Telehealth:
Telehealth defines as “the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”
Telehealth Program Advantages:
For Patients:
• By using Telehealth, Patients can save time & money by not travelling to hospitals and also not spending money on travel, food and lodging expenses.
• Specialist supervision via Telehealth has the advantage to the patients with limited mobility of staying with their family and friends.
• No travel during severe weather conditions like snow blizzards, rainy season.
• No need of taking leaves for clinic/Hospital visits especially contract employees can save a lot as they usually don’t have paid sick leaves.
• Remote & critical areas can have access to Telehealth 24 X7
• No patient waiting time and can easily reschedule with one click appointments.
• Improve patients' access to care by reducing the need for travel extending care to areas where it might not otherwise be available.
• Extend specialist coverage to ED, ICU patients.
For Providers:
• Clinicians can save travel time and can see more patients thus easing provider shortages.
• Practices can become more efficient by seeing distal patients.
• Rural clinical teams can receive training and education through Telehealth connections.
• Clinical staff can sometimes visit patients; perform lab draw and small procedures with the help of clinician’s instruction through video call.
• Providers can support multiple locations at the same time efficiently without travelling and can also save lot of waiting time.
• Attract new patients and keep recurring patients engaged in their healthcare.
• Your physicians can provide consultation for rural organizations, schools, nursing homes, and correctional facilities.
• Physicians can send a patient’s chart to a specialist as an E-Consult message, and the specialist can respond with recommendations.
Other Benefit for Critical Access Hospitals, Communities & Payers:
Critical Hospitals: Local Revenue Growth, expand specialty services, Staff online training and meetings.
Payers Benefit: Emergency transport cost reduction, Patients can receive care sooner.
Technical Options available to Providers/Patients with Telehealth Program:
Synchronous communication is two-way real-time communications like video and teleconferences
Tele &Videoconferencing:
• Installation of camera and audio system in conference rooms
• Mobile telehealth stations with a camera and lap-top system that we can use anywhere
• Desktop videoconference set up with webcam, microphone and headset
• Mobile phones and tablets highly used for ease of access for video conferences
• There ae several approved, HIPAA complaint video conference software’s being used by present healthcare organizations like Cisco Telepresence, Cisco JABBER, Polycom ,Skype for Business ,WebEx
• We can do recording capabilities, simultaneous video conference and sharing documents with clients/patients during sessions, access to electronic health records (EHRs).
E-Visits:
Clinician can do E consult with patients and checks the symptoms, along with any pictures or videos the patient sent, and recommends a treatment.
Clinic-to-Clinic Video Visits:
Rural area patient can schedule an appointment at the local primary care to connect with a specialist at a distant clinic.
E-Consults
With E-Consults, a primary care physician can communicate with a specialist for advice about a patient’s condition through internal messaging apps.
Remote Monitoring in the Hospital
Remote monitoring helps providers keep an extra eye on high-risk patients, such as ICU patients, using multiple screens for an efficient review process.
Tele stroke
Tele stroke technology connects patients with neurologists in a different location, providing quick access to a specialist and improving care without the costs associated with having a neurologist onsite.
Asynchronous communications is one-way at a time communication like fax, email, SMS texting, digital image sharing/uploads in portals.
Home Monitoring: Patients can upload information from health-tracking devices and services such as Fitbit, Health Kit into portals for physicians to see and keeps patients involved in their own healthcare.
Example: patients with congestive heart failure can use scales to send weight readings to their physician, who can automatically be notified when there is a significant weight change.
Implementation challenges implementing Telehealth:
Reimbursement: Payers like insurance companies did not address virtual care and Medicare only reimburses to rural physician’s shortage areas where telehealth services delivered, how Hospitals and care givers get paid.
New York State passed a telehealth law addressing Medicaid and commercial insurance and took the necessary step of protecting patients, it did not mandate reimbursement for providers..
Informed Consent:
Providers disclose appropriate information to a patient so that patient can take voluntary on service. With telehealth technologies, informed consent procedures should consider the following risks like confidentiality and encryption methods to secure communication, health record storage, interruption caused by technology failure, emergency plans if connect fails.
Privacy and Data Security:
If any Healthcare Organization shares patient data electronically should follow Health Insurance Portability and Accountability Act compliance. Organizations need to make sure the, video conferencing equipment, software applications, and network meets HIPAA requirements. For example, contacting with a patient via e-mail or a text message needs to comply with HIPAA requirements.
Licensure Requirements:
Clinicians must be licensed in the state in which they practice medicine but state medical licensure regulations typically do not anticipate many of the possible scenarios created by telehealth.
Examples: Connecticut licensed provider who resides in Rhode island has a telehealth communication/visit with the patient who stays in Connecticut or Connecticut resident patient travels out of state while he or she has telehealth visit with primary physician, in such scenarios regulations are not clear to address telehealth practice.
Legal Requirements:
Each organization should meet federal, state law and Telehealth policies. Organizations should limit telehealth to only certain approved locations and services. It is organizations responsibility to follow mandates and best practices, regardless of the technology that is used.
Malpractice and Liability:
Liability issue comes when we observe how clinicians interact with patients virtually. We believe that physicians would be able to provide high-quality virtual care, but not sure these interactions have a greater legal liability as compared to in-person visits and not sure on health insurance coverages.
Point to Point VS Direct to Consumer: Advantages for Patients &Providers
Point to Point: Patient’s presents at one of the facility location with clinical staff and clinicians can connect through video/tele conference from remote location.
• Providers can provide services remotely from anywhere and can save travel time.
• Nursing care, sister care, palliative care and elderly care services greatly benefited by connecting specialist through telehealth which reduce the cost and travel.
• Critical access hospitals with clinical staff can do better services to local communities by connecting any provider through telehealth.
• During natural calamities, nonprofit organizations like Red Cross get benefitted by these services from providers through HIPAA complaint like face time or Skype
• Physicians get benefitted by expanding patient base and maintain relationships with recurring patients. Telehealth helps in areas like Primary care, Remote monitoring ,Consumer health info and Health education
Direct to Consumer: Provider presents at the facility with can connect through video/tele conference with patients who are from remote location or home.
• Infrastructure not controlled on patient end leads to session interruptions
• Elderly patients and differently abled patients can call for urgent care.
• Required sophisticated applications with 24X 7 technical support
• Patients get benefitted when they are in remote locations, can connect with any provider.
• A recent study found the average clinicians visit costs a patient $43 just in lost time other than patient medical bill. Saving time and travel especially patients with chronic conditions and frequent visits.
• Example of a direct-to-consumer initiative took place after Hurricane Sandy hit, when Mount Sinai Health System and Mount Sinai Beth Israel launched their Tele doc service.