A fundamental change in the way healthcare is delivered is rapidly gaining ground in the United States. Telehealth (or telemedicine) is connecting patients and providers — or providers and providers — in ways that don't rely on face-to-face contact. In remote or underserved areas, it can be a way to deliver specialty services and education by optimizing the use of available professionals. And even in large urban areas, the rise of e-ICUs and other telehealth specialties like e-pharmacy, e-dermatology and even e-psychiatry makes the sting of specialty shortages less acute.
In what many say will be the most far-reaching consequence of this trend, patients, through remote monitoring at home, can begin to take charge of their disease — with chronic conditions managed effectively in a home setting, conserving valuable hospital resources for the most critical cases. With the costs of treating chronic conditions at a staggering 75 percent of the $2 trillion health expenditure, according to Health Industry Insights, a consulting company based in Framingham, Mass., remote patient monitoring (RPM) technology will be an effective way to address that cost. “There are many drivers that will feed growth in this area,” says Marc Holland, research director of the company. Those drivers, he says, are the increasing prevalence of chronic conditions, the aging of baby boomers, the escalating shortages of medical professionals, and the spiraling cost of care.
Two legislative acts passed in July of 2008 may also spur growth: the approval of Medicare reimbursement for telemedicine-enabled follow-up inpatient consultations, and the expansion of the list of qualifying sites authorized to bill Medicare for telemedicine services.
In addition, millions of dollars in government funding have recently become available to states that will support telemedicine expansion, often through broadband and connectivity initiatives. For example, six hospitals in rural Maryland will implement Baltimore-based Visicu's eICU, thanks to a $3 million grant from CareFirst BlueCross BlueShield (Owings Mill, Md.). And in November, the USDA awarded more than $1.5 million in Rural Utility Service grants to hospitals around the country to fund expansion of e-ICU services to rural communities.
One recipient of that grant is Alegent Health, a nine-hospital system in Omaha, Neb., which according to CIO Ken Lawonn, will use the grant money to expand the telemedicine program it already has in place. Alegent will be growing the program to its four rural hospitals, along with another four that are part of a critical access network. “The grant can help us offset the cost of expanding the service to the rural hospitals,” he says.
The grant will be used to fund the e-ICU start-up costs — equipment licenses, integration and connectivity for the small facilities and, for those that need it, new patient monitoring equipment to connect to the e-ICU equipment. Lawonn says his telemedicine program was driven by patient safety. There was a shortage of intensivists and clinicians to support the ICUs in his hospital system. “Being able to provide the effective level of coverage was impossible, so we're really driven around how do we ensure a high level of quality and safety in our ICU without having to transfer patients around.”
Though the rural applications like e-ICU and specialty visits are exciting, some of the most cutting-edge work is being done in urban environments like Boston-based Partners Healthcare. Its Center for Connected Health, operational since 1994, has been a pioneer in many areas of telemedicine, including the growth area of home-based monitoring.
Founder and Director of the Center, Joseph C. Kvedar, M.D., says the program has continued to evolve in ways no one could have predicted. “The biggest lesson learned is that we thought the big story was going to be that we were able to empower our clinicians with a richer data stream to make a thoughtful decision about care,” he says. “What we found was that the patients themselves become their own provider.” Kvedar says patients using home monitoring became very involved in their own care and started making decisions about how to manage their lifestyle, and stay out of the hospital. “That's why we've continued to design it more and more patient-focused.”
At Partners, the telemedicine program has expanded its specialty visits to include e-visits for dermatology, cardiac and more. And at Alegent, Lawonn is also planning to expand the telehealth program. “We have a strategy called the e-hospital that looks at those very scarce and high specialist services that are difficult to staff and recruit to. We're looking to see whether we can extend this model to provide coverage from a central location,” says Lawonn, who is already using an e-pharmacy model with a pharmacist around the clock in his central location.