Tag Archives: telehealth

Why Patients Want Telehealth – And How Providers Can Benefit From It

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A recent study reveals how patients feel about telehealth. More than 50 million U.S. consumers are willing to switch to a provider that offers telehealth services. Notably, patients want telehealth for a broad scope of issues ranging from minor tasks like getting prescription refills to managing chronic conditions and as an alternative to late-night ER visits.

65% of consumers want their primary care physician to offer telehealth video calls, not emails, or phone calls. Notably, most patients do not wish to switch a PCP because they trust their physician, but 20% are willing to make the switch to get the service.

According to 2017 Consumer Telehealth Index [pdf], 67% of adult patients delay visits to doctors. The reasons are obvious – high costs of care and, most importantly, long time it takes to see a doctor or nurse. For most U.S. consumers living in a city, it takes 18.4 days on average from the day they make an appointment to the day they visit a doctor. Once in the office, the visit takes 120 minutes on average – 100 to get in, 20 to talk to the doctor.

Having trouble to squeeze the visit into a busy schedule, or hoping the problem would go away on its own contribute to the list of reasons Americans are reluctant to see a doctor.

The patients delay seeking care for serious health issues, not just minor ones. A third of delayed visits accounts for serious conditions that could have cost the payer and the provider significantly less had the initial visit to the doctor been timely. Late diagnosis translates into aggravated conditions and more expensive treatment.

Delayed visits for routine checks and minor issues – preventative exams, flu shots – can lead to equally serious ramifications.

Time, Location, and Cost Benefits of Telehealth

With the waiting time and the tediousness of getting a brick and mortar appointment with the doctor, consumers value the time-saving advantages of telehealth. The survey estimates that when using telehealth video conferences with their physicians, patients spend an average of 5 minutes waiting, and 8-10 minutes “seeing” the doctor.

The great convenience of being able to have a video conference with a doctor from home, office or while traveling has significant cost savings for the payers. Increasingly more health plans now cover telehealth at a lower cost than a typical visit to the doctor.

Interestingly, the U.S. adults report their concerns were resolved completely in 64% of in-office visits to the doctor, and in 85% of telehealth video calls. A separate study found repeat visits for the same conditions within two weeks were lower for telehealth than for office visits.

Areas Where Consumers Want Telehealth

Emergency Rooms. 20% of Americans are willing to have a video call as an alternative to the late-night ER visits. The Houston Fire Department’s ETHAN program is a telling example of how telehealth averts low-acuity ER visits, ambulance rides, and makes the work of ambulance teams more productive and fast.

Traditionally, ER is a place with long waiting lines, and high costs, for both provider and payer. ERs, on the other hand, are highly overloaded, which does not help increase productivity or reduce staff burnout.

Telehealth is a lower cost alternative to an ER visit. Timely video calls help avert low-acuity ER visits, decreasing the pressure on the emergency care facilities, and the cost of care for the provider and the patient.

Follow-up visits. With preventable readmissions being a pressing financial concern for the providers, reducing the readmission rate is critical. 52% of patients want to use video conferences with their doctors for post-discharge follow-up visits.

Telehealth helps doctors achieve a greater level of control over the post-discharge care, give timely reminders and identify serious symptoms on time. Likewise, patients are less stressed physically during a video call than a visit to the office. Patients enjoy greater control over their treatment and are more likely to adhere to recommendations than with the office visits.

Chronic conditions. 60% of adult Americans want to have regular video conferences with their physicians to help them manage a chronic condition. Chronic conditions’ cost is high for the provider and the payer. So, telehealth solutions for such chronic conditions as diabetes and hypertension make care more accessible for the patients.

Getting a prescription refill is particularly tedious. So, most patients want their PCP to be available for a video call to get their prescription refilled. Half of female respondents are willing to have routine birth control-related visits via video calls.

79% of respondents who care for an elderly relative would like to be able to participate in the video conferences with the doctor. They expressed the need to be more informed and involved in the treatment. The group conferences doctor-patient-caregiver have a great potential to improve outcomes.

What This Means for Providers

One of the key takeaways from HIMSS17 was the urgent need for a patient-centric approach. As patients get more choices, they will inevitably switch to providers and care plans that offer more for less money. Telehealth allows patients achieve that goal – get an accessible care in a convenient format for the same or lower cost.

Doctors, on the other hand, want telehealth because it lifts the burden. ER units are more focused on acute patients, with the rest diverted via telehealth. Physicians service more patients in less time with video calls rather than office visits.

Combine that with the ability to complete EHR documentation instantly, during the video visit, sign prescriptions, view medical images, and get live updates from remote patient monitoring devices. That way, a doctor minimizes the time spent on the EHR documentation after work (2-3 hours of uncompensated time daily).

The benefits of telehealth for minimizing preventable readmissions and improving outcomes are significant. As much as in-room infotainment systems, telehealth solutions offer many user-friendly formats for educational material.

Now that providers see the wisdom in investing in telehealth, it is vital to screen solutions carefully.

Providers are responsible for electronic patient health information (ePHI) privacy and security. They need to control the flow of confidential data to and from their systems. Therefore, advanced authentication and remote administration are a must. Windows medical tablets have a biometric reader, CAC/Smart Card, and RFID Imprivata SSO. Add in the Windows native authentication mechanism, end-to-end encryption for incoming and outgoing data, and you get a compliant and secure solution.

Bring Your Own Device is not the best fit for the task. A fleet of disparate operating systems, rooted Android and jailbroken iPhone devices, poor cyber security awareness, bad browsing and downloading habits mean there is very little a provider can do to protect ePHI.

The providers need a reliable solution with minimum investment and maximum output. Windows medical tablets offer high ROI. Most programs are designed for Windows primarily, so you don’t need to cripple a desktop program to squeeze it into a mobile operating system.

Windows medical tablets have legacy ports, USB mini and regular ports, and allow encrypting data on external drives. They can run EHR. Resources of a Windows medical tablet are far superior to those of a typical BYOD device. Multitasking and viewing medical images is a breeze with Intel 5th-gen Intel processors.

Add in full-shift uptime with durable batteries, or hot-swap batteries, MIL-STD components, antimicrobial coating, barcode reader and full disk imaging, and you get a durable powerhouse that lasts for years.

Despite the seemingly low initial cost of BYOD, the total cost grows exponentially when you need to deploy mobile-dependent healthcare solutions. Only medical grade tablets are capable of powering your clinical needs, providing the security, resources, and usability required by your staff.

Houston Fire Dept.’s Mobile Innovations and Telehealth In Emergency Care

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From Feb. 19 to 23, 2017, Orlando’s County Convention Center (OCCC) hosted this year’s largest health IT conference and exhibition, HIMSS17. Cybernet traditionally attended, and we have a lot of news and impressions to share. With 7 million square feet, OCCC is one of the country’s largest convention centers, so there was a lot of ground to cover.

Of particular interest was “Mobile Innovations and Telehealth in Emergency Care” session by Professor James Langabeer, Ph.D., M.B.A. The session focused on how Emergency Telehealth and Navigation program (ETHAN), in conjunction with mobile medical tablets, is helping the City of Houston Fire Department be more efficient in responding to medical emergencies, especially when serving low acuity patients.

ETHAN

ETHAN, funded by Delivery System Reform Incentive Payment, launched in 2015 based on the belief that there must be a more efficient solution to provide care to non-emergent patients. By now, ETHAN has served nearly 9,000 patients, which is approximately 5% of all emergency calls in the city.

The challenge that prompted the City of Houston Fire Department (HFD) to seek better solutions is that of an increasing Emergency Department overload. Long waiting lines in EDs are growing, as increased population is finding it easier to dial 911 from their smartphones.

With 600,000 911 calls and 400 EMS transports per day, HFD is stretched beyond its capacity. If an average person used to call 911 once or twice in a lifetime, the current population has drastically increased the level of 911 engagement. Densely populated cities can not keep up with the number of calls. Prof. Langabeer notes how educational programs that aim to increase population awareness on when to use 911 always end up increasing the number of 911 calls instead of reducing them. In Houston, the number of fear-related, low acuity visits to ED is 20%-50% of all 911 calls.

Hence, HFD ambulances respond to a large number of low acuity situations that do not require medical equipment or urgent medical attention. It is these low acuity visits that call for ETHAN activation.

How It Works

Ambulance and firefighter teams are equipped with mobile tablets running ETHAN program developed by CISCO. It is a commercially available solution customized specifically for the HFD needs. The requirement was to make the solution HIPAA compliant, encrypted, with the capability to record interactions, and guarantee a reliable connection between the ETHAN crew and the remote physician, who might be on the move.

If the crew, upon arrival, decide that the patient may not require an ED visit, they activate ETHAN and initiate a video call with a remote physician using a medical tablet.

The remote emergency physician interviews the patient as if he/she were at the bedside, and, based on vitals, history, and assessment of the medic on site, may offer several options:

  • The ambulance transport to ED.
  • Referral to an ED with a prepaid taxi.
  • Clinic referral with taxi transport.
  • Referral to the primary care provider or home care.

 

The goals of ETHAN are to:

  • Reduce the number of ambulance ED transports for low-acuity cases that do not require urgent medical attention
  • Improve unit availability & total turnaround times
  • Improve focus on true emergencies
  • Connect patients with a medical home
  • Improve care quality, reduce costs

 

There are some situations, in which people are over-utilizing 911, says Prof. Langabeer. Patients may be new to the city and do not have a primary care provider yet, or they may have chronic conditions and bounce from ER to ER whereas what they need is an appointment with their primary care provider, and tests, or they just need a medication refill.

If a remote physician decides the case is low acuity, he/she can recommend the patient be redirected to the clinic right away. The physician even schedules an appointment the same day or the next day. The taxi service is prepaid by the HFD. The cost savings are significant, as the taxi fare is several times cheaper than the ambulance transportation.

One of the special features of the program is the follow-up calls. The multiple callers get follow-ups that aim to engage them with other programs (primary care, home care) to reduce the number of non-emergent repeat callers.

Patient Disposition

The results in changing patient disposition are promising. Of a total 8,561 ETHAN patients:

  • 65% chose to go to a hospital ED with a taxi instead of an ambulance.
  • 7% chose the clinic referral with a taxi.
  • 6% chose the referral to PCP or home care.
  • 16% chose ambulance transport to ED.

 

Results summary:

  • ETHAN unit productivity (39 minutes per visit on average) is higher than that of the traditional EMS units (83 minutes per visit on average) by 44 minutes.
  • The cost of ETHAN unit visit is $167 per patient, while that of the traditional EMS unit is $270/patient.
  • Disposition to ED by ambulance is 67% in ETHAN patients, and 74% in traditional EMS units patients.
  • ETHAN’s ROI is $928,000/year; $2,468/ED visit averted.
  • At the same time, patient satisfaction is even for both ETHAN and traditional EMS patients.

 

As we can see, the crew productivity is doubled with ETHAN assistance, while cost savings in averted ED visits and reduced ambulance use are significant.

Challenges

At the same time, there are a few roadblocks that the program encounters:

  • Insufficient budget.
  • Policy and reimbursement issues.
  • Certain resistance from the healthcare community as providers get fewer ED visits that are expensive and more primary care visits that are cheaper (but more relevant).
  • Patient reluctance and lack of awareness, as most patients insist on ED visits and tend to feel their needs are not addressed when offered alternatives.
  • Staff training on the use of telehealth technology and the criteria that call to ETHAN activation.

 

“If this was your family member, would you be comfortable with sending them somewhere other than the emergency room?” said Prof. Langabeer, when asked about the criteria units rely on to activate ETHAN.

Revolutionizing Healthcare, One Step At A Time

ETHAN is the first of its kind in telehealth and the use of medical tablets, and it revolutionized Houston healthcare by enabling an instant and remote partnership between responders and caregivers. It transformed how the city handles emergency calls from patient, responder and health care perspectives by boosting turnaround time, and minimizing the number of unnecessary ED visits. The cost efficiency is apparent at the payer level, as the patients get expert advice on alternatives that are more reasonable and affordable than an ED ride with an ambulance.

The next step for the program is to expand telehealth into EMS and further incorporate mobile technology solutions. Projects such as ETHAN call for deployment of HIPAA-compliant, EHR-ready medical tablets with antimicrobial housing to ensure patient and staff protection from nosocomial infections. There is a need for hot-swap battery technology to ensure full-shift uptime, and RFID Imprivata SSO with integrated biometric scanner to enable advanced authentication and data protection.