Telemedicine and Telehealth News 4/16/2008
After a four-year study, Dr. Alfred Bove of the School of Medicine at Temple University Hospitals said he believes the healthcare system could use telemedicine to bridge what he calls the "medical divide" between treatment and outcomes for upper- and lower-income patients.
Bove, along with researchers at Temple's Telemedicine Research Center, recently finished a four-year study that examined the prevention of heart disease in at-risk, but otherwise healthy patients in rural and urban settings through frequent patient-doctor communications. The patients and doctors interacted via an internet-based health reporting system in conjunction with regular clinic visits.
Researchers found that adding the internet reporting system to traditional office visits allowed participants to communicate more frequently with their healthcare providers, and as a result, they were able to lower their risk of heart disease by improving blood pressure, blood lipid levels and cardiovascular disease risk score.
Bove believes that telemedicine's use in populations that are generally underserved by the healthcare system can bridge what he calls the "medical divide" between treatment and outcomes for upper- and lower-income patients. Communications with a doctor between in-person visits encourages these patients to take a more proactive approach to their healthcare through self-monitoring and self-reporting.
Participants were randomly divided into a control group or a telemedicine group and received a device to measure blood pressure and a pedometer to measure daily steps, along with advice on exercising and its benefits in preventing heart disease. The telemedicine group also regularly transmitted their blood pressure, weight and pedometer data to cardiologists, and received feedback and educational information via the internet.
Participants of both groups had significant reductions in blood pressure, lipids and cardiovascular disease risk scores, and were able to walk farther distances. While researchers expected an improvement among the telemedicine group, based on previous research, they were surprised at the success the control group had, due in large part to clinic nurses, who Bove said "did an excellent job in communicating to patients the importance of preventing cardiovascular disease."
"Communication between a patient and their primary care provider works for prevention of cardiovascular disease, whether it's in the office, or over the internet," said Bove, adding that the telemedicine approach does have some advantages to traditional patient visits.
"With rising healthcare costs, a telemedicine system can encourage communication between patients and their doctors with less cost and time commitment than frequent doctor visits," he said.
While both urban and rural groups showed marked improvement in their heart health, those in the rural location were found to do slightly better overall than the urban group. Study co-author Carol Homko, R.N., Ph.D., an adjunct faculty member at the School of Medicine, noted that this was most likely because at baseline, those participants had a better understanding and more knowledge of cardiovascular disease than did their urban counterparts.
Several additional research projects regarding telemedicine are currently ongoing at Temple University, including its use in monitoring hypertension, gestational diabetes, head trauma, and gastrointestinal and pulmonary health. Bove and his team are hoping to next study telemedicine's use in controlling diabetes, given the success that diabetic participants had while enrolled in this study.
"There are myriad different uses for this system, and we've been very fortunate to be at the forefront," said Bove. "This is an excellent way to encourage patients to communicate directly with their primary care physicians and become empowered to ask questions and become proactive in their healthcare."
(Source: Science Daily, April 1, 2008)
Philips Electronics recently released the final results of a survey conducted by Fazzi Associates of nearly 1,000 home care agencies in the United States. Results of the Philips National Study on the Future of Technology and Telehealth in Home Care show that nearly one third of large agencies are currently using a telehealth system and that industry use of telehealth is expected to double over the next two years, principally as a means of managing patients with chronic disease. In addition, over 88 percent of agencies report that telehealth services led to an increase in quality outcomes, as evidenced by a reduction in unplanned hospitalizations and ER visits, and over 71 percent report an improvement in patient satisfaction.
Co-sponsored by Philips, the National Association for Home Care & Hospice (NAHC), and Fazzi Associates, this first-of-its-kind study gathered insights about the use of home care technology from nearly 1,000 agencies across the U.S. The study represented all major segments of home care: large and small, rural and urban, free-standing and hospital-based, and for profit and not-for-profit.
"What makes this study so important is that it is the first representative sample study on technology and telehealth in home care that has ever been undertaken," said Val Halamandaris, president and CEO of NAHC. "We now have a much clearer sense of how specific segments of home care are responding to and using these technologies. One finding that is particularly significant is that the utilization of telehealth by home care agencies also correlates directly with providing the highest quality of care."
"Philips Home Healthcare Solutions was pleased to sponsor a study of this magnitude that could provide insights to advance the home care industry, as well as share these findings at no cost to the field," said Mike Lemnitzer, senior director, Philips Telehealth Solutions. "We believe that home health agencies will be a critical part of the solution to the U.S. healthcare crisis and ensure a continuum of care from the hospital to the home."
According to Dr. Robert Fazzi, project co-director, the Philips study was designed to address questions that are most on the minds of agency leaders about the role of four major home care technologies: human resources and billing systems, point of care systems, electronic medical records, and telehealth systems. Given the importance of telehealth to the future of home care and hospice agencies, much of the study focused on the various types of telehealth systems being used, the components of these systems, what agency leaders liked and disliked about their systems and most importantly, what leaders felt were the most significant impact of these systems on various aspects of quality and financial outcomes. Among the findings were:
The Centers for Medicare & Medicaid Services (CMS) has published a new regulation establishing Part D e-prescribing standards for four types of information. The new rule will go into effect on April 1, 2009. According to HHS Secretary Mike Leavitt, establishing standards for e-prescribing under Medicare's prescription drug program will help pave the way for the widespread adoption of e-prescribing throughout the medical community.
This regulation applies to:
The nation's ability to rein in future healthcare costs, which hospital executives fear could reach unsustainable levels within a decade, may depend in part on emerging technologies that are taking patient engagement to a higher level, especially in the home. Home health monitoring and telemedicine for post-discharge care are nothing new, particularly with cardiovascular care, but it is taking on added dimension as new technology permits.
William Petasnick, CEO of Froedtert Hospital, Milwaukee, said the next generation of home health monitoring, also called home telehealth, will take consumers beyond routine pacemaker monitoring and into total remote monitoring. The business value of this new direction goes beyond the desire to reduce hospitalization, and therefore cost, and extends to better resource utilization in an era of nursing and other workforce shortages, the need to better manage chronic diseases, and the desire for better patient service and outcomes.
The hospitals of today, Petasnick noted, are trying to become more highly intensive in terms of their care environments. "With less-acute patients, the more we can keep them out of an institutional setting, that's better for care and it's a more effective use of resources," he said.
Home telehealth, according to Jonathan Edwards, research vice president for Gartner and a lead analyst on telemedicine, is a concept that uses these technological developments to assist patients who suffer from chronic or long-term medical conditions that historically require frequent visits to the hospital. Monitoring for cardiac patients is popular with several types of portable devices, but the technology is also used for cancer or diabetes patients whose vital signs suddenly can fluctuate.video conferencing.
"For patients with expensive conditions, it makes sense to have these devices rather than being admitted into the hospital," Edwards said.
Joan Maro, vice president of home care and hospice and chief nurse executive at Aurora Health Care in Wisconsin, said the technology Aurora uses for patient monitoring collects chemical levels and vital signs, with specialization to meet the requirements of many conditions. Monitors can read heart rate, blood pressure, weight, oxygen saturation, and temperature, sending signals to the Aurora offices for review and (if necessary) response by a trained nurse.
Daily monitoring, Maro said, allows clinical professionals to both keep an eye on patients in the event of emergency and also plan ahead for any new developments in their condition. Depending on the issues surrounding patient privacy, it may one day be possible for a patient's family to access their information over a distance.
"It would be a wonderful offering for the families caring for loved ones from a distance," Maro said. "They would be able to see that their blood pressure was in line or that they had taken their medications - even monitor them via camera."
One barrier to the use of telemedicine, Edwards said, is not the devices themselves but transmittal of data from those devices, and the lack of an infrastructure to monitor and detect the data. Without an appropriate recording system, the information collected cannot be compared to normal health criteria and therefore is of limited use to doctors and other providers.
Developing these records systems can be a problem, since telemedicine is held back by the oldest issue in the medical field: money. Maro said that at this time reimbursement for in-home monitoring is limited, chiefly due to a lack of documentation to prove that home health monitoring is cost-effective and leads to improved outcomes.
Funds are limited for telemedicine, Edwards said, because insurance and payer companies have been slow to lend support for the technology. These limitations mean that, in many circumstances, patients have to cover their own costs, leading to circumstances where third-party vendors have to bypass primary care and therefore are not integrated with the physicians' medical records.
"The group is paid by activity, so they don't have any incentive to keep the patient at home," Edwards said of healthcare's profit mentality.
Telemedicine's success, Edwards added, will depend on the success of pilot projects and grant funding, which help develop interest and documentation in the field. One of the more encouraging investments has been made by the U.S. Veterans Health Administration, which has thousands of patients suffering from conditions such as diabetes and cardiac failure. The field also is driven by organizations such as the Continua Health Alliance, which unite device developers committed to improving technology for home health devices.
Device development will also play a role, as the three areas of telemedicine identified by Edwards - messaging systems to prompt and alert patients, devices to record vital signs, and tools for video conferencing - continue the trend of merging into one device. Unified devices like these would allow healthcare providers to consolidate operations, a move that also could lead to wider adoption by insurance companies.
Of course, the most important factor for home health monitoring will be for developers to remember who they are designing the technology for. "For anybody, the issue is creating a healthcare environment and creating it where services are needed," said Nina Antoniotti, director of telehealth for Marshfield Clinic. "It's what's efficient for providers and giving [patients] a good experience."
Telemedicine is expected to expand with the specter of "Baby Boomers" approaching retirement, a trend that will dramatically increase the elderly population. "The elderly patients are more likely to have chronic conditions, which are typically more expensive to manage," Edwards said. "Therefore, an elderly population will need more home health monitoring."
Not everyone believes the aging population will be the primary driver of future healthcare costs. Donna Friedsam, associate director for health policy with the University of Wisconsin-Madison Population Health Institute, cited recent U.S. Congressional Budget Office and Office of Management and Budget analyses that suggest the aging population is not the only culprit.
In challenging the conventional wisdom, the Congressional Budget Office has issued a series of reports on the growth in healthcare costs. In one analysis, it notes that the aging of the population is frequently cited as the major factor contributing to the large projected increase in federal spending on Medicare and Medicaid, but asserts that aging accounts for only a modest fraction of projected growth.
According to the CBO, the main factor is the extent to which the increase in healthcare spending exceeds the growth of the economy. The CBO also indicates that gains from higher spending are not clear, but there is substantial evidence that more expensive care does not always mean higher-quality care. "Consequently, embedded in the country's fiscal challenge are opportunities to reduce costs without impairing health outcomes overall," the CBO stated.
The Office of Management and Budget goes a step further, saying the long-term fiscal challenge is "almost entirely unrelated" to demographics and Social Security, but it is mostly confined to inefficiencies in the private and public healthcare system - inefficiencies that concepts like home telehealth would address.
(Source: Wisconsin Technology Network News, April 2, 2008)
HRSA has issued a Sources Sought/Market Survey to locate firms with the capability to develop a model infant audiology diagnostic protocol using telemedicine. This will help professionals provide diagnostic services in rural areas. Audiology as a profession has been slow to adopt telemedicine, but it is now becoming necessary and more feasible to use telemedicine since inexpensive interactive video systems are now available.
Preliminary research suggests that telemedicine models might prove to be effective for audiologists to use to deliver hearing services to locations where no services now exist. This is vital because diagnostic audiology needs to occur between the ages of one to three months after a baby fails to pass a follow-up screening. However, only half of the infants referred are generally evaluated due to the shortage of pediatric audiologists and equipment. Data shows that an infant with a significant hearing impairment who receives intervention by six months of age will perform significantly better in language development than the infant who is identified after six months of age.
The goal is to place diagnostic equipment in a spoke site of an existing telemedicine network. Audiologists at the hub site would then observe the correct use of the equipment, interpret the results, and interact with the families.
The methodology, once demonstrated could be spread through the National Center for Hearing Assessment and Management. NCHAM has a regional network of pediatric audiologists operating throughout the U.S.
This Sources Sought notice is for information and planning purposes only and is not a solicitation announcement for proposals. For more information please see the Sources Sought announcement posted on www.fbo.gov on April 11, 2008.
(Source: Federal Telemedicine Update, April 15, 2008)
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About the authors: Josie Henderson is the Director of the Telemedicine Research Center. Will Engle is the Executive Director of the Association of Telehealth Service Providers.
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