I will no longer say “turning the corner” when it comes to telemedicine

For years we talked about reaching the point when telemedicine services became self-sustaining outside of temporary grants, going from promise to reality. We have long passed the point of telemedicine being a new application. After eighteen years the corner is turned and I promise to put that phrase away. This is what I mean about the reality of telemedicine:

• There are areas where remote health services have made a measurable difference in healthcare. At least half of the 5,000 U.S. hospitals are using teleradiology or other forms of remote imaging and the leading firm in this space, Virtual Radiologic, provided over 7 million reads last year. The Ontario Telehealth Network manages over 100,000 live physician-patient video consults a year for a variety of specialty and primary care services. The MedTrix Group provides 10-12 thousand video-based pediatric consults per month for the largest HMO plan in the Israel. The U.S. Veterans Administration is using remote health monitoring for 55,000 veterans.
• Revenue generated from telemedicine has resulted in profits for independent service providers and is a self-sustaining business within some healthcare delivery systems. For example, Epocrates, an online and mhealth drug interaction application is used by 1.3 million health professionals including 45% of U.S. physicians and reported a first quarter profit for 2011 of $3.7 million.
• Medical systems are integrating remote health care into the normal delivery of care. A recent survey of Washington, DC hospitals found that every hospital in the metropolitan area was using one or more telemedicine application as part of their normal delivery of health care for area residents. For example, to reduce time to catheterization , EKGs are transmitted from the ambulance to cardiologist’s cell phones at the George Washington University Hospital prior to arrival at the emergency room.

I tire of talk about needing to "prove the case." The argument that telemedicine is too new and needs more research falls away when looking at a list of a few other medical innovations that emerged around the same time or later than telemedicine (1960s-70s) and are now fully in use and reimbursed by most payer organizations including Medicare:
• Arthroscopic surgery
• CAT Scans
• Cochlear implant surgery
• Controlled drug delivery technology
• Deep-brain electrical stimulation
• Implantable cardioverter defibrillator (ICD)
• Laser surgery on human corneas
• Magnetic resonance imaging
• Permanent artificial heart implants
• Soft contact lenses

Global Opportunities for Telemedicine

Over the past year ATA has increased its presence and its role internationally. This reflects the transformation of both the market and practice of telemedicine. The mission of ATA is to be an advocate and a voice for telemedicine with government and other bodies, provide education, promote research and establish standards. This remains the priority and core responsibility of the organization. However, as telecommunications breaks through the walls of health institutions, crosses the barriers of distance and goes across state lines, so too is telemedicine starting to traverse international boundaries. The United States is not alone in deploying telemedicine. In fact, other countries have been investing millions of dollars in the development of telemedicine services and networks. Their knowledge and experience are critical to the growth of telemedicine everywhere.

ATA’s corporate, institutional and individual members now come from 50 countries. Our meeting is truly international in attendance and with the presentations. The interests of many of ATA’s U.S.-based members are international. So it is no surprise that one of the priorities of ATA’s current President, Dr. Dale Alverson has been to look at opportunities for ATA to build international bridges.

I am writing this from Xiamen, China where, as a guest of the China Ministry of Health, I addressed the Ministry’s annual conference on health information technology. I am a lucky substitute for ATA Past President Karen Rheuban who had a scheduling conflict. There are over 1,300 people in attendance and include health administrators from China’s 31 provinces as well as from the national government, major hospitals, and leading technology vendors. China is starting to invest billions of dollars in improving health care delivery to its 1.9 billion people and the national government is playing a much stronger role. At the meeting, the China Ministry of Health revealed its next 5 year plan for health care which includes building a nationwide broadband backbone to support healthcare delivery including telemedicine.

A month ago, four of us representing ATA were invited to attend and speak at a health care conference sponsored by the Tehran University Medical School in Iran. Despite the current political differences between the U.S. and Iran, it is clear that there is a real and sincere interest to learn from each other about ways to use telemedicine to provide services to the most in need. The visit was an important opportunity to start to build bridges with the health providers in that nation.

These are not isolated activities. Many ATA board members work extensively with other countries providing technical assistance and providing direct health services using telemedicine. Over the past year, ATA President Alverson has traveled to Korea, India and Nepal to speak about his experiences in deploying telemedicine in New Mexico and has been working in Ecuador to improve their use of remote care. ATA has established a Virtual International Resource Center and have started developing Memorandums of Agreements with various organizations outside of the U.S. We have two international Chapters and an International Special Interest Group.

So where do we go from here? That is a question that will be discussed by the board of ATA as well as our members in the year ahead. We remain the American Telemedicine Association but it is clear that ATA has become international already and cannot ignore the developments in the world around us. It is important to seize the opportunity to learn and work with the global community as we all seek to use telecommunications to improve the healthcare of mankind.

Ford Produces an Electronic Health Record for Cars

Car owners can now get a text message of their car’s health. Why can’t we get something similar for ourselves?

The Ford Motor Company offers an option for car owners to develop and track a VHR – Vehicle Health Report for several of its models. The data links to a website, http://www.syncmyride.com/ using the customer’s Bluetooth-paired and connected mobile phone.

A comprehensive report is generated from the vehicle data that includes system information and uses diagnostic software to generate recommended actions for any vehicle warning indicators, open recalls, scheduled maintenance, and unserviced maintenance and wear items from previous dealer visits.

Users can select to receive a text message or e-mail when their report is ready. They can print the report, e-mail it to others or, in one click, be at their preferred dealer’s Web site with their health report information waiting to schedule service online. Depending on the user’s preference settings, SYNC can also deliver a text message alert to the user’s cell phone if a severe issue exists with one of the SYNC-monitored systems.

A sample VHR is available at http://www.syncmyride.com/Own/Modules/VHR/vhr_pdf_sample.pdf.

Here is the bottom line:

1. We now have access to better, faster and more consumer-firendly information including automated diagnostics for our car than for ourselves.
2. Most of the current HIT hullabaloo focuses on agreeing on a simple electronic health record that is still primarily intended for use by a health professional, that is mostly only for static data and without any built-in capabilities for decision-support diagnostics.
3. Electronic medical record? Electronic health record? Personal health record? We can’t even agree on a name.

Efforts to move forward have been stopped in their tracks with statements such as: "you don't understand how complicated this is" or "we need to make sure privacy is completely protected" or “we need to make sure it is compatible with every other system” or "we need to investigate the ownership of the medical data." Many say an electronic health record can't be done without millions of government dollars and years of work.

Yet somehow Ford, the company that almost went out of existence last year, came up with a solution!

Of course, this is not the first time the problems of developing an interoperable, consumer-friendly and secure record were overcome. Years ago the financial industry linked together worldwide interbank networks, which are the magic behind ATMs. They are interoperable, work consistently with a very high level of privacy and security and developed with the consumer in mind.

Finally, it is interesting to point out that the ATM networks and now VHRs were implemented without years of government investigation, research and incentives.

Telemedicine, Telehealth, Remote Monitoring and the Latest Congressional Health Reform Proposal

This week, the United States Senate Finance Committee announced its proposed health reform bill. This is the last of five proposals in Congress (two in the Senate, three in the House) to come forward. The proposals in the House are being combined into one bill and the same will probably happen in the Senate. Although it has already come under attack by many groups, the Finance Committee proposal, put forward by Sen. Max Baucus (D-MT), has been touted as having the best chance of actually going forward. So it’s important to take a look at the provisions and how they affect many of the areas of interest to ATA members.

The Finance Committee issued a document that describes the proposed bill in relatively plain language. It’s available at http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf.

The comments and referenced page numbers here are based on this document.

Much of the bill takes a broad approach to health reform; financing, insurance options, etc., and it rarely gets into specifics on coverage issues. So it’s not surprising that the bill does not include the specific recommendations put forward by ATA. Nor does it include some telemedicine provisions that are included in the House bill, such as the establishment of a Telehealth Advisory Committee. But it does address many areas directly related to the use of telecommunications technology and health and opens the door for more specific provisions that might get added later.

• The bill calls on the federal Center for Medicare and Medicaid Services (CMS) and other parts of the Department of Health and Human Services (HHS) to compile data and launch pilot programs designed to reduce hospital readmissions. It is widely recognized that the use of remote patient monitoring is a safe and effective approach to reducing such readmissions. It gives the Secretary of HHS, working with a newly proposed Innovations Panel, the authority to include readmission rates as part of an incentive payment policy for health institutions. Language beginning on page 97 of the document addresses recommendations made by the Medicare Payment Advisory Committee (MedPAC) about readmissions. The bill calls for immediate data collection and enforcement actions related to this issue starting in 2012. As part of this approach, language on page 99 also calls for a new “Transitional Care” pilot program with an authorization of $500 million over three years. Remote monitoring is not specifically mentioned but the examples provided of appropriate services could lead one to conclude that remote monitoring is a logical approach.
• In setting up a new CMS Innovation Center (page 90) the bill directs the Center to test models of delivery that include the use of care-coordination for the chronically ill and the use of home telehealth technology. In each of the models to be evaluated, the bill calls on the Center to include “patient-based remote monitoring” as one of the approaches it tests in developing patient-centered delivery and payment models.
• Under Title II – Promoting Disease Prevention and Wellness, (page 69) the bill provides that Medicare beneficiaries would have access to a comprehensive health risk assessment by 2011. “The assessment could be provided through an interactive telephonic or web-based program or during an encounter with a health professional. The Secretary would also set standards for the electronic tools that could be used to deliver the assessment.”
• A Workforce Advisory Committee would be established (page 107) to address issues of provider shortages. The Committee is to develop a national strategy to address the issue. The language refers to the role of health information technology in addressing such needs.
• The bill endorses the use of a medical home (page 77) and includes references to using health technology to link services and the provision of service virtually.
• Demonstration Projects on Culture Change and use of Information Technology in Nursing Homes are proposed (page 183). The bill would require the Secretary to conduct two demonstration projects for nursing homes: (1) for the development of best practices for facilities involved in culture change; and (2) for the development of best practices in facilities for the use of information technology to improve resident care. The Secretary would be required to submit a report to Congress after completion of the demonstration projects. The report would evaluate the projects and make recommendations for legislation and administrative actions. The demonstration projects cannot exceed three years.

Much work remains and there are still opportunities to add or change certain provisions. Such provisions might be in the form of amendments to the bill in Committee, on the Floor of the Senate, in conference with the House or in report language that would accompany the Senate bill or the final joint bill. Also, language already in the consolidated House bill relating to telemedicine may be expanded and inserted in the Senate bill.

Stay tuned.

Telemedicine and Health Reform: a little progress, a lot of hope

Over the past few months you have heard a lot from ATA about the various machinations going on with national health reform. Starting out with high hopes we have witnessed the usual highs and lows of the legislative process. ATA has promoted a broad expansion of governmental support for telemedicine, only to have parts of it dashed by a few parties that refuse to consider what telemedicine can do for cost savings and improved quality of care. However, most of our problems are that telemedicine is lost under the shouting and publicity around the overall costs of health reform.

However, telemedicine has a lot of friends in high places.

Yesterday, the Federal Communications Commission held a workshop on healthcare and broadband. It amounted to a love fest for telemedicine. President Obama's Chief Technology Officer, Aneesh Chopra, gave a strong close. He stated: “We can’t move forward in advancing our nation’s health reform goals without the appropriate use of technology and telemedicine is a key component.” He went on to recount personal experiences and his perspectives on how critical telemedicine can be for the nation. Clearly, Chopra gets it.

In addition to Chopra, three important members of ATA were asked to speak at the meeting: ATA President Karen Rheuban, ATA President-Elect Dale Alverson and Chair of ATA’s Standards Committee Nina Antoniotti. All three gave outstanding presentations. Details of the meeting and a recorded version of the webcast are available at: http://www.americantelemed.org/i4a/pages/index.cfm?pageID=3337#updates