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Putting Teleservices in Care Pathways

October 15, 2013
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Innovators adding mobile apps, remote monitoring to patient engagement toolbox, CSC researchers say

With so much on their plates — from meaningful use to ICD-10 — are there good reasons that CIOs and CMIOs should turn their attention to a whole new range of telehealth services on the horizon?

Yes, say two researchers from CSC. In a recent white paper, Jared Rhoads, a senior research specialist with CSC’s Global Institute for Emerging Healthcare Practices, and Clive Flashman, a global healthcare industry strategist with CSC, argue that an array of nascent technologies from social media and mobile computing devices to mobile medical devices may be crucial to providers seeking to improve patient engagement with populations with chronic conditions.

CIOs and CMIOs should play an active role in looking at integrating teleservices in care pathways, said Flashman. “These are new options for patient engagement that haven’t previously existed,” he said in a recent phone interview.  They open up new possibilities for access to care and care at different locations such as the home. That has implications for cost-effectiveness, he explained. As providers are getting penalized for readmissions, the cost of readmitting a patient for one night might be equal to two or three months of telehealth monitoring of the patient at home.

“You can extrapolate out from that and find justification for doing more things like telecoaching because it is still cheaper than having patients in the hospital,” he added. Then you can start to ask if it is possible to do things like have patients who have tolerated a certain chemotherapy well in the clinic do it at home and monitor their health remotely. “That way, providers can begin to get reimbursed for treating those patients without incurring the overhead and fixed costs involved in treating them in the hospital or clinical setting.” That may also free up hospital space to treat other patients with more serious conditions, so it could allow you to see more patients and be a revenue-enhancer. So even though reimbursement issues remain challenging for funding telehealth, some return on investment arguments can be made that the services will start paying for themselves.

Rhoads and Flashman noted that providers are starting to experiment with taking data from mobile and remote monitoring solutions. Mobile health apps can be effective at getting patients engaged because they make it easier for people to track their conditions and receive meaningful feedback, they note.

I asked them how likely it is that my providers would want to take data from my FitBit and include it in their EHR. (Unlikely, since my primary care doctor doesn’t even use an EHR, but that is a story for another day.) Rhoads said that if I am a healthy person using my FitBit just to remind myself to get out of the chair and walk more, it is unlikely that my provider would be interested in that data. But if I am chronically ill, that might be another story.

CSC is considering launching an end-to-end managed service to provide a monitor center to look at a range of devices such as blood pressure monitors and Bluetooth scales so that providers can track patients with chronic conditions such as congestive heart failure and be alerted to any data outside normal ranges. That data could also be sent to a community nursing team.

“We are already seeing pockets of this,” Flashman said. “The trick is clinicians don’t want to see all the data and get overloaded. They want a relevant snapshot, a graph of the direction. They are wary of too much information.”

And although the Health IT Policy Committee is looking at ways to include patient-generated data in Stage 3 of meaningful use, many clinicians remain reluctant to mingle patient-generated data in clinical records. The most likely way this will happen, the CSC execs said, is through segregated PHRs, making it clear that data is coming from the patient or from their devices.

Are patients ready to take a more active role in their care and approach healthcare in a self-service mode that they apply to online shopping? It depends on the age of the patient, the CSC researchers say. The younger generation is more use to taking responsibility for using technology proactively for day-to-day things in banking, travel, etc. In healthcare, we are traditionally more used to having “infomediaries,” but increasingly patients are taking a more active role and want to provide more input. “Many older people aren’t used to that and they need encouragement from providers and patient advocacy groups to think about taking a more active role,” Flashman said.