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Interest in Technology-Enabled Care Grows, But Concerns about Quality, Data Security Remain, Study Finds

September 6, 2016
by Heather Landi
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Consumers are open to technology-enabled healthcare, such as using remote patient monitoring tools and telemedicine, but continue to have strong concerns about the quality of care and the security of their healthcare data, according to a recent consumer survey-based study.

The 2016 Survey of U.S. Health Care Consumers study by Deloitte Center for Health Solutions, the research division of Deloitte Life Sciences and Health Care practice, polled 3,700 Americans in February and March 2016 about their current use of technology as well as their expectations, preferences, and concerns around technologies, including re­mote monitoring (the IoT), telemedicine, and ro­bots and drones, that can deliver health care ser­vices outside of traditional care settings.

Consumers have an appetite for using technology-enabled care, according to the study findings. Seven in ten respondents are likely to use at least one of the tech­nologies presented in the survey. The study examined consumers’ use of technology for health and fitness purposes compared to other uses, such as financial planning, tax filling, mobile banking and shopping. Overall, while use of technology for health and fitness purpose is growing, it’s still lagging behind other uses. Eighty-six percent of consumers use technology for shopping and 72 percent use it for mobile banking compared to only 32 percent of respondents who use it for measuring health and fitness goals.

The health appli­cation with the greatest usage (actually exceeding tax filing and financial planning) was refilling prescriptions, which 58 percent of Rx users reported doing. Looking at other healthcare technology uses, the study findings indicated that 31 percent of respondents pay a medical bill online and 24 percent use a technology-enabled platform to monitor health issues, such as blood pressure. Only 18 percent of respondents use an online cost-tracking tool provided by their insurance companies to check the cost of care and even fewer, 17 percent, receive alerts as reminders to take medications. In addition, only 15 percent measure, record or transmit data about medication they are taking or other treatment information.

As part of the survey, respondents were specifically asked about technology-enabled home care in 15 scenarios cov­ering different types of technology and applications—telemedicine, remote patient monitoring/ sensors (IoT), and drones/robotic. Respondents were asked about reasonable cost and any concerns that technology developers, providers, or plans offering the technology should address.

Researchers found that telemedicine, in which half the respon­dents show interest, is the most popular technology. Respondents are most interested in using it for post-surgical care and chronic disease monitoring, (49 percent and 48 percent, respectively,) according to the study findings. Only 32 percent of respondents expressed interest in using telemedicine for a minor injury.


And, particular subgroups are especially keen on various technologies presented in the study, espe­cially in those who have chronic diseases, Mil­lennials using telemedicine, and seniors using remote monitoring, the study authors stated.

A number of factors are driving an increased willingness and interest among patients and caregivers to use IoT devices, including a growing aging population, high prevalence of obesity and chronic diseases like diabetes and increasing demand for caregivers. In addition, consumers are showing a preference to age at home as opposed to moving into a facility and value-based care models also are driving providers to adopt technologies to help improve their patients’ health outcomes.

More respondents in the 2016 survey reported going online for health-related purposes than in 2015, with the biggest jumps related to measuring fitness and health improvement, which grew from 28 percent to 32 percent, and for receiv­ing alerts to take medication, which grew from 13 percent to 17 percent.

And, the study authors content that caregivers are a key population for technology-enabled care. More consum­ers say they are likely to use sensor technology (the IoT) when caring for others rather than for themselves. And, the survey results indicated that experienced caregivers are more likely to use telemedicine and remote monitoring technology than non-caregivers.

In addition, 40 percent of respondents say they would likely approve of sensor use for location tracking and fall detec­tion if they were caring for someone else.

The study also found that heavier users of the healthcare system show the most interest in all technologies. “Across the board, consumers with chronic condi­tions are the most interested in using technolo­gy-enabled care. Those reporting a major impact from their condition report even greater inter­est. Among generations, seniors show the high­est interest in using sensors but lower interest in telemedicine,” the study authors wrote.

When examining respondents’ viewpoints on the cost of these technologies, for the consumers who expressed interest in us­ing remote patient monitoring, a majority said that in­surers should pay for it. “Only two out of ten said they’d be willing to pay out of pocket, while the rest said they would use monitoring only if the sessions were covered by their health insurance policy/plan with a small co-pay,” the study authors wrote.

And, of the 20 percent surveyed who were willing to pay out of pocket, when asked, “How much?,” consum­ers on average say that $58 is a reasonable cost for a monthly subscription for remote patient monitor­ing. This amount varies by generation, according to the study.

As with remote monitoring, a majority of consumers surveyed (80 percent) who are interested in using telemedicine think that insurance should pay for it. Of the 20 percent willing to pay out of pocket, they indicated, on average, that $70 is a reasonable cost for a telemedicine session. This varies by generation, with the youngest willing to pay the most.

The survey findings also indicate that seniors and baby boomers are more likely to use sensors than younger generations, however younger generations are willing to pay more out of pocket for remote patient monitoring than older generations, up to $100 for a one-time fee.

Looking at consumers concerns with regard to these technologies, the respondents indicated that they demand high-quality, person­alized care, and they also want assurance that their personal information will be safe. About a third of respondents expressed concern about the security of their information or that their personal health information might be misused. Four in ten think that care quality could be lower than if they saw a provider in person (43 percent for telemedicine, 35 percent for remote patient monitoring), the study findings indicated.

In conclusion, the study authors outlined a number of implications for healthcare stakeholders regarding developing and employing technology-based healthcare. Stakeholders developing and adopting these technologies need to earn patients and caregivers’ trust. “Quality of care and protection of personal information can be essen­tial for adoption,” the study authors wrote. And, stakeholders should consider developing risk mitigation strat­egies that take into account possible uses and misuses of personal information.

Provider should make care delivery more patient-centric and include the caregivers. The study authors suggest that vendors should target caregivers as well as patients for adop­tion, and work to coordinate care via integrated platforms. “And potentially toughest of all: To win customer buy-in, the user experience—for caregiv­ers, patients, insurers, and everyone else—will likely need to be as seamless as possible,” the study authors wrote.

“Create a seamless user experience. Tools likely need to provide an end-to-end experience. For example, if a tool helps patients obtain and track prescriptions but doesn’t allow them to re­fill medication, many would rather not use that tool at all,” the authors wrote. “And, give consumers what they want. Consum­ers have clear preferences for which health care services they are interested in using telemedi­cine and remote patient monitoring.”

“For ex­ample, there is more interest in chronic disease monitoring than for acute care in telemedicine. Retailers, providers, and plans should con­sider aligning their offerings where the interest is highest,” the study authors concluded.

The study also highlighted a number of technologies employed by providers today, including edible smart pills and smart pillboxes for medication adherence and a mobile prescription therapy technology for diabetes patients that is an app with an integrated a blood glucose monitor for self-management.

Looking ahead at the use of drones and robotics in healthcare, four in ten respondents indicated an interest in using drones for medication assistance and robots for disease diagnosis assistance.

According to the study authors, within the next several decades, researchers hope to introduce drones and robots capable of assisting older indi­viduals with health risks who want to stay in their homes as long as possible. “Some potential applica­tions include household cleaning, retrieving medi­cation from another room, and other tasks that could reduce the risk of falls in older adults who live alone. Although drones hold great promise for health care, monitoring, and medical product trans­port, care applications remain mostly hypothetical,” the study authors wrote.


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KLAS: EHR Integration, Enterprise Scalability Key Challenges Facing Telehealth Vendors

December 11, 2018
by Heather Landi, Associate Editor
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Healthcare organizations report high satisfaction with their telehealth virtual care platforms (VCPs), however there are significant differences in how broad the various platforms are and in the quality of the vendors’ service. What’s more, integration with electronic health record (EHR) systems is a key challenge facing every telehealth vendor, according to a KLAS report.

In its report, “Telehealth Virtual Care Platforms 2019: Which Telehealth Vendors Have the Scalability Customers Need?,” KLAS evaluates some of the top telehealth companies including American Well, MDLive and Epic, and analyzes what capabilities will set vendors apart as more healthcare organizations adopt virtual health technology solutions.

Most virtual care platform vendors receive positive performance ratings, but the depth and breadth of their capabilities vary, and this can impact scalability for organizations looking to grow, according to KLAS. No two vendors are alike in their capabilities, offering different combinations of functionality and experience.

Of the companies KLAS evaluated, the most common type of visit varied—most of American Well’s visits were on-demand urgent care, while the majority of Epic’s visits were associated with virtual clinic visits.

A key factor of scalability is the ability to support multiple visit types, KLAS researchers note. While multiple vendors offer support for all three visit types (on-demand or urgent care, virtual clinic visits and telespecialty consultations) no single vendor has a large proportion of customers using all three (only 12 respondents across all vendors said they were doing so).

American Well, a market share and mindshare leader, and MDLIVE, two of the vendors used most frequently for multiple visit types, receive generally positive—but lower than average—performance scores. Vendors more specialized in specific visit types or component layers (e.g., Vidyo and Zipnosis) have high scores but narrower expectations from customers.

No one vendor meets all needs equally well, but several are reaching for “all-purpose” status with internal development and/or recent acquisitions (American Well acquired Avizia; InTouch acquired TruClinic), according to the report.

KLAS’ analysis also uncovered a general trend of poor integration. In most cases, the addition of a virtual care platform also means the introduction of a second EHR into the clinician workflow.

“Although integration between EMRs is generally understood to be important for care quality, patient safety, efficiency, and productivity, few interviewed VCP customers have full bidirectional transfer in place. Most say that they are too early in their virtual care programs to pursue integration or that it simply costs too much,” KLAS researchers wrote.

Only American Well, Epic, and MDLIVE have more than half of interviewed customers currently on an integrated path, KLAS found. Epic has placed virtual care capabilities directly into their top-rated MyChart patient portal, which many patients already use. Epic integration means clinicians are able to stay within their existing workflow environment as well.

Many provider organizations are in the early phases of their virtual care programs where showing an ROI is an important milestone and one that organizations want to achieve as soon as possible, KLAS notes. “A key promise from vendors is that their technology and accumulated expertise will result in a fast start and continuous acceleration. When this comes at significant cost or progress is slower than expected, provider organizations can experience disappointment,” the KLAS researchers wrote.

When it comes to getting their money’s worth and achieving desired outcomes, Epic and InTouch are rated highest among fully rated vendors, and swyMed and Vidyo perform well among their smaller groups of respondents, KLAS researchers note.

“For each vendor, the current value proposition is somewhat narrow but well understood: Epic’s use is limited to existing patients of Epic EMR customers; InTouch is used primarily for consults; swyMed is used by respondents primarily for mobile, first responder needs; Vidyo delivers video-conferencing tools,

which are typically combined with other VCP solutions. SnapMD is seen as a low-cost option, but some customers say the impact has been limited. Commentary from VSee customers suggests a similar experience,” KLAS researchers wrote in the report.

Many healthcare organizations are early on in their virtual care journeys, and their ability to achieve desired results depends on guidance from vendors. According to KLAS’ analysis, swyMed and InTouch receive the most praise for taking initiative in proactively guiding customers and also in quickly responding to support problems.

While respondents praise American Well’s platform scalability, some customers blame the vendor’s “exponentialgrowth for staffing shortages that have led to implementation holdups and backlogged service requests. Some SnapMD customers say hard-to-beat pricing comes with a support model that is spare in terms of providing tailored guidance, according to the KLAS report.

Most vendors offer two additional options that can help accelerate customers’ expansion and growth—supplemental services, including added-cost advisory and outsourced services, and tools that automate patient-facing tasks that traditionally require additional staff. I

KLAS found that few customers mentioned these options in top-of-mind conversations. “Respondents who spoke of their vendor’s supplemental services most often referred to marketing support or strategic planning services from vendors American Well, MDLIVE, or Zipnosis. Those who referred to task automation report patient-self-service capabilities around check-in, scheduling, surveys, and/or patient flow from InTouch Health (TruClinic), Epic, MDLIVE, or Zipnosis,” the KLAS researchers wrote.



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Study: Neonatal Telehealth Reduces Hospital Transfers, Saves Money

December 11, 2018
by Heather Landi, Associate Editor
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Neonatal video-assisted resuscitation reduces transfers from hospitals without newborn intensive care units and provides significant cost savings, according to study published in the November issue of Health Affairs.

The study authors, led by Jordan Albritton of Intermountain Healthcare, examined a newborn telehealth program implemented at eight Intermountain Healthcare community hospitals in November 2014–December 2015 and the impact on the transfer of newborns from those eight hospitals to level 3 newborn intensive care units.

Studies show that 10 percent of newborns require assistance breathing at birth, and 1 percent require extensive resuscitation. At Intermountain Healthcare, approximately 1–2 percent of all babies born in suburban and rural hospitals are transferred to newborn intensive care units (NICUs) for higher-level care, according to the study.

In response to the need to improve outcomes for complex newborn patients, an innovative telehealth program was established at Intermountain Healthcare in 2013 to provide synchronous, video-assisted resuscitation (VAR), bringing a neonatologist to the bedside. As a result, access to specialized neonatal services in rural and suburban settings is no longer limited to telephone calls or the arrival of a neonatal transport team, the study authors wrote.

While telehealth can facilitate video connections between neonatologists at tertiary care centers and providers at smaller hospitals, there is little empirical evidence about the benefits of telehealth programs for neonatal resuscitation, according to the study authors.

Although Intermountain Healthcare began using telehealth technologies in 2013, the current VAR program was implemented in the period November 2014–December 2015. Today, neonatologists from four level 3 NICUs provide VAR support for nineteen referring hospitals.

As part of the study, the researchers evaluated eight hospitals that contained either well-baby (level 1) or special care (level 2) nurseries staffed by physicians, advanced practice clinicians, nurses, respiratory therapists, and other health care professionals. T

The study found that video-assisted resuscitation was associated with a reduction of 0.70 transfers per facility-month and a 29.4 percent reduction in a newborn’s odds of being transferred. Annually, this resulted in 67.2 fewer transfers and an estimated cost savings of $1.2 million per year.

The study authors conclude that reducing transfers keeps families closer to home, increases community hospital revenue, and reduces risk associated with transfers.

“This program helps keep newborns in level 1 or 2 nurseries, which in turn allows families to stay closer to home, improves social support, and increases the revenue of community hospitals while reducing costs and risks associated with transfers,” the study authors wrote. “Payers should consider reimbursement for pediatric subspecialty telehealth consults for neonates in level 1 and 2 nurseries. Through improvements in care quality and cost savings, this service would likely pay for itself many times over.

However, the authors also note that lack of reimbursement for telehealth services limits widespread implementation.

“Policy changes are necessary to align payment incentives and promote the use of telehealth services,” the study authors wrote.

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Can Telehealth Slow the Traffic Between Nursing Homes, Emergency Departments?

December 6, 2018
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The RUSH Act seeks to reduce the 1.3 million transfers from skilled nursing facilities to emergency rooms each year

There are 1.3 million transfers from skilled nursing facilities (SNFs) to emergency rooms each year, and CMS estimates that two-thirds of those are avoidable. The result is as much as $40 billion in unnecessary spending. Could telehealth be part of the solution?

That question led Timothy Peck, M.D., formerly chief resident in the Emergency Department at Beth Israel Deaconess/Harvard, to co-found a startup company, Call9, and become an advocate for legislation, the RUSH (Reducing Unnecessary Senior Hospitalizations) Act of 2018, to support reimbursement for connecting emergency physicians and SNFs.

Peck has spent considerable time studying the issue. “I didn’t know much about nursing homes when I started,” he said.  “I went and lived in one for three months. I wound up sleeping on a cot in a conference room.”

Peck was trying to understand nursing home finances and operations and why the patients are being transferred. They usually have things like urinary tract infections or pneumonia, which could be treated in the outpatient setting, but the SNFs aren’t equipped with the right tools to be able to treat these patients. Those patients come in without their families and 43 percent have dementia, he said. “Most become delirious upon transfer. We don’t have much information about them so we order every test under the rainbow, driving up the bill unnecessarily. We put them in hallways. They get bedsores. We inevitably admit these patients for an average of $15,000 to $20,000 per admission.”

The two-thirds of transfers that are avoidable represent about $40 billion in unnecessary spending for something that harms patients,” he said. “We are spending money on hurting patients.”

Peck zeroed in on three operational issues:

• First, on average, nurse to patient ratios in nursing homes are 1 to 36. If one patient becomes acutely ill and spikes a fever, that nurse does not have time to take care of that patient when they have 35 other patients to take care of. Also, most nursing home nurses are trained to handle chronic care, not emergency or acute care. It is a mismatch of skills, not a people problem in any way, he said.  

• Second, diagnostic equipment is sparse, and EKGs and lab tests take 24 hours to 48 hours to come back. That doesn’t work well for acute care.

• Third, physicians are not present in nursing homes. “When I was living in that nursing home and walking the halls weekends and nights, I never once saw another physician. Long-term care patients are seen once a month by their primary care doctors.”

Peck described the Call9 service: They embed 24x7 a paramedic or EMT or a nurse with emergency experience in the SNF. They go to the patient’s bedside and connect to a remote emergency physician who is available 24x7 and working from home. They can see a patient in nursing home A with a paramedic by the bedside and then jump to nursing home B and see a patient there with a first responder with them. “It makes the physician a scalable resource,” Peck said. “Believe it or not, they are our least expensive resource because they get scaled.”

Call9 has full integration with the three most commonly used EHRs in the SNF world. The solution also deploys a suite of mobile diagnostics and can return lab test results in a few minutes. It offers real-time telemetry and real-time ultrasound.

After treating a few thousand Medicare Advantage patients, he said the model has shown that it can save payers more than $8 million per nursing home per year. That allowed Call9 to get involved with Medicare shared savings value-based contracts with several payers nationally. But he notes that 60 percent of patients in nursing homes are Medicare patients. “We took that data to CMS and showed it to them,” Peck said. “The Ways and Means Committee in the House of Representatives got ahold of the data and got excited and started writing the Rush Act.”  He stressed that Call9 is not the only organization creating a program like this. There are others working on similar solutions.

Peck said CMS is interested in using telehealth in this way, he said. “But they don’t have any way to change payment mechanisms in a quick manner. They would have to ask CMMI to run demos, which takes years. But Congress could pass new legislation.” He described the RUSH Act as creating a value-based shared savings arrangement with Medicare where 50 percent of the savings goes back to Medicare, and 37.5 percent goes to a company like Call9 or a physician group or medical staffing group that administers the program and 12.5 percent goes to the nursing home, aligning all stakeholders, he said. “The bill has been introduced by a bipartisan group, because it is a nonpartisan issue.” With time running out in this session, he said, the bill still has strong support among Democrats set to take over House leadership in 2019.

Besides bipartisan sponsors in Congress, the bill also has support from patient advocacy groups such as the Alzheimer’s Association, Michael J. Fox Foundation for Parkinson’s Research, American Heart Association, the National Alliance on Mental Illness, and the American Telemedicine Association. “They are saying that the patients need it; the taxpayers benefit; why are we not doing this?” Peck said.

As someone who has seen family members and friends make that repeated, disruptive round trip from nursing home to emergency room, I concur.  



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