish privacy concerns related to the digitization of personal health information (PHI),” the authors add.

As well as considering the use of a national patient identification system, the healthcare industry must retool its approach to telehealth, starting by addressing the convoluted patchwork of state and regional regulations that make it difficult for providers to deliver remote care.

“Hospitals and health systems are embracing the use of telehealth technologies because they offer benefits including the ability to perform high-tech monitoring without requiring patients to leave their homes, which can be less expensive and more convenient for patients,” CHIME says.

“Yet whether public and private payers cover telehealth services and adequately reimburse hospitals and other health care providers for providing those services, is a complex and evolving issue and, as a result, a possible barrier to standardizing the provision of these valuable services.”

CHIME asks Congressional leaders to take an active part in revising regulations that restrict the delivery of telehealth services according to geographical boundaries.  While parity laws that require private payers to cover remote care services are reaching a growing number of communities, licensing concerns and sluggish Medicare payment approvalare restricting the way providers can extend chronic disease management services to rural populations, homebound patients, and those who find it difficult to travel to a care location on a regular basis.

Telehealth can also be an important strategy for improving patient engagement, Branzell and Christian continue.  “One of the most common limitations of physical presence healthcare is time,” the letter says. “Providers’ time limitations have been well documented, while patients’ time pressures can lead to forgotten questions and concerns.”

The use of asynchronous telehealth communications, which allow patients and providers to communicate at their leisure, might help to make the care experience more satisfactory and comprehensive for patients who feel flustered by the clinical environment.  This may lead to more meaningful contact with the healthcare system for those patients with ongoing chronic care needs, CHIME predicts.

Remote monitoring can provide another strong link between patients and their providers, the letter continues, and may become increasingly vital to the care process as healthcare’s Internet of Things becomes a daily realityfor more and more patients.

“The adoption of remote monitoring technologies has increased, especially as the market for fitness trackers and wearable devices continues to thrive,” say Christian and Branzell. “Providers are increasingly prescribing remote monitoring in the care plans of both patients with acute and chronic conditions. Thus, the need to address the technical complexities is even more important.”

Congress should develop and promote policies that encourage the high level of health data interoperability and adoption of data standards that are necessary to provide a foundation for the big data analytics that will make remote monitoring worthwhile for chronic disease management, CHIME concludes.  The Committee should also seek ways to continue integrating meaningful use and other current initiatives into the ongoing process of regulating and fostering population health management across the evolving continuum of care.

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By Kyle Murphy, PhD on May 26, 2015

More good news! The telehealth adoption section of the 21^st Century Cures Act is pending review from the House of Representatives.

After receiving the unanimous support of the House Energy & Commerce Committee, the 21st Century Cures Act now awaits the consideration of the entire House of Representative, including its provisions for expanding use of telehealth services for Medicare beneficiaries.

The purpose of the introduced legislation (HR 6) is “to accelerate the discovery, development, and delivery of 21st century cures, and for other purposes” and telehealth falls under the third category of delivery along with interoperability and continuing medical education for physicians.

Chief among its telehealth provisions, the 21st Century Cures Act calls on the head of the Centers for Medicare & Medicaid Services (CMS) to provide Congress with reports on four areas.

The first would comprise an account of Medicare beneficiaries “whose care may be improved most in terms of quality and efficiency by the expansion … of telehealth services under section.” The second would provide an account of the work by the Center for Medicare & Medicaid Innovation on telehealth adoption and use. The third would detail high-volume procedure and diagnostic codes that “might be suitable to the furnishing of services via telehealth.” The last would identify barriers in the way of expanding telehealth services.

CMS would be required to furnish Congress with information in a year’s time following the enactment of the proposed bill. Through the bill, Congress would seek similar information from the Medicare Payment Advisory Commission (MedPAC).

The remaining telehealth-related components of the 21st Century Cures Act provide insight into the federal government’s vision for the future of telemedicine.

First, Congress indicates that states need to address provider licensure through the use of “common licensure requirements services in order to facilitate multistate practices and allow for health care providers to provide such services” in multiple states.

Second, the proposed bill identifies the physical location of the patient receiving services in determining appropriate licensing.

Third, Congress looks to expand eligible originating sites.

Lastly, the 21st Century Cures act specifies how the Medicare program should go about expanding telehealth services:

(A) recognize that telemedicine is the delivery of safe, effective, quality health care services, by a health care provider, using technology as the mode of care delivery;

(B) meet or exceed the conditions of coverage and payment with respect to the Medicare program under title XVIII unless specifically address in subsequent statute, of such Act if the service were furnished in person, including standards of care; and

(C) involve clinically appropriate means to furnish such services.

The most current version of the proposed bill does little to address the criticism of the likes of the American Telemedicine Association which recently found fault with its plans to commission another series of reports rather than adopting new measures.

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A combination of providing higher quality of care and lowering organizational cost is what Bedford Nursing & Rehabilitation Center (BNRC) based in New Hampshire will accomplish by using remote patient monitoring technology.  

By Vera Gruessner on May 20, 2015

Remote monitoring tools could impact the healthcare sector in a variety of ways from reducing hospital readmissions and improving health outcomes to lowering costs and advancing quality care improvements. Bedford Nursing & Rehabilitation Center (BNRC) based in New Hampshire is one such organization that has seen the potential within remote monitoring tools.

BNRC has recently partnered with Geneia to adopt an analytics platform and remote monitoring tools to improve the quality of care across their facility. mHealthIntelligence.com spoke with John Turcotte, President and CEO at BNRC, and Deb Harpin, Director of Admissions at BNRC, to learn more about their remote monitoring implementation plans.

“For about 30 years beginning in the early 1980s, our facility had been operated by 3^rd party operators,” John Turcotte began. “We reassumed control last September in large part because – the facility has been good to my family, we have a lot of committed staff, and we felt we owed an obligation to our resident populations. Our goal over the next few years is to rehabilitate the facility. We’re excited about this partnership opportunity with Geneia because it offers us the potential to bring the facility and care to a state-of-the-art level.”

When asked why they felt remote monitoring technology was right for their organization, Deb Harpin explained, “When we started looking at Geneia and what the technology had to offer, we were sitting down and trying to decide who and what we wanted to be. Ultimately in everything we’re doing right now, we want to be able to provide the highest quality of care possible at the lowest cost.”

“The remote monitoring coupled with the analytics platform gives us a powerful tool to lay a strong foundation for the focus of highest possible quality care at lowest cost for our residents,” Harpin continued.  “It gives us a lot more opportunity to manage both our short-term and long-term population that are admitted into the facility. We’re seeing a lot more with our chronic diseases, congestive heart failure, diabetes and the comorbidities that go with these conditions. The monitoring is allowing us to intervene earlier and ultimately prevent costly hospitalizations.”

When asked what Turcotte and Harpin hope to achieve at Bedford Nursing from implementing the remote monitoring tools, Harpin spoke about having real-time access to data and trends about the facility’s patients. Having the tools necessary for more powerful analysis will lead to better care and lower costs across their organization.

“A lot of the information is there. The vital signs are being taken on a regular basis. Blood sugar is being taken on a regular basis. It’s taking a human to sit down and integrate all of the data from our clinical system, our pharmacy data, lab data, and vital signs. It’s relying on somebody physically doing the analysis. This is going to give us a really strong tool to do a lot of this analysis. It’s never going to replace the nurse or the MD, but it’s going to provide a lot more power to what they’re able to do.”

“The other advantage of the system is that these metrics get assembled in real-time,” Turcotte added. “We’re gathering all the information but it doesn’t get assembled into a single point until a later time when our staff has the opportunity to put it altogether. This system gathers all the information electronically and puts it in a single format.”

“We have a current resident here who’s 76 years old, has atrial fibrillation, congestive heart failure, diabetes, hypertension, and dementia,” Harpin spoke about a patient. “Having been her nurse prior, she’s alert, she’s conversant, but not able to articulate when she’s experiencing an episode of atrial fibrillation or breathing difficulty. The real-time data and clinical alert settings show if her congestive heart failure may be exacerbating. We’re going to be able to intervene clinically before it becomes anything acute.”

When asked whether they predict hospitalization rates to decrease and health outcomes to improve after integrating the remote monitoring tools, Harpin confirmed, “Absolutely. We’re going to be able to intervene earlier and not all of our folks are able to tell us when they’re experiencing something. In a skilled nursing facility, you don’t have the same state of the art technology that a hospital will have.”

Turcotte added that, “Typically, in a hospital, you have this type of monitoring going on constantly. Traditionally, skilled nursing facilities are not set up to provide that constant degree of monitoring because our residents are not bedridden as most people are in a hospital. This mobile technology allows us the flexibility to do more consistent and constant monitoring in a fragile population where that opportunity has not existed previously.”

Harpin spoke further about their plan to reduce healthcare costs throughout their facility with the implementation of the analytics platform.

“Our key set of metrics will help us identify what we are spending for the treatment of each person,” Harpin explained. “The goal is to lower costs. We’re a fairly low-cost provider for our area but I think we have a lot of room for improvement. Across the board, we’ll be able to look at the balance of high quality versus low cost.”

The Admissions Director concluded by discussing the implementation plans for both the Geneia analytics platform and the remote monitoring tools.

“We’re working right now on a plan for kicking off the implementation,” She continued. “We’ll be starting in late May/early June. We’re going to phase in. Our initial plan is to focus on the analytics platform and getting that integrated. We’re using Point Click Care for our clinical data, a separate system houses our pharmacy data, Therapute for therapy-related data, and Medicare data sets. This is going to give us the ability to integrate all of that into a single repository where we can identify our metrics and cost saving opportunities.”

“Once that is set, we will look at integrating the @home remote monitoring platform and the kits that go with that,” Harpin concluded. “The kit comes with a Samsung tablet. Each kit has some type of wireless technology tablet to report everything. It has a blood pressure monitor that transmits data wirelessly, an oxygen saturation machine for tracking oxygen, a scale for weight, and the bio-patch for heart rhythms and EKGs.”

BNRC and Geneia expressed excitement about the possibilities and benefits that will result from this new partnership.

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We are thrilled to announce that IdealLIFE expands their product portfolio with the new Nonin Model 3230 Bluetooth Smart wireless pulse oximeter. This latest telehealth platform addition provides Dr. Miltie Remote Patient Monitoring (RPM) users more easy-to-use health management solutions.

MINNEAPOLIS, April 30, 2015 PRNewswire — Nonin Medical, Inc., the inventor of finger pulse oximetry and a leader in noninvasive medical monitoring, today announced it has partnered with IDEAL Life, a Toronto-based leader in remote health management solutions. IDEAL Life will integrate the Nonin Model 3230 Bluetooth® Smart wireless finger pulse oximeter into its latest telehealth platform. The IDEAL Life system remotely monitors the oxygen saturation and other vital signs of chronic illness patients at home, then transmits the data to the hospital or clinic.

“More than ever, the healthcare industry is striving for measurable improvements in societal health and wellness,” said Jason Goldberg, IDEAL Life president. “We focus on keeping healthcare professionals connected to their patients by delivering solutions that leverage high quality products and services. The latest is the Model 3230 Bluetooth® Smart Pulse Oximeter from Nonin Medical, a high quality partner in medical sensing, with high quality products.”

“Nonin Medical is thrilled to partner with IDEAL Life to help reduce health costs, improve the quality of people’s lives and prevent rehospitalizations,” said Mark VanderWerf, Vice President of OEM and mHealth for Nonin Medical. “IDEAL Life recognizes that not all pulse oximeters perform alike. Accuracy does matter when remotely monitoring patients with chronic illnesses who need to frequently, easily and reliably measure their blood oxygen saturation levels from home.  Unlike health and wellness oximeters, the 3230 is a cleared medical device that provides the accuracy and performance standards required for clinical use,” VanderWerf said.

Model 3230 advantages include:

• Bluetooth® Smart (low energy) wireless technology, which provides long battery life and simplified pairing with quality systems like IDEAL Life
• Nonin’s clinically proven PureSAT® pulse oximetry technology, which utilizes intelligent pulse-by-pulse filtering to provide precise oximetry measurements—even in the presence of motion, low perfusion or other challenging conditions
• Nonin’s CorrectCheck™ technology, which provides digital feedback when the patient’s finger is placed incorrectly in the device
• Nonin’s SmartPoint™ capture algorithm that automatically determines when a high quality measurement is ready to be wirelessly transmitted to help improve accuracy

The Nonin Model 3230 Bluetooth^® Smart Pulse Oximeter won the Bluetooth Breakthrough Award in 2014. More information about the device can be found at http://www.nonin.com/presskits. The 3230 will be demonstrated May 2-5, 2015 at the American Telemedicine Association (ATA) 2015 show at the Nonin Medical booth (#1608); the integrated system will be demonstrated at the IDEAL Life booth (#1309). For more information about ATA 2015, visit http://www.americantelemed.org/ata-2015.

About Nonin Medical, Inc.

Nonin Medical, Inc. invented the finger pulse oximeter and is a leader in designing and manufacturing noninvasive medical monitoring solutions that meet customers’ technology needs today and tomorrow. Headquartered in Plymouth, Minn., USA, with an additional customer service center in Amsterdam, the Netherlands, Nonin Medical sells its pulse and regional oximeters, capnographs, sensors and software to health professionals and consumers in more than 125 countries. The company also has more than 200 OEM partners worldwide. For more information, visit www.nonin.com.

About IDEAL Life

IDEAL Life, an industry leader in remote health management solutions, has created an innovative platform that addresses many of today’s most challenging and costly healthcare issues. Guided by a medical advisory panel of experts, the IDEAL Life program makes proactive prevention more realistic than ever as it is instrumental in gauging health issues before chronic conditions manifest themselves into acute events. For people managing chronic illnesses such as congestive heart failure, hypertension, diabetes, asthma or obesity, IDEAL Life provides relevant, real-time, reliable and actionable data from a person either at home or while on the go. It delivers interactive, personalized communication to incorporate feedback to the knowledge base, allowing individuals to become more engaged and active participants in their own health.

The easy-to-use IDEAL Life system utilizes digital, wireless, secure two-communication, allowing for a more personalized and cost-effective wellness experience. The FDA-cleared and HIPAA-compliant system has, for example, been proven to reduce congestive heart failure hospital admissions by 57 percent, demonstrating they can significantly reduce healthcare costs. For more information, visit www.ideallife.com.

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Optimistic strides are being taken by the Senate Commerce Committee to enable Medicare reimbursement for telehealth services.

April 22, 2015 by Alex Ruoff

After years of pushing for higher levels of Medicare reimbursement for physicians providing telehealth services and tracking their patients’ health via remote patient monitoring tools, technology advocates say they’re finally expecting some significant wins this year.

Following a Senate Commerce Committee hearing where lawmakers said they plan to introduce legislation that would expand Medicare reimbursement for telehealth services, the head of one of the telehealth industry’s largest trade groups, the Americanhttps://drmiltie.com/blog/?p=1033&preview=true Telemedicine Association, told me telehealth issues have garnered more support than ever in Congress.

“There is certainly greater interest in telehealth now than I have ever seen,” Jonathan Linkous, chief executive officer of the ATA, said. “I would say 10 or 15 years ago I would have been absolutely tickled if I could get a single senator to write a letter or even meet with me.”

Medicare has tight purse strings for telehealth: the program paid providers less than $12 million for telehealth services last year, according to the Robert J. Waters Center for Telehealth and e-Health Law.

Sens. Roger Wicker (R-Miss.) and Thad Cochran (R-Miss.) will later this year reintroduce the Telehealth Enhancement Act, Wicker said during the hearing. Previous versions of the bill would have authorized accountable care organizations covered by Medicare Advantage plans to be reimbursed for providing telehealth and remote patient monitoring services and expand the number of hospitals nationwide eligible to receive Medicare reimbursements for telehealth services.

Telehealth advocates said earlier this month they were pleased that the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2), better known as the bill that permanently repealed the SGR, removed some restrictions on Medicare payments for telehealth services under certain alternative payment models.

Additionally, Linkous said he expects that the House Energy and Commerce Committee’s 21^st Century Cures legislation, expected to be unveiled later this month, will include “some telehealth language,” but he wasn’t sure what it would be.

Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.

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