In the past year, American advocates of telehealth may have gotten their biggest boost from across the pond. In what is to date the largest controlled trial involving telehealth, the UK’s Department of Health looked at approximately 6,400 patients with varying chronic conditions across three separate sites, and gave approximately half of them telehealth services for two years starting in 2008. The ultimate question the UK government was trying to answer through this study was, ‘Does the use of technology as a remote intervention make a difference?’
The initial results of the study, called the Whole System Demonstrators (WSD) program, pointed to a resounding yes. Released in late 2011, the study found that the correct use of telehealth can lead to a 45 percent reduction in mortality rates. In addition, the study found that the use of telehealth reduced unplanned readmissions by approximately 18 percent. The study was released and conducted in collaboration with the UK’s well-known ‘Three Million Lives’ campaign, which seeks to have three million people with chronic and long-term health problems in the country connected to telehealth over the next five years.
In the U.S., progress on pro-telehealth reform is much more fragmented. In several states, such as California, Colorado, Georgia, Hawaii, Vermont, Oklahoma, and elsewhere, private insurers are required to cover telehealth-provided services. However, the states that don’t have this requirement are far greater in number, even though some insurers cover the costs regardless. Studies similar to the WSD program have run in the U.S., mostly from the Veterans Administration, but nothing is as wide-scale as the effort from British government.
One state government that has appears to have embraced the telehealth concept is Maine. The Pine Tree State is among those states that have required insurers to cover telehealth services. Furthermore, leaders in Maine gather each year for a conference that aims to improve and expand telehealth within the state. At the seven-hospital, Eastern Maine Healthcare Systems (EMHS), many leaders, such as Lisa Harvey-McPherson, R.N., vice president of continuum of care, are out to prove the results from the WSD trial are no international fluke.
Lisa Harvey-McPherson, R.N.
10 Years in Telehealth
From a geographical standpoint, EMHS covers five hundred thousand patients dispersed across two-thirds of the state. Last year alone, EMHS provided more than 64,000 home care visits to 3,300 patients, traveling 1.25 million miles. In the most northern county of the state, an area that is approximately 6,000 sq. miles, there are three medical facilities for home healthcare patients. For this reason, McPherson says, EMHS has been a telehealth proponent for 10 years.
“It [telehealth] is critically important to serve this large rural geographic area and provide access to home care and hospice,” McPherson says. “On any given day without telehealth, we could not continue to service this large rural region. Then, do we look at restricting our service to look at how we can gain efficiency in deploying our staff? The technology allows us to service this large rural geography, and gain efficiencies on how we deploy the staff. We know having the telehealth nurse work daily with high-risk patients, we’re not deploying nurses in home as frequently as we need to without the technology. So then when we do deploy our staff, it’s for timely interventions.”
At first, EMHS used simpler telehealth devices, such as video phones. In recent years, it has brought in more complete telehealth systems for its patients, from Philips Healthcare (Andover, Mass.). Overall, EMHS’ telehealth program has 77 total devices in total, with 29 on the way thanks to U.S. service grants, according to McPherson.
The remote devices, which connect back to an EMHS facility in Caribou that houses a telehealth nurse, have been given to patients with chronic diseases in an effort to reduce readmissions. So far, so good, according to McPherson, who says that after using the telehealth device for three months, patients who were previously frequent users of the emergency department have seen their ED utilization rate shrink significantly. Those with chronic obstructive pulmonary disease (COPD), for instance, went from an ED hospitalization rate of 83 percent prior to telehealth to a rate of six percent afterwards.
The telehealth nurse, McPherson says, monitors the patient vital data, and can call and bring attention on anyone who has drawn a red flag. In a rural community, it provides a sense of timeliness, she says.
“We had a patient who was on the program and the data showed that she was at risk. The telehealth nurse called the patient, who we knew well. The nurse recognized that her speech was off and she was slightly confused. So we identified she was having a stroke. We advised her that we were calling 911, and we notified her family, who lived some distance from her. Because of the timeliness, she returned back home within a few days,” McPherson says.
Even for patients who aren’t in a dire circumstance, the telehealth service can provide a significant clinical outcome, McPherson says. It has embedded research-based questions on their specific health processes, which helps homecare nurse focus its teaching and make the visits more effective.
EMHS has been collecting data on ED utilization for 2-3 years in an effort to improve grant writing, which funds the deployment of additional telehealth devices. Naturally, the cost savings component of this research is critical to supporting this movement.
For the 57 patients who used telehealth and had congestive heart failure, the savings amounted to $490,049, according to research from EMHS. Total savings for 162 patients in one 60-day telehealth deployment period over readmissions within the same time period amounted to $2 million, McPherson says. Furthermore, patients usually only need the 60 days to sustain their behavior changes, she says. Thus, a further investment is not needed.
The project has gotten support, McPherson says, from the Bangor Beacon Community, one of 17 sites nationwide dedicated to advancing EHR adoption and health information exchange across the country. Furthermore, as one of 32 Pioneer accountable care organizations, EMHS has plans to use telehealth as part of a larger initiative to expand home and community-based services in partnership with the organization’s patient-centered medical home (PCMH).
“In the Beacon project, we have a premise where we’re supporting patients with chronic disease who are not homebound, but who can still benefit from this technology in the home. I’ll be expanding that model under the ACO,” McPherson says. “These are patients with chronic diseases who are not homebound, and thus not eligible to receive homecare telehealth under Medicare. The challenge is they are mobile, they are going to see their doctor, but they do not understand how to take their medications correctly. So they are in and out of the ER. Whether or not they are mobile and in the community, their challenge is in the home.”