It was my privilege and pleasure last week to moderate a panel discussion on telehealth and population health at the Health IT Summit in New York, sponsored by our publication, Healthcare Informatics. Our panel discussion, under the title “Telehealth: New Platform for Population Health,” was privileged to have with us Rahul Sharma, M.D., emergency physician-in-chief in the Division of Emergency Medicine, New York Presbyterian-Weill Cornell Medical Center; Mony Weschler, chief and senior director, applications and innovations strategy, at Montefiore Health Systems; and Todd D. Ellis, a managing director at KPMG.
We looked at a broad range of issues, including payment, industry, clinical practice, and technological developments that have been dramatically expanding the concept and implementation of telehealth. For example, as noted in the report on the session published by our Assistant Editor Heather Landi, Dr. Sharma shared extensively with our audience about a telehealth initiative that has been very successful at New York Presbyterian-Weil Cornell, involving efforts to reduce waiting times in that organization’s emergency department by offering patients waiting in the ED the opportunity to move next door in the facility to a space where they can immediately be seen by a physician via a telehealth connection. “We launched a pilot telehealth program so when a patient comes into the ER, they have the option of a virtual visit through real-time video interactions with a clinician after having an initial triage and medical screening exam. So they go to a private room and see a clinician via a telehealth monitor,” Sharma noted. “The analogy we use is that years ago there were banks going up on every single street corner, and then the banks all put in ATMs. And people said that’s crazy, why go to ATM when can go to the teller? It’s the same concept. We’re allowing patients a choice in how they get healthcare.”
This was just one example of newer initiatives that are using telehealth strategies to improve care delivery, efficiency, and the patient experience, that have nothing to do with the initial types of telehealth efforts, involving linking rural primary care physicians with specialists at large urban hospitals.
That initial concept, which led to initially rather smallish-scale telehealth efforts, was sincere and meaningful at the time. But as all of my panelists noted, U.S. healthcare is changing very rapidly now, and all the shifts taking place are fueling a reassessment of what telehealth should be. We all know that exploding costs across the U.S. healthcare system, driven by the aging of the population and an explosion in chronic illness, are leading the purchasers and payers of healthcare to demand that providers come up with solutions to the cost juggernaut.
And certainly, care delivered in the emergency department is being delivered in one of the most expensive venues available. So Dr. Sharma’s solution at New York Presbyterian-Weil Cornell makes sense from multiple standpoints—not only in terms of patient satisfaction and outcomes, but also in terms of cost-effectiveness and efficiency.
What is interesting is how the policy, cost/reimbursement, operational, clinical care and outcomes, technological, and patient satisfaction/experiences elements in this situation are all aligning towards the inevitable expansion of the telehealth concept. Indeed, that was the point behind the concept of our panel discussion in New York last week, as the concepts “telehealth” and “population health” are inevitably beginning to draw together and align. And all of that makes eminent sense.
The fact is that, as the leaders of patient care organizations take on risk-based contracting, whether it be through accountable care organization (ACO) formation, broad population health initiatives, patient-centered medical home (PCMH) development, or outcomes measurement and value-based payment generally, they will need to expand attributed patients’ access to healthcare, via the most patient-friendly, patient-satisfying, family-satisfying, time-efficient, and cost-effective means and venues possible, all the while assuring the correct clinical care parameters and safeguards. As Dr. Sharma noted in our panel, patients with serious symptoms such as chest pain or bleeding, are never offered a telehealth redirect. The telehealth option is for those with simple symptoms like colds, coughs, and low-grade fevers.
Data and information systems seen as crucial
Meanwhile, Wechsler noted in our discussion that, when it comes to Montefiore’s population health efforts and its telehealth technology platform, his organization’s leaders have learned important lessons about using data and developing data analytics. “It’s all about the data, so the more data you have on a patient, the more you can have a longitudinal view, the better you can treat that patient,” he told the audience. “If a patient stays in our system, then we have data and we do very well. But if the patient leaves our system, then we need to fill in the gaps as there are holes in the data, and we don’t do as well, so we learned from that.”
Instead, providing physicians and nurses at the point of care with key data points they need to treat patients, will naturally help to expand population health and telehealth capabilities across numerous dimensions and venues.
Indeed, Wechsler said, the core electronic health record is going to be a vital element in expanding all these concepts. “We’ve also learned that we need to make this easy and very seamless for the physician,” he said. “While most of these technologies can interface with the electronic medical record, he called on EMR vendors to “step up to the plate and make it seamless.”
And KPMG’s Ellis emphasized that hospital and health system leaders need to develop a strategy to evaluate the value of telehealth at their specific organizations. “When understanding and starting a telehealth program, you need to ask where you want to be five years or 10 years from now as telehealth is going to be a critical part of value-based payment,” he said.
What’s particularly exciting going forward, and is something that Wechsler noted, is the prospect of technology, including home-based technologies and wearable technologies, to combine the concepts of telehealth, consumer-based/consumer-facing health and fitness engagement, home-based health, and care management, in new and exciting ways. “This is the future, to use sensors, wearables and implantables, and the technology is being developed right now to enable continuous monitoring of the patient and to be able to do vitals and get real data from the patient, as that’s one of the last obstructions to telehealth,” he said.
I agree. Looking at the current landscape and the potential landscape of five years from now, the U.S. healthcare system (and also potentially the healthcare systems of many advanced nations) could be on the verge of a true breakthrough, in which policy, reimbursement, technological, and clinical practice changes and advances align in such a way that individuals with chronic illnesses and other health conditions could be both broadly and deeply connected to the patient care delivery system on a moment-to-moment basis, allowing for rapid, highly effective interventions, at the earliest appropriate moment, and often in the home or even as patients navigate their daily lives. Getting there will require not only ongoing investments in still-evolving technologies; it will also require a commitment to population health at the highest conceptual level; and an acceptance and indeed, an embrace, of a fundamental shift away from inpatient care wherever possible, towards and through outpatient care, into the home and into patient’s mobile daily lives.
But the end result could be amazing: a new world of healthcare and health, one no longer circumscribed by many of the physical, technological, payment and policy limitations that we all now face—and one that could make our society both healthier and less financially burdened.
So yes—one day, “telehealth” really will simply be “health.” And that is a vision of the future that patient care leaders need to plan for.