Telemedicine: Transforming Community Long-Term Care

Abstract

Consider this: Telemedicine will be fully integrated into health care systems to improve quality, access, equity, and affordability of health care throughout the world. That, in fact, is the vision statement of the American Telemedicine Association (ATA), the leading international resource and advocate promoting the use of advanced remote medical technologies. Recently, I had a conversation with Jonathan Linkous, MPA, executive director of the ATA, to understand what this means for community long-term care. What do we know and what do we think we know? What are the opportunities and the challenges?One of the founding board members of the ATA in 1993 was past AMDA President Eric G. Tangalos, MD, FACP, AGSF, CMD, from the Mayo Clinic. And Jonathan Linkous? Back in the 1980s and early 1990s, he was chief executive officer of the National Association of Area Agencies on Aging. The “triple A's” are as aware of the challenges of community LTC as we are.So what is the ATA, what are its goals and policies, and what do they have to say to us?The ATA is a diverse, international association, with members from across the world and the medical spectrum: health care professionals, researchers, health care institutions and industry partners, including Verizon and AT&T. The organization's interests include traditional telemedicine, remote monitoring, wireless/mobile apps, online services, development of practice guidelines, working with government on the national and state level for appropriate telecommunication standards, online training, and recently, accreditation for online clinical consultation services.There is a distinct and varied nomenclature in this emerging arena of care: telehealth, telemedicine, mobile health, connected care, remote medicine, eHealth. To the ATA, it's all telemedicine. They use the words “telemedicine” and “teleheath” interchangeably, to mean anything that delivers care to patients or exchanges medical information to improve health status using telecommunications.Telemedicine is changing the landscape of health care delivery, but Mr. Linkous is quick point out that technology is “far ahead of our ability to use it.” But that is changing quickly. Telemedicine is a significant and rapidly growing component of health care in the United States. There are currently about 200 telemedicine networks with 3,500 service sites in the United States, according to Mr. Linkous. More than half of all U.S. hospitals now use some form of telemedicine, and nearly 1 million Americans are currently using remote cardiac monitors. Around the world, millions of patients use telemedicine to monitor their vital signs and to help them to remain healthy and out of hospitals and emergency rooms. Consumers and physicians download health and wellness applications for use on their cell phones.Seniors Like TechnologyProbably the single greatest advancement that has affected the capacity of technology to deliver health care services that enable individuals to age in place has been the ubiquitous deployment of broadband connectivity, either through cable or telephone service. This has created the highway by which new services can be delivered and which, in turn, creates the consumer demand for more and better services. Familiarity breeds appetite.That is certainly true for the consumers of home and community-based services (HCBS). A common myth has been that seniors don't adapt to new technologies. As Mr. Linkous pointed out, that is just not true. They may be later adopters, but they do adopt. What older person doesn't use a microwave? What grandparent, when they're first introduced to “FaceTiming” with their grandkids, doesn't use it again? Once usefulness is demonstrated and proven, they jump on board.Increasingly, consumers – seniors included – will be looking and asking for remote and mobile medical technologies that enhance and support their quality of life. Advocates for chronic disease populations, like Parkinson's, are already calling for the use of telemedicine in the home to allow visual monitoring of the patient and greater access to specialist care.Resources and Case StudiesFor a state by state analysis of telemedicine coverage and reimbursement, and in physician practice standards and licensure, see: ▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Coverage and Reimbursement. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Physician Practice and Standards and Licensure. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center.The ATA posts case studies of telemedicine applications across the health care spectrum, many of which are relevant to LTC practitioners. You can check out these and other stories on the ATA website at www.americantelemed.org:▸“Reducing CHF Readmission Using Telehealth” (University of Arkansas for Medical Sciences)▸“Kansas iCare: mHealth Clinic Appointments Using iPad Minis between Multiple Professionals and Complex Patients in their Homes” (University of Kansas Medical Center)▸“Telepsychiatry in North Carolina: A Hospital Initiative Evolves into a Statewide Telepsychiatry Program” (Albemarle Hospital Foundation)▸“Avera eCARE Supports 675 Rural Clinicians in the Delivery of Highest-Quality Care” (Avera Health System in South Dakota)Early AdoptionEarly adopters of telemedicine technology are evident across the country. Rural areas and rural providers such as the Avera Health System (see box), have been responding to the obvious demographic and geographic challenges of rural states. But states differ. In terms of varying coverage and reimbursement policies across states, per ATA analysis, Mississippi, Tennessee, New Mexico, Virginia, New Hampshire, Maine, and Maryland would rate the highest; Iowa, Connecticut, and Rhode Island rate the lowest. Two reports on the ATA website provide state by state analysis of telemedicine coverage and reimbursement, and in physician practice standards and licensure (see box).As a health system, the Veterans Administration (VA) is clearly an early adopter. In 2011, the VA delivered more than 300,000 remote consultations using telemedicine. Currently, more than 1 million services are delivered remotely to VA beneficiaries, with 80,000-90,000 patients being monitored at home. VA studies have documented cost savings, reduced ER visits, and reduced hospital lengths of stay.On the Adoption CurveInnovation and adoption will increase as technology becomes even more ingrained in our everyday life. Cell phones, internet, Wi-Fi, Bluetooth, and cable services all mean greater access to health care. The time is close, Mr. Linkous said, when every physician will use electronic means to communicate routinely with their patients – to talk, to schedule, to monitor, even to see.But surely there are challenges, and LTC/HCBS providers feel them acutely.Payment mechanisms would perhaps be the greatest challenge, but they are evolving. Although Medicare is probably the least progressive payer for telemedicine, 47 state Medicaid programs reimburse at some level. Twenty-one states have telemedicine parity laws that direct private insurers to cover these services.But, in fact, medical providers are often late adopters, particularly large institutions. They may be quick to adopt new technologies and equipment like computed tomography scans but slower in areas that require services outside their walls.The greatest impact of telemedicine is on the patient, the patient's family, and the community. But telemedicine “is not a medical specialty; it's a tool,” Mr. Linkous pointed out. It's a tool for 21st century health care and for community LTC providers and practitioners. And it's a tool that improves access and can improve overall health care quality. So where are you on the adoption curve?Jonathan LinkousView Large Image Figure ViewerDownload Hi-res image Download (PPT) Consider this: Telemedicine will be fully integrated into health care systems to improve quality, access, equity, and affordability of health care throughout the world. That, in fact, is the vision statement of the American Telemedicine Association (ATA), the leading international resource and advocate promoting the use of advanced remote medical technologies. Recently, I had a conversation with Jonathan Linkous, MPA, executive director of the ATA, to understand what this means for community long-term care. What do we know and what do we think we know? What are the opportunities and the challenges? One of the founding board members of the ATA in 1993 was past AMDA President Eric G. Tangalos, MD, FACP, AGSF, CMD, from the Mayo Clinic. And Jonathan Linkous? Back in the 1980s and early 1990s, he was chief executive officer of the National Association of Area Agencies on Aging. The “triple A's” are as aware of the challenges of community LTC as we are. So what is the ATA, what are its goals and policies, and what do they have to say to us? The ATA is a diverse, international association, with members from across the world and the medical spectrum: health care professionals, researchers, health care institutions and industry partners, including Verizon and AT&T. The organization's interests include traditional telemedicine, remote monitoring, wireless/mobile apps, online services, development of practice guidelines, working with government on the national and state level for appropriate telecommunication standards, online training, and recently, accreditation for online clinical consultation services. There is a distinct and varied nomenclature in this emerging arena of care: telehealth, telemedicine, mobile health, connected care, remote medicine, eHealth. To the ATA, it's all telemedicine. They use the words “telemedicine” and “teleheath” interchangeably, to mean anything that delivers care to patients or exchanges medical information to improve health status using telecommunications. Telemedicine is changing the landscape of health care delivery, but Mr. Linkous is quick point out that technology is “far ahead of our ability to use it.” But that is changing quickly. Telemedicine is a significant and rapidly growing component of health care in the United States. There are currently about 200 telemedicine networks with 3,500 service sites in the United States, according to Mr. Linkous. More than half of all U.S. hospitals now use some form of telemedicine, and nearly 1 million Americans are currently using remote cardiac monitors. Around the world, millions of patients use telemedicine to monitor their vital signs and to help them to remain healthy and out of hospitals and emergency rooms. Consumers and physicians download health and wellness applications for use on their cell phones. Seniors Like TechnologyProbably the single greatest advancement that has affected the capacity of technology to deliver health care services that enable individuals to age in place has been the ubiquitous deployment of broadband connectivity, either through cable or telephone service. This has created the highway by which new services can be delivered and which, in turn, creates the consumer demand for more and better services. Familiarity breeds appetite.That is certainly true for the consumers of home and community-based services (HCBS). A common myth has been that seniors don't adapt to new technologies. As Mr. Linkous pointed out, that is just not true. They may be later adopters, but they do adopt. What older person doesn't use a microwave? What grandparent, when they're first introduced to “FaceTiming” with their grandkids, doesn't use it again? Once usefulness is demonstrated and proven, they jump on board.Increasingly, consumers – seniors included – will be looking and asking for remote and mobile medical technologies that enhance and support their quality of life. Advocates for chronic disease populations, like Parkinson's, are already calling for the use of telemedicine in the home to allow visual monitoring of the patient and greater access to specialist care.Resources and Case StudiesFor a state by state analysis of telemedicine coverage and reimbursement, and in physician practice standards and licensure, see: ▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Coverage and Reimbursement. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Physician Practice and Standards and Licensure. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center.The ATA posts case studies of telemedicine applications across the health care spectrum, many of which are relevant to LTC practitioners. You can check out these and other stories on the ATA website at www.americantelemed.org:▸“Reducing CHF Readmission Using Telehealth” (University of Arkansas for Medical Sciences)▸“Kansas iCare: mHealth Clinic Appointments Using iPad Minis between Multiple Professionals and Complex Patients in their Homes” (University of Kansas Medical Center)▸“Telepsychiatry in North Carolina: A Hospital Initiative Evolves into a Statewide Telepsychiatry Program” (Albemarle Hospital Foundation)▸“Avera eCARE Supports 675 Rural Clinicians in the Delivery of Highest-Quality Care” (Avera Health System in South Dakota) Probably the single greatest advancement that has affected the capacity of technology to deliver health care services that enable individuals to age in place has been the ubiquitous deployment of broadband connectivity, either through cable or telephone service. This has created the highway by which new services can be delivered and which, in turn, creates the consumer demand for more and better services. Familiarity breeds appetite. That is certainly true for the consumers of home and community-based services (HCBS). A common myth has been that seniors don't adapt to new technologies. As Mr. Linkous pointed out, that is just not true. They may be later adopters, but they do adopt. What older person doesn't use a microwave? What grandparent, when they're first introduced to “FaceTiming” with their grandkids, doesn't use it again? Once usefulness is demonstrated and proven, they jump on board. Increasingly, consumers – seniors included – will be looking and asking for remote and mobile medical technologies that enhance and support their quality of life. Advocates for chronic disease populations, like Parkinson's, are already calling for the use of telemedicine in the home to allow visual monitoring of the patient and greater access to specialist care. Resources and Case StudiesFor a state by state analysis of telemedicine coverage and reimbursement, and in physician practice standards and licensure, see: ▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Coverage and Reimbursement. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Physician Practice and Standards and Licensure. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center.The ATA posts case studies of telemedicine applications across the health care spectrum, many of which are relevant to LTC practitioners. You can check out these and other stories on the ATA website at www.americantelemed.org:▸“Reducing CHF Readmission Using Telehealth” (University of Arkansas for Medical Sciences)▸“Kansas iCare: mHealth Clinic Appointments Using iPad Minis between Multiple Professionals and Complex Patients in their Homes” (University of Kansas Medical Center)▸“Telepsychiatry in North Carolina: A Hospital Initiative Evolves into a Statewide Telepsychiatry Program” (Albemarle Hospital Foundation)▸“Avera eCARE Supports 675 Rural Clinicians in the Delivery of Highest-Quality Care” (Avera Health System in South Dakota) For a state by state analysis of telemedicine coverage and reimbursement, and in physician practice standards and licensure, see: ▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Coverage and Reimbursement. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Physician Practice and Standards and Licensure. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center.The ATA posts case studies of telemedicine applications across the health care spectrum, many of which are relevant to LTC practitioners. You can check out these and other stories on the ATA website at www.americantelemed.org:▸“Reducing CHF Readmission Using Telehealth” (University of Arkansas for Medical Sciences)▸“Kansas iCare: mHealth Clinic Appointments Using iPad Minis between Multiple Professionals and Complex Patients in their Homes” (University of Kansas Medical Center)▸“Telepsychiatry in North Carolina: A Hospital Initiative Evolves into a Statewide Telepsychiatry Program” (Albemarle Hospital Foundation)▸“Avera eCARE Supports 675 Rural Clinicians in the Delivery of Highest-Quality Care” (Avera Health System in South Dakota) For a state by state analysis of telemedicine coverage and reimbursement, and in physician practice standards and licensure, see: ▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Coverage and Reimbursement. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center▸Thomas L, Capistrant G. State Telemedicine Gaps Analysis: Physician Practice and Standards and Licensure. American Telemedicine Association. September 2014: Available at: www.americantelemed.org/policy/state-policy-resource-center.The ATA posts case studies of telemedicine applications across the health care spectrum, many of which are relevant to LTC practitioners. You can check out these and other stories on the ATA website at www.americantelemed.org:▸“Reducing CHF Readmission Using Telehealth” (University of Arkansas for Medical Sciences)▸“Kansas iCare: mHealth Clinic Appointments Using iPad Minis between Multiple Professionals and Complex Patients in their Homes” (University of Kansas Medical Center)▸“Telepsychiatry in North Carolina: A Hospital Initiative Evolves into a Statewide Telepsychiatry Program” (Albemarle Hospital Foundation)▸“Avera eCARE Supports 675 Rural Clinicians in the Delivery of Highest-Quality Care” (Avera Health System in South Dakota) Early AdoptionEarly adopters of telemedicine technology are evident across the country. Rural areas and rural providers such as the Avera Health System (see box), have been responding to the obvious demographic and geographic challenges of rural states. But states differ. In terms of varying coverage and reimbursement policies across states, per ATA analysis, Mississippi, Tennessee, New Mexico, Virginia, New Hampshire, Maine, and Maryland would rate the highest; Iowa, Connecticut, and Rhode Island rate the lowest. Two reports on the ATA website provide state by state analysis of telemedicine coverage and reimbursement, and in physician practice standards and licensure (see box).As a health system, the Veterans Administration (VA) is clearly an early adopter. In 2011, the VA delivered more than 300,000 remote consultations using telemedicine. Currently, more than 1 million services are delivered remotely to VA beneficiaries, with 80,000-90,000 patients being monitored at home. VA studies have documented cost savings, reduced ER visits, and reduced hospital lengths of stay. Early adopters of telemedicine technology are evident across the country. Rural areas and rural providers such as the Avera Health System (see box), have been responding to the obvious demographic and geographic challenges of rural states. But states differ. In terms of varying coverage and reimbursement policies across states, per ATA analysis, Mississippi, Tennessee, New Mexico, Virginia, New Hampshire, Maine, and Maryland would rate the highest; Iowa, Connecticut, and Rhode Island rate the lowest. Two reports on the ATA website provide state by state analysis of telemedicine coverage and reimbursement, and in physician practice standards and licensure (see box). As a health system, the Veterans Administration (VA) is clearly an early adopter. In 2011, the VA delivered more than 300,000 remote consultations using telemedicine. Currently, more than 1 million services are delivered remotely to VA beneficiaries, with 80,000-90,000 patients being monitored at home. VA studies have documented cost savings, reduced ER visits, and reduced hospital lengths of stay. On the Adoption CurveInnovation and adoption will increase as technology becomes even more ingrained in our everyday life. Cell phones, internet, Wi-Fi, Bluetooth, and cable services all mean greater access to health care. The time is close, Mr. Linkous said, when every physician will use electronic means to communicate routinely with their patients – to talk, to schedule, to monitor, even to see.But surely there are challenges, and LTC/HCBS providers feel them acutely.Payment mechanisms would perhaps be the greatest challenge, but they are evolving. Although Medicare is probably the least progressive payer for telemedicine, 47 state Medicaid programs reimburse at some level. Twenty-one states have telemedicine parity laws that direct private insurers to cover these services.But, in fact, medical providers are often late adopters, particularly large institutions. They may be quick to adopt new technologies and equipment like computed tomography scans but slower in areas that require services outside their walls.The greatest impact of telemedicine is on the patient, the patient's family, and the community. But telemedicine “is not a medical specialty; it's a tool,” Mr. Linkous pointed out. It's a tool for 21st century health care and for community LTC providers and practitioners. And it's a tool that improves access and can improve overall health care quality. So where are you on the adoption curve? Innovation and adoption will increase as technology becomes even more ingrained in our everyday life. Cell phones, internet, Wi-Fi, Bluetooth, and cable services all mean greater access to health care. The time is close, Mr. Linkous said, when every physician will use electronic means to communicate routinely with their patients – to talk, to schedule, to monitor, even to see. But surely there are challenges, and LTC/HCBS providers feel them acutely. Payment mechanisms would perhaps be the greatest challenge, but they are evolving. Although Medicare is probably the least progressive payer for telemedicine, 47 state Medicaid programs reimburse at some level. Twenty-one states have telemedicine parity laws that direct private insurers to cover these services. But, in fact, medical providers are often late adopters, particularly large institutions. They may be quick to adopt new technologies and equipment like computed tomography scans but slower in areas that require services outside their walls. The greatest impact of telemedicine is on the patient, the patient's family, and the community. But telemedicine “is not a medical specialty; it's a tool,” Mr. Linkous pointed out. It's a tool for 21st century health care and for community LTC providers and practitioners. And it's a tool that improves access and can improve overall health care quality. So where are you on the adoption curve?