The Landscape: As the U.S. population ages and the number of patients with chronic conditions continues to rise, hospitals are beginning to leverage remote technology to improve care post-discharge and cut down on avoidable hospital readmissions. In addition, rural areas with increasingly limited access to specialists are using telemedicine to provide care without transporting patients from small, critical care hospitals into the larger cities.
The Future: As healthcare reform begins to change the payment structure, episode of care reimbursement will provide the push for hospitals to increase their chronic care management programs. The cost of technology for in-home monitoring is rapidly dropping, and patients will begin to play a greater role in managing their own care. In addition, Washington's pledge to increase the national network infrastructure means that rural areas will have better, faster connections to link specialty services to the cities, and the use of telemedicine for specialty services like telepsychiatry, telestroke and wound care may rise.
Changes from Washington are coming. Though many areas of telehealth, like e-ICUs, have seen steady growth in recent years, many believe a slew of different initiatives lumped under ARRA are going to provide the push to make these technologies more mainstream.
In rural areas, for example, Rural TECH (Telemedicine Enhancing Community Health) Act of 2009 aimed to increase the use of telehealth technologies like video conferencing to connect medical experts with providers, facilities and patients, and provide critical health services and education. The Act created three telehealth pilot projects to analyze clinical health outcomes and the cost-effectiveness of telehealth systems in medically underserved communities.
“We do not have a shortage of specialists, we have a disproportionate distribution of specialists,” says Gregg Malkary, founder of Menlo Park, Calif.-based Spyglass Consulting Group. “They're all in the cities.” Today, telemedicine systems such as Netherlands-based Phillips Visicu e-ICU - already in use in many small critical care hospitals - are linking city-based specialists to rural areas and allowing patients to receive care without leaving their communities. And most say that as infrastructure improvements abound, the trend will continue to grow.
According to Marc Holland, principal in the New City, N.Y.-based System Research Services consulting firm, ARRA provisions state that by 2011, the National Coordinator for Health IT (currently David Blumenthal, M.D.) is obliged to present recommendations to the Senate in this area. “There's a billion dollars for improving the broadband infrastructure in this country,” says Holland, “and telemedicine was cited as part of that push.”
In total, the USDA has awarded more than $1.5 million in Rural Utility Service (RUS) grants to hospitals around the country to fund expansion of e-ICU critical care services to rural communities. ICU telemonitoring programs are closing the coverage gap as physicians and critical care nurses, staffed 24/7 at an e-ICU hub, can now assist bedside caregivers in the diagnosis, treatment and management of critically ill and trauma patients.
“We're seeing an increased demand for specialists and certainly not a growing supply,” says Ken Lawonn, senior vice president and CIO at Alegent Health in Omaha, Neb. “What we're seeing is building out a better network infrastructure for higher speed connections between the smaller communities so we can do some things that are above and beyond what you can do on low speed connections.”
Alegent is currently using Visicu's e-ICU technology to monitor 120 beds in eight locations, and Lawonn says the plan is to expand further. “We're working on a plan to offer it to non-Alegent small critical care hospitals,” he says. “We think it would provide not only better care and some revenue, but also provide a connection with the community and help with referrals - we do have some competition in the area.”
While e-ICUs have experienced early popularity, the scarcity of rural specialists is having an effect on other telemedicine initiatives as well. The Atlanta-based Centers for Disease Control, for example, recently awarded a three-year grant to the Louisiana Department of Health and Hospitals Heart Disease and Stroke Prevention Program to build a telestroke network in collaboration with Ochsner Health System and the American Heart Association.
Ochsner, a seven-hospital system based in New Orleans, plans to utilize Reach Call's (Augusta, Ga.) telestroke and telehealth services to improve stroke care in urban and rural areas throughout the state by connecting neurologists with patients. The aim? To develop a regional TeleStroke Network in southeastern Louisiana that will address the lack of access to stroke neurologists and availability of stroke-treating hospitals in the state.