As I mentioned in last week’s blog item previewing the American Telemedicine Association meeting in Baltimore, I was interested in going because it seemed to me that large health systems are taking telehealth more seriously as they move toward value-based purchasing and accountable care. For instance, several of the sessions had to do with using telemedicine to prevent re-admissions.
I was not let down. Although I was sorry I could attend only one day of the conference, it was obvious to me from the presence of execs of Kaiser, Intermountain, Mayo Clinic, Partners Healthcare, University of Michigan Health System, just to name a few, that telehealth is definitely becoming more mainstream. (Although I also wish there had been more CIOs and CMIOs in attendance. They need to be in on the discussion, because integrating telehealth with EHR and other clinical systems and work flows is crucial to success.)
Here’s one example: Both Kaiser and Cleveland Clinic announced plans to work with a relatively new company, called HealthSpot. Cleveland Clinic and HealthSpot will form a joint venture that will offer patients alternative options to access healthcare through HealthSpot's virtual walk-in kiosks. The HealthSpot station's two-way high-definition video screen delivers a face-to-face experience between patients and medical providers. An array of digital medical devices embedded in each unit — stethoscope, scale, blood pressure cuff, pulse oximeter, thermometer, otoscope and dermascope — streams medical information to the provider and patient in real time.
One great panel session I attended focused on how some health systems are scaling up virtual visits. Sandhya Pruthi, M.D., medical director of patient experience and connected care innovation for the Mayo Clinic, spoke about her experience creating a pilot “Virtual Breast Center” that has provided education, risk assessment, and consultation for patients at high risk for breast cancer in Alaska. Dr. Pruthi got licensed to practice in Alaska, and worked in partnership with the Alaska Federal Health Care Access Network. The model included a navigator to facilitate patient encounters (referrals, electronic records, and scheduling) and a subscription-billing contract. In 2011, 60 consultations were provided to the Alaska Native Medical Center, and patient and provider impressions of the service were very good, she said. As Mayo moves forward with more virtual visits to the home for followup care, state licensing issues may be a problem, she added.
Ray Dorsey, M.D., a professor of neurology and co-director of the Center for Human Experimental Therapeutics at the University of Rochester Medical Center, said the healthcare field is moving to virtual visits because the status quo doesn’t work. “The way we provide care doesn’t work. It is not timely, equitable or efficient.” For example, he said, more than 40 percent of Medicare beneficiaries with Parkinson’s disease don’t see a neurologist regularly.
Virtual visits allow providers to offer care directly in the home. He says research has shown that virtual care saves hundreds of miles and hours of travel and is comparable in clinical outcomes to clinic visits. With grant funding from PCORI, he is expanding the research across the country. (For more information, go to http://connect.parkinson.org.) “There is a huge amount of latent demand," Dorsey added. "Every patient should receive the care they need, and the same should hold true for patients with any chronic condition. We just need the will and creativity to make it happen.”
Michael Carter, enterprise manager of media and telemedicine systems, at Partners Healthcare’s Center for Connected Health, talked about the changing business requirements involved. Partners will do 2,000 virtual visits this year in fields ranging from psychiatry to Crohn’s disease and colitis. For those starting out, he recommended focusing on specialties where the waiting room experience is problematic, such as working with autistic children.
Paul Penta, WebCare program manager at the Joslin Diabetes Center, stressed focusing on work flows. “You need to understand the current work flow to integrate a new one,” he said. “We were not set up to see patients virtually. There was a long learning curve. We first did a usability pilot just to see the bugs, then iterated.”
Mayo Clinic’s Dr. Pruthi said it is difficult to find physicians who can engage patients in a video consultation. “A patient can tell if the provider is bored,” she said. “You have to build the relationship in the first two minutes. We don’t teach physicians how to build rapport over a video screen and not everyone can do it.”