Telemedicine and the Underserved Community

This week I had the pleasure of sharing a podium with Dr. Garth Graham, the Deputy Assistant Secretary for Minority Health in the Department of Health and Human Services. We spoke at the annual meeting of the Health Information Management Systems Society in a session titled: “Underserved Communities and the Health Information Technology Landscape – the Necessity for Partnership.”

Dr. Graham pointed out the critical healthcare issues facing underserved and minority communities and the work of the National Partnership for Action to End Health Disparities. More information is available on this initiative at http://minorityhealth.hhs.gov/.

I spoke about the potential role of telehealth in addressing some of these issues. This came out of previous discussions with the Office of Minority Health and a special meeting they sponsored on this issue several weeks ago.

It seems to me that three facts frame the issue:

1. Minority populations suffer from a number of chronic diseases at a disproportionate rate. A few examples:

• African Americans are about twice as likely to have diabetes.
• Hispanic Americans have a higher prevalence of diabetes.
• African Americans have 4.5 times more asthma-related emergency room visits.
• African American men are 30% more likely to die from heart disease.

2. For a variety of reasons, minorities have more difficulties accessing quality health care. Notable reasons include: cost; accessibility to the work place or home; travel time and language.

3. This lack of regular access to health provider is an important factor leading to greater use of emergency room visits for non-emergency conditions. The average use of emergency room visits is more than double for minorities. The average visit to an emergency room costs about $1,000 in 2007 so paying for avoidable emergency room visits has reached crisis proportions for health insurance payers, American tax payers and for those who must pay out of pocket for their health care.

So, how can telehealth help? Study after study has concluded that remote monitoring can spot health problems sooner, reduce hospitalization and use of emergency rooms, improve life quality and save money.

• A meta analysis of research studies related to the use of remote monitoring for congestive heart failure concluded that the use of remote monitoring resulted in a 27%–40% reduction in overall admissions.
• The study authored by VA national telehealth staff members, looked at health outcomes from 17,025 VA home telehealth patients. The results show that when home telehealth was used, there was a 25% reduction in the average number of days hospitalized and a 19% reduction in the number of hospitalizations for patients. The data also shows that for some patients, the cost of telehealth services in their homes averaged $1,600 a year which is lower than in-home clinician care costs.
• A study of 281 congestive heart failure patients who received telehomecare found that they experienced a 60 percent reduction in hospital admissions, a 66 percent decline in emergency room visits and a 59 percent reduction in pharmacy utilization. In contrast, the control group experienced increases in all of these areas.

Using telehealth to overcome such disparities requires a change of thinking for many U.S. policy makers.

One of these changes is recognizing that telemedicine is not just a rural solution. Historically, government grants and program targets have only supported telemedicine services for those living in rural and remote areas. Such a policy may have been appropriate when telemedicine was first established. However, times have changed. Medical devices have become cheaper, better and smaller. So too have telecommunications services. The growth of cell phones and small health monitoring devices have matched the growth in older and chronically ill populations.

Another is recognizing and paying for remote health monitoring. While recognized as an important component in the delivery of health services for veterans and other covered populations, Medicare still has resisted any effort to encourage and pay for remote monitoring as part of covered home health services.

Of course telehealth will not solve all of the problems related to the underserved. But it is a critical tool. The evidence is in, the need is well documented and the conclusion is self evident. Using telehealth to help meet the needs of all underserved populations should be a priority for the U.S. as well as all governments.