Telemedicine: Can In-Person Pre-treatment Communication be Expanded by Video Consultation?

Informed consent for radiological or other interventions should give a patient sufficient time to make an informed decision. Currently, patients typically have to be present, in-person, to be briefed about procedures and an extra appointment is often necessary. While in an urban setting this is mostly just a nuisance, in a rural area, similar to ours, it may not be possible at all for patients with limited access to transport. In some countries, teleconsultation via videoconference has proved beneficial in comparable situations.

The full piece can be downloaded below.  

Simplifying Physician Licensing Across State Lines Will Promote the Expansion of Affordable Healthcare Delivered via Telemedicine

Technology has changed the way we live, work and play; its widespread adoption continues growing at a rapid rate, and its improving affordability makes it possible for much of the U.S. population to be connected electronically. The physician demographic is shrinking, and by 2025, physician supply is expected to be in crisis with a shortage of as many as 90,000 doctors. At the same time, wait times to see a physician are increasing, due in large part to growing demand as baby boomers age and chronic diseases become more prevalent. Technological advances in health information technology and video-conferencing make diagnosis, treatment and management of healthcare remotely possible. 

Physician licensure is managed by each individual state medical board, and the constitution gives the state its police power to protect the health, safety and wellbeing of its population. It is both expensive and time consuming and on average it can take four to six months. Promoting widespread use of telemedicine involves better defining what it encompasses within the practice of medicine, thereby allowing for special licensing of practitioners seeking to engage across state lines.  The Veterans Administration, Medicare and Medicaid have developed telehealth programs in order to expand and afford coverage in gap areas, and the federal government is better suited to develop telemedicine licensure guidelines and standardize the process for interstate commerce. Congress has ultimate power to control commerce, as granted by the Constitution, irrespective of the size or volume of the market. As a result, physician licensure for telemedicine should be administered by the federal government, so that simplifying physician licensing across state lines will promote the expansion of affordable healthcare delivered via telemedicine.

The full commentary can be downloaded below.  

The Association Between Willingness of Frontline Care Providers’ to Adaptively Use of Telehealth Technology and Virtual Service Performance in Provider-to-Provider Communication: Quantitative Study

Telehealth technology can create a disruptive communication environment for frontline care providers who mediate virtual communication with specialists in electronic consultations. As providers are dealing with various technology features when communicating with specialists, their flexible attitude and behaviors to use various telehealth-related technology features can change the outcome of virtual care service.

The objective of this study is to examine frontline care providers’ technology adaptation behaviors in the electronic consultation context. From the perspective of frontline care providers, we reapply and retest a theoretical model, reflecting a mechanism through which technology users’ personal characteristics and technology adaptation behavior enhance virtual service performance, which is an important performance enabler in this online meeting context. In provider-to-provider communication, particularly, we explore the association among providers’ information technology (IT)–related personal characteristics, adaptive telehealth technology use, and virtual service performance.

An online survey was administered to collect individual providers’ personal traits, IT adaptation, and perception on virtual service performance. Partial least squares-structural equation modeling was used to estimate our predictive model of personal traits—IT adaptation, such as exploitative use (use the telehealth technology in a standard way), and exploratory use (use the telehealth technology as innovative way)—and virtual service performance.

We collected 147 responses from graduate nursing students who were training to be nurse practitioners in their master’s program, resulting in 121 valid responses from the cross-section online survey. Our theoretical model explained 60.0% of the variance in exploitative use of telehealth technology, 44% of the variance in exploratory use of telehealth technology, and 66% of the variance in virtual service performance. We found that exploitative IT use is an important driver to increase virtual service performance (β=0.762, P<.001), and personal characteristics such as habit are positively associated with both exploitative (β=0.293, P=.008) and exploratory use behaviors (β=0.414, P=.006), while computer self-efficacy is positively associated with exploitative use of telehealth technology (β=0.311, P=.047).

This study discusses the unique role of frontline care providers in a virtual care service context and highlights the importance of their telehealth adaptation behavior in provider-to-provider communication. We showed that providers perceive that telehealth technologies should function as intended, otherwise it may create frustration or avoidance of the telehealth technology. Moreover, providers’ habitual use of various technologies in daily lives also motivates them to adaptively use telehealth technology for improving virtual care service. Understanding providers’ technology habit and adaptation can inform health care policy and further provide a better view of the design of telehealth technology for online communication.

The full article can be downloaded below.  

Can Artificial Intelligence Cure Mental Health Conditions?

Mental illnesses have become one of the biggest medical challenges of the 21st century. According to the World Health Organization, around 450 million people globally are affected by mental illness. 

But two-thirds of people with a known mental condition, such as anxiety, depression and co-occurring disorders, fail to seek help from medical professionals. This can be due to a number of factors, including stigma and discrimination.

London-based digital health and artificial intelligence company BioBeats is on a mission to change the perception of mental health globally by using data. It’s developed a wearable device, an app and machine learning system to collect data and monitor users’ level of stress, before predicting when stress could be a cause of a more serious or physical health condition. 

The full Forbes article can be viewed at this link.  

Telehealth Has An Awareness Problem

Two-thirds of adults are willing to consult with a doctor via video, but only 8% have tried it, according to a new consumer survey by American Well, a major provider of telehealth services.

The poll closely tracks other studies that show consumers have been slow to adopt telehealth (also known as telemedicine), despite the fact that more health plans and self-insured employers are offering it as a benefit. “It’s troubling,“ says Roy Schoenberg, the co-founder and CEO of Boston-based American Well. “Now more people are covered, but they don’t know it’s available.”

Another disconnect: Although 23% of primary care physicians say they now offer virtual visits, only 6% of consumers report that their doctor does. The fact that doctors are increasingly using telehealth should help clear a major hurdle, since most patients prefer to stick to their doctors or see them in person. “The biggest revolution isn’t the adoption of telehealth by patients, it’s by doctors,” says Schoenberg, who has a medical degree. “The vast majority [of patients] follow the orders of physicians, there’s a lot of comfort in that.”

The full Forbes article can be viewed at this link.  

Hospital Utilization Among Rural Children Served by Pediatric Neurology Telemedicine Clinics

We found lower rates of hospital encounters among children who received neurology care in their own communities using telemedicine compared with children who received neurology care in the in-person clinics, even in multivariable analysis and certain matched analyses. Our findings suggest that by improving subspecialty access in underserved communities and enhancing care coordination among physicians, telemedicine may reduce the utilization of high-cost hospital care for children with neurologic conditions.

The full article can be downloaded below.  

The Evolution of Elderly Telehealth and Health Informatics

Many elderly individuals experience memory loss and often dementia as they age. This causes problems for the elderly due to diminished skills and increase in medical problems and natural decline. The Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Such programs are cost-effective. Long-term care insurance companies are likely to cover these services. Home care and nursing home corporations are following the VHA’s lead. We have recently witnessed significant advances in technology. Internet and mobile applications have opened a new world, providing information and opportunities for individuals to learn more information about illness and at a much faster rate. Smart home technology has evolved. Elderly patients often encounter difficulties using these technologies. Despite the advances in telehealth and telemedicine and the evolution of the technology, many individuals cannot afford the treatment or the technology. These same individuals and families are part of the digital divide, and they have not embraced the new technology. Federal programs have been developed and implemented to help this portion of the population.

The full chapter can be downloaded below.  

Reimbursement of Apps for Mental Health: Current Practices and Potential Pathways

Although apps and other digital and mobile health tools are helping improve the mental health of Americans, they are currently being reimbursed through a varied range of means, and most are not being reimbursed by payers at all.

The aim of this study was to shed light on the state of app reimbursement. We documented ways in which apps can be reimbursed and surveyed stakeholders to understand current reimbursement practices.

Individuals from over a dozen stakeholder organizations in the domains of digital behavioral and mental health, care delivery, and managed care were interviewed. A review of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCSPCS) codes was conducted to determine potential means for reimbursement.

Interviews and the review of codes revealed that potential channels for app reimbursement include direct payments by employers, providers, patients, and insurers. Insurers are additionally paying for apps using channels originally designed for devices, drugs, and laboratory tests, as well as via value-based payments and CPT and HCSPCS codes. In many cases, it is only possible to meet the requirements of a CPT or HCSPCS code if an app is used in conjunction with human time and services.

Currently, many apps face significant barriers to reimbursement. CPT codes are not a viable means of providing compensation for the use of all apps, particularly those involving little physician work. In some cases, apps have sought clearance from the US Food and Drug Administration for prescription use as digital therapeutics, a reimbursement mechanism with as yet unproven sustainability. There is a need for simpler, more robust reimbursement mechanisms to cover stand-alone app-based treatments.

The full article can be downloaded below.  

Presentation slides from August 6, 2019 Webinar.

Increased patient satisfaction; Reduced cost of care; Better health outcomes. Sounds right at home with the Triple Aim, doesn’t it?

Since 2016, Marshfield Clinic Health System (MCHS) has been caring for patients in their own home environment instead of the hospital through their Home Recovery Care program. As a result, they’re seeing extremely high patient satisfaction from those participating in the program, costs are down, and physicians are reporting improved outcomes.

But what does it take to make a home recovery model work? Join eHI for a webinar featuring MCHS and their partner Contessa Health, who will share the ins and outs of their innovative initiative that allows patients to receive the high quality, personalized care they need in their own homes.

Webinar participants will hear about:

• The makeup and model needed to successfully implement a Home Recovery Care model, including payment models and the incorporation of technologies that support care coordination, patient management, utilization analytics, and documentation
• How hospitals and health systems can use a Home Recovery Care model to drive market share, deliver a better patient experience, and improve clinical outcomes
• How to structure a Home Recovery Care model to see sustained improvements in quality, safety, and efficiency

Speakers

-Narayana Murali, MD, FACP, CPE
EVP, Care Delivery & Chief Clinical Strategy Officer, Marshfield Clinic Health System;
Executive Director, Marshfield Clinic

-Travis Messina
Co-Founder, CEO, Contessa

The Futures of eHealth: Social, Ethical, and Legal Challenges

Looking into the futures of eHealth? The title of this publication might seem quite presumptuous at first. Its objective, however, is to serve a much more modest purpose, in that it strives to take a look at potential, likely, desired, anticipated or feared futures of digital health technologies and practices. When analysing the opportunities and risks associated with them as well as the social, legal and ethical challenges they might pose, what we also see in the process are the expectations and promises projected onto them.

eHealth or “digital health”, according to the World Health Organization’s European Office, “involves a broad group of activities that use electronic means to deliver health-related information, resources and services: it is the use of information and communication technologies for health” (World Health Organization 2017). As far as current developments and technological solutions are concerned, the WHO has further identified the following areas:

• Electronic health records and interoperability of data;
• Mobile health or mHealth;
• Telehealth, where a patient can consult with a healthcare worker using Skype or even a regular telephone;
• Wearable technologies (fitness trackers, medical devices, etc.) and
• Technologies to support integrated care (WHO 2017).

Looking into the futures of anything always involves creating narratives. Rather unsurprisingly, the WHO’s definition characterises the role of technology use as entailing “strengthening health systems and health information systems” (World Health Organization 2017), a narrative of opportunity. These promises of eHealth are embedded in and reflective of much larger discourses that are often associated with (digital) technologies, which are mainly seen as a remedy to existing social problems. These discourses often centre around terms such as “empowerment”, “democratic potential”, “unifying cross-border force”, “special care for vulnerable groups” or “bridging distances”. And, indeed, there is an abundance of opportunities in digital health solutions that are directly associated with these technologies and practices.

The full paper can be downloaded below.