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Telemedicine Not Connecting With EMRs

As smartphones and tablets become a standard part of healthcare as we know it, telemedicine is gaining a new foothold in medicine too. In some cases, we’re talking off the cuff transactions in which, say, a patient e-mails a photo to a doctor who can then diagnose and prescribe. But telemedicine is also taking root on an institutional level, with health systems rolling out projects across the country.

The problem is, however, that these telemedicine projects simply don’t integrate with EMRs, according to an article in SearchHealthIT. The piece’s writer, Don Fluckinger, recently attended American Telemedicine Association’s 2013 Annual International Meeting & Trade Show, where complaints were rife that EMRs and telemedicine don’t interoperate.

I really liked this summary of the situation one executive shared with Fluckinger:

For now, the executive (who asked not to be named) said, telemedicine providers need to keep away from the “blast radius” of EHR vendor conflicts, lest their budgets get consumed by building interfaces to the various non-interoperable EHR systems.

Not only are health systems struggling to integrate telemedicine data with EMRs, telemedicine providers are in a bit of a difficult spot too, Fluckinger notes. As an example, he tells the tale of Seattle-based Carena Inc., a provider of primary care services to patients via phone and video, which provides after-hours support to physicians at Franciscan Health System in Tacoma, Wash.

Carena itself has an EMR which has the ability to share searchable PDF documents for use in patient EMRs, but Franciscan’s seven hospitals are bringing up an Epic implementation which can’t support this trick. Top execs at Franciscan want to connect Carena’s data to Epic, but that won’t happen right away. So Franciscan may end up setting up Carena’s after-hours service within Franciscan’s Epic installation to work around the interoperability problem.

This is just one sample of the interoperability obstacles healthcare organizations are encountering when they set out to create a telemedicine service. As telemedicine explodes with the use of portable devices, I can only imagine that this will impose one more pressure on vendors to conquer compatibility problems. (But sadly, I doubt it will force any real changes in the near future.)

EMR Ready: The Smartphone Physical

Here’s the kind of thinking that makes me wish I was going to TEDMED 13 (John Lynn will be there if any other readers are attending.). At this years’ show, a team of current and future medical professionals plan to do a complete “smartphone physical” for attendees, using a bunch of devices that appear to be compatible with an iPhone. Not only is the data immediately readable as the testing goes on, it’s EMR-ready, too, both pretty neat features.

Check out just how thorough the physical is going to be (courtesy of the TEDMED blog):

• Body analysis using an iHealth Scale.

• Blood pressure reading using a Withings BP Monitor.

• Oxygen saturation/pulse measured simultaneously with blood pressure, using an Masimo iSpO2 placed on the left ring finger.

• Visual acuity via an EyeNetra phone case.

• Optic disc visualization using a Welch Allyn iExaminer case attached to a PanOptic Ophthalmoscope.

• Ear drum visualization with a CellScope phone case.

• Lung function using a SpiroSmart Spirometer app to conduct a respirometer test.

•Heart electrophysiology using the AliveCor Heart Monitor.

•Body sounds: A digital stethoscope from ThinkLabs auscultates and amplifies the sounds of a patient’s lungs and heart.

• Carotid artery visualization using a Mobisante probe.

Participant Shiv Gagliani, a Johns Hopkins medical student, tells TEDMED that the smartphone physical can improve doctor-patient relationships, as the real-time, audible and visual results help connect patients to the tests and increase their understanding of their bodies. Not only that, the patients can help gather the data themselves, increasing their engagement with their care.

And of course, the devices that make the smartphone checkup possible are also very portable, making it possible for doctors to take them wherever they go, be it down the street or across the globe. What’s more, less-trained global health workers will be able to use these devices to gather baseline readings and via telemedical links, get instructions on how to treat patients. This device connectivity is part of what John suggested was needed for successful Telehealth.

To learn more about this project, visit http://www.smartphonephysical.org/. I’d definitely take a look; it seems to me that this type of mobile health technology is here to stay.

Keys to Successful Telehealth

Rob Sobie wrote a nice post on the Point of Care Corner blog about the 4 Keys to a Successful Telemedicine Launch. These are the 4 keys he offers:

Reliability
Ease of Use
Mobility
Flexibility

Most of the ideas are pretty self explanatory, but check out the full post for his explanation of each item. I agree with each item, but I think there are a number of other things that are needed for successful telehealth as well.

Multiple Application Support – While we’d love to have the entire Telehealth experience on one application, it’s unlikely to ever happen. While doing a Telehealth visit, the doctor is going to need access to a number of other applications such as their EHR. This is where the dual monitor Telehealth setup is so beneficial. They can have the Telehealth visit up on one screen while they browse their EHR or other health application on the other screen.

Telehealth Reimbursement – I recently asked an insurance company executive about Telehealth and if they’re really start reimbursing for it. He said they were happy to reimburse a Telehealth visit, as long as they had a way to know that there was indeed a visit that justified payment. You can see where they’re afraid of Telehealth reimbursement fraud. His solution to that was reimbursing Telehealth systems that were their trusted partners. With this in mind, you want to make sure whatever Telehealth solution you use is trusted by the payers so that you get paid.

Device Connectivity – One of the challenges of Telehealth is the ability to get device information from a patient. There’s a new wave of Telehealth technologies that are incorporating medical devices into the Telehealth experience. Integrating Telehealth and devices really takes Telehealth to the next level and since the cost of devices is dropping dramatically we’re going to see more and more integrations. Just be careful because many Telehealth platforms won’t have the forethought to do this type of device integration.

I’m sure there are other keys to Telehealth success. I’d love to hear your additional ideas in the comments. Where are you seeing it implemented? What’s been most successful?

I believe the Telehealth market is set to grow like it’s never grown before. The technology and infastructure are in place for it to become a reality. Things like shared savings will drive adoption of Telehealth as a way to lower costs. The article linked above says that Telehealth is projected to be a $27.3 billion industry in 2016. I’m personally looking forward to the shift to Telehealth.

Frontline Female Veterans Likely to Benefit from New VA Telemedicine Project

As anyone in healthcare will tell you, the U.S. government has an interesting sense of timing. A day after the Pentagon announces it plans to end its ban on women in frontline combat, the VA announces that it has awarded grants to VA facilities that are launching women’s health projects, including establishing telehealth services for female veterans living in rural areas. Coincidence, or well-timed marketing/public relations strategy?

According to the VA’s press release announcing the grants, “Women serve in every branch of the military, representing 15 percent of today’s active duty military and nearly 18 percent of National Guard and Reserve forces. By 2020, VA estimates women Veterans will constitute 10 percent of the Veteran population.”

No mention was made in the release, of course, of the 237,000 jobs that will be available to women in the armed forces now that the combat ban has been lifted. I wonder if that 10-percent figure might jump a little once 2016 rolls around and arguments amongst government agencies regarding combat roles that should remain closed to women are laid to rest.

Telehealth grants were awarded to 10 facilities, and, according to the VA, will be used to provide services including tele-mental health, tele-gynecology, tele-pharmacy and telephone maternity care coordination.

While I applaud Secretary of Veterans Affairs Eric K. Shinseki’s statement that “[t]hese new projects will improve access and quality of critical health care services for women,” I’m not quite sure where I stand on the underlying issue – why aren’t female veterans already given 100 percent access to care at VA facilities, and why does the government seem to be planning for an increased need for healthcare services? But that speaks to a bigger problem that is probably best addressed elsewhere.

New Telemedicine Stats Bode Well for EMRs

With the recent projection that telemedicine will reach 1.8 million patients worldwide by 2017, I think it’s fitting to continue the discussion I started last week pertaining to the current ROI of EMRs. While current utilization based on scrambling to meet Meaningful Use for federal incentives may not be all it’s cracked up to be, I do believe EMRs will ultimately provide a fiscally sensible return on investment, especially if telemedicine technology becomes part of any given vendor’s standard EMR package/offering.

I decided to bounce the idea off Sande Olson, a Twitter friend (@sandeolson) and Senior Healthcare Consultant at Olson & Associates. Being a healthcare professional that has worked in telemedicine long enough to witness its evolution, Olson seemed a fitting expert to speak with on the subject of EMRs, telemedicine and the bottom line.

How have you seen the telemedicine landscape change over the last few years?
Olson: Until recently, telemedicine has been a niche industry. Early users recognized the potential value of telemedicine, but successful business models (showing a viable ROI) didn’t exist, and technology was costly. The challenge was reimbursement; who was going to pay for it? Without reimbursement or a viable business model, telemedicine could not go viral.

The telemedicine landscape began to change with advancements in information and communication technology on the heels of The Affordable Care Act. The push for healthcare reform provided financial incentives to “nudge” healthcare providers towards EMRs. Reform mandates and the availability of government funding created new opportunities around technology. Telemedicine, a valuable if fledgling technology, became a buzzword around technology and healthcare reform.

Industries saw business opportunity as solution providers for an “industry poised to undergo radical change.” Entrepreneurs, inventors, investors and healthcare visionaries followed new and sometimes disruptive ideas. Care delivery tools moved from PCs to tablets, along with mobile apps.

The confluence of all these influencers is creating a potential tipping point for telemedicine; it only needs wider reimbursement and licensure portability. Our aging population and forecasted physician shortage will help continue to thrust telemedicine into the forefront of change. Telemedicine is already being used successfully; reimbursement is still a challenge. But, healthcare innovation is just getting started. We have challenging times ahead, but this is also the most exciting time to be in healthcare ever!

Do you think there’s been a trickle down effect from the Affordable Care Act in terms of increasing interest in and adoption of telemedicine?
There has been a trickle-down effect on telemedicine. The Affordable Care Act has increased interest in exploring the possibilities of telemedicine outside of previous niche markets. As I noted, it is the confluence of influencers around healthcare reform that continues to push the tipping point for telemedicine.

Do you think EMRs will prove their worth in the coming years by better facilitating more novel methods of healthcare delivery, like telemedicine, or integrating with consumer-friendly mobile health apps?
Will EMRs prove their worth? Well, data silos do not support healthcare’s philosophy of providing a continuum of care from cradle to grave. And, you cannot provide care without a medical record; you can’t measure outcomes. So, interoperability– across all silos– is critical to successful healthcare reform. EMRs today may fall a bit short, but they will create efficiencies and improve patient outcomes. They will get simpler to use. EMRs will assist in improving reimbursement and revenue cycles. And, future EMRs will push and pull data from HIEs, PHRs and mobile health apps; we are just not there yet.

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Telemedicine Not Connecting With EMRs

EMR Ready: The Smartphone Physical

Keys to Successful Telehealth

Frontline Female Veterans Likely to Benefit from New VA Telemedicine Project

New Telemedicine Stats Bode Well for EMRs

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