mHealth and telehealth flight for inclusion

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Telehealth is one of the fastest growing markets, and broad adoption is building from modular telemedicine units to teleaudiology. Not all providers are finding transitioning skills easy.

The global telemedicine market is projected to grow to $66.6 billion by 2021, at an estimated CAGR of 18.8 percent during the forecast period 2016 to 2021, according to Mordor Intelligence. While this seems significant, it's a fraction of the market, especially considering that U.S. health care expenditures were estimated to be $3.24 trillion in 2015, and forecasted to increase to $3.78 trillion by 2018, reported by Forbes.

The adoption curve

Gartner published an excellent overview in mid-2015 that covered the hype cycle for telemedicine and virtual care. The Gartner Hype Cycle has five phases: 1. Technology trigger (tech breakthrough), 2. The peak of Inflated Expectations (media over hypes the technology), 3. A Trough of Disillusionment (pilots fail to deliver and interest declines), 4. The slope of Enlightenment (value is apparent as pilots are refunded), and 5. Plateau of Productivity (mainstream adoption becomes a reality).

The definition of telemedicine appears straight forward. Telemedicine is the use of telecommunication and information technologies to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. What does that mean? Healthcare institutions are interpreting clinical care in different ways. Executives do have options to understand better how other practitioners are approaching telehealth. The mHealth + Telehealth World conference held in Boston July 25-26, 2016 will tackle the role of technology in health and help executives to understand the impact of the connected world on the future of healthcare.

Telehealth clinical applications

Telehealth is used in various areas to improve clinical care across the healthcare industry. The Gartner hype report presented evolving concepts to help CIOs define business strategies and prioritize their investments.

1. On the Rise – Digital Telepathology, Patient Decision Aids, Telepsychiatry, Telesurgery, EHR Support of Virtual Care, and Teleaudiology.

2. At the Peak – Modular Telemedicine Units, Healthcare-Assistive Robots, Medication Compliance, Management, Quantified Self, Wearables, Real-Time Virtual Visits, and Teletrauma.

3. Sliding into the Trough – Continua, Personal Health Management Tools, Telepharmacy, Mobile Health Monitoring, Video Visits, and Teleretinal Imaging.

4. Climbing the Slope – Home Health Monitoring, Telestroke, Teledermatology, Remote Electrocardiogram Monitoring, and Patient Portals.

5. Entering the Plateau – E-Visits and Remote ICU.

Applied perspectives for better health

The best approach for telehealth will depend on the provider practice. However, in almost all cases it starts with a champion who is a clinical practitioner who thoroughly comprehends the reimbursement cycle.

Once the champion is on board start with a pilot that will have depth. Two classic business cases where telehealth can be beneficial are chronic disease management and episodic care management or continuous care. Chronic illness management can shift a significant portion of facility care to telehealth. This is, however after face-to-face visits resulted in a relationship between the physician and the patient. The is nothing more important than trust in healthcare, and it’s built best in person. Episodic care management is less frequent and therefore makes a good case for telehealth replacement. MedStar Health operates more than 120 entities with over ten hospitals in the Baltimore area. Medstar Health started to offer telehealth first to employees through a pilot during 2015. This pilot expanded in 2016 to encompass those they insure. The last step is to beta telehealth in public.  

The hill to climb

We will get past the technical issues with mobile coverage and poor connectivity. Let’s also assume that the current fee-for-service (FFS) models are replaced with value-based payment models (shared savings, bundles, shared risk, and global capitation).

MedStar experienced three main challenges: scheduling across states (given providers are state-licensed), equipment setup, and administrative policies (coding online visits). 

We all want to reach the tipping point where societal perceptions of healthcare include telehealth. This collective benefit will impact the cost of care, quality of care, and access to care. This leads us to one question: are providers ready to transition their skills?

There is a significant difference between bedside manner and webside manner. Doctors must combine their medical knowledge with technical knowledge. How will doctors be trained for this new environment? Computer-based training (CBT) is out. Train-the-trainer is also ruled out. We're left with a training approach that requires providers to train-by-doing. To provide telehealth, you must practice providing telehealth. This means bringing telemedicine into the academic setting to prepare residents of the challenges early and educate on the huge societal benefit of remote care.

Compensation, administration (billing), and technology still have issues to work out. We'll get there, but before the patient can be placed in charge of their health, they need to be educated. This education will require more provider time, not less. Telehealth offers an alternative to providing education to patients without a physical visit allowing providers to explain medication, images, and diagnoses more thoroughly.

Telehealth has the potential to increase patient satisfaction and trust. The success of telehealth begins with everyone starting from the same step – getting educated.

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