Telehealth: A Cure for the Coming Healthcare Crisis
Healthcare is in a precarious state. Spending has reached an all-time high $2.0 trillion in 2005 and is expected to reach 20 percent of the gross domestic product by 2015.[1] Two key drivers behind rising costs the aging of America and a significant increase in people with chronic conditions are straining our already-overburdened healthcare system to the breaking point.
The number of people over 65 is set to double in the next 25 years,[2] and by 2040, the number of people with a chronic condition will also increase 50 percent.[3] Almost 40 percent of healthcare spending already goes to people 65-plus,[4] and those with chronic conditions are the heaviest utilizers of medical care, accounting for 96 percent of home health, 88 percent of prescriptions, 72 percent of physician visits and 76 percent of inpatient stays.[3] On top of these pressing issues, healthcare is in the midst of a nursing shortage that is expected to intensify as baby boomers age and the need for healthcare grows.
Caring for an aging population and chronically ill patients requires a new strategy a paradigm shift that telehealth is uniquely positioned to provide. Although telehealth technology spans the basic to the futuristic, its fundamentally defined as the use of electronic data and communication systems to deliver medical information and services remotely through a telephone line or the Internet. Although the concept is simple, the impact is significant. Telehealth has the capability to wire the industry for virtual medical care anytime, anywhere. By linking patients, families and clinicians, telehealth creates a connected continuum of care that leads to improved outcomes and a better quality of life for patients.
Due to its many benefits, telehealth is expected to increase exponentially. The Wall Street Journal reported that sales of telehealth products are projected to grow from $461 million in 2005 to over $2.5 billion in 2010,[5] and a report by research and consulting group Parks Associates concluded that telehealth will reach 64 million patients by that same year.[6]
The History and Hurdles to Adoption
Telehealth first became available in the early 1990s. Initially, transmission of health data was static and one-way, providing just one reading and lacking the ability to adapt to a patients health status. Systems typically worked only within one environment, providing communication with either a hospital or a home care agency but not other venues. These early systems were extremely expensive and difficult for patients to master.
Furthermore, as is often the case with the introduction of a new healthcare technology, reimbursement became another issue that slowed adoption.
Due to these constraints, telehealth didnt receive widespread acceptance until 2000, when the Centers for Medicare & Medicaid Services phased in a new funding plan for home health agencies that paid a per-patient fee based on diagnosis rather than number of visits. This and other pay-for-performance reimbursement programs encouraged home health agencies, as well as other providers, to look for more efficient means to provide care. Consequently, providers began to rethink the potential in telehealths remote monitoring capabilities.
The New Telehealth Paradigm
Telehealth technology has come a long way; basically a quantum leap in the past five years. Although some products still connect over phone lines, with the broad availability of high-speed Internet connections that can handle more complex medical data, sophisticated telehealth systems are on the rise.
Telehealths Vital Signs
Care in the telehealth paradigm typically centers on a sophisticated
interactive monitor. The monitor is often used in conjunction with
other devices that measure a patients vital statistics, including:
- Blood pressure monitor;
- Glucometer that uses a tiny blood sample to measure bloodsugarlevels;
- Digital scale that electronically transmits patient weight;
- Fluid monitor to ensure patients are properly hydrated;
- Home ECG monitor to record the hearts electrical signal; and
- Digital camera to ensure proper wound recovery.
All this data and more can be sent via the Internet, so clinicians can track and analyze it. A Web interface allows caregivers to access the information. The system automatically informs them which patients are having problems and creates a Web page for each patients vital statistics and health information.
Today telehealth is becoming software-based versus equipment- and device-focused, and more in sync with dynamic, interactive monitoring. Physicians and nurses can frequently check in on patients without a costly in-person visit. They feel more confident in their patients health status, because theyre monitoring real-time vital statistics and can detect changes before serious problems ensue.
From the patients perspective, todays telehealth technology is user-friendly, allowing them to become more involved in their own care. For instance, patients can review their measurements and health progress. The monitor gives patients instructions either visually in large print or audibly in multiple languages. It can act as an educational tool, allowing patients to access useful health information and training material via the Web.
Comprehensive Disease Management for Chronic Conditions
What the telehealth industry has experienced in the last five years
is an overall shift in paradigm from conventional monitoring of
vital signs to a more comprehensive and interactive virtual care
and disease management model.
By leveraging telehealth tools, the growing number of people who have chronic conditions can now benefit from remote disease management for various conditions, including cardiovascular disease, congestive heart failure, chronic obstructive pulmonary disease, hypertension, diabetes, obesity, asthma and even depression.
Remote disease management is a cost-effective means for caregivers to monitor daily vital signs, a routine that detects problems faster than monthly clinical visits. Telehealth essentially connects critically ill patients to caregivers 24 hours a day, seven day a week. If a patients vital signs start heading in a downward spiral, a physician can intervene early to get them back on track, even before they need to be admitted to the hospital.
The New Generation of Telehealth
The advantage of systems that are software-based include their
ability to be customized for the unique needs of a single patient,
to take in or send information in any setting through a PC and to
be more interactive than in the past.
For example, a system can be customized to measure specific disease-related symptoms or to obtain general health information. A patient with hypertension might have a monitor that asks, Have you been following a low-salt diet today? Responses are relayed, along with her other statistics, like blood pressure and weight, to the physician. The monitor can also be programmed to provide daily patient reminders: Good morning, John. Its 9:00 a.m. Have you taken your medication? The system can notify physicians automatically, in real time, if critical thresholds have been surpassed, such as an abnormally high blood pressure reading.
The latest systems also enable two-way communication. For instance, a patient might send the message, The medication makes me dizzy. And in response, the physician might instruct the patient to lower the dosage.
Many patients being managed at home need wound care.With a virtual telehealth system, a nurse can take a digital picture of a patients wound in the home, have it transmitted not only to her but also to the physician and placed in the patients chart.
Telehealth systems can be adapted to benefit other maladies, beyond those usually identified as chronic illnesses. Because many people suffering from chronic illnesses also experience depression, which in turn lowers compliance with their medical regime, programs that help patients manage this component of their illness are now available.
More advanced telehealth systems are incorporating sensors placed throughout a patients house to track whether and when a patient is home, gets out of bed, bathes and even eats. This is extremely useful for Alzheimers patients who may unexpectedly leave the premises.
Benefits for All
The healthcare industry consists of numerous stakeholders, and telehealth delivers tremendous benefits and advantages for all.
Patients and Families
Telehealth offers patients continual connectivity to clinicians, while
enabling them to enjoy a better quality of life in their normal living
situation. It empowers patients to manage their own illnesses
for better health, longer lives and continued independence.
Family members are also given peace of mind. The need to
rush loved ones to the hospital for avoidable emergencies is now
dramatically reduced. With patients permission, family members
can log on and view their information. More families across
the country are beginning to experience the proactive value of
telehealths disease management capabilities, and they are willing
to pay the nominal fee to participate.
Hospitals
Hospitals across the country are in critical condition. Emergency
rooms (ERs) are overcrowded with long waits; ERs have experienced
a 26 percent increase in patients over the past decade, due
to the growing number of uninsured Americans who use ERs as
their healthcare safety net.[7] Meanwhile, 50 percent of emergency
care is uncompensated, resulting in hundreds of hospitals
and ERs closing their doors.[8]
To survive, hospitals need innovative solutions, and telehealth is one of them. Telehealth enables hospitals to reduce frequent flyers patients with chronic illnesses who bounce in and out of the hospital overall ER visits and hospital readmissions.Many hospitals experience a significant ROI in just a short time. For example, one hospital saved $52,244 in just the first six months of its program, since telehealth prevented patients from requiring additional inpatient care.[8]
Home Care Agencies
With 96 percent of home health users suffering from chronic illnesses,
home care agencies need a more comprehensive solution to
manage these cases remotely. Today with reimbursement changes
from pay per visit to pay for performance, home care agencies are
incentivized to leverage solutions that proactively manage care,
reduce costs and minimize the need for in-person visits. Telehealth
enables these agencies to accomplish all these objectives. Several
studies have shown that homebound patients using telehealth
make fewer trips to the emergency room and hospital. Using a telehealth
strategy, one home care agency was able to reduce its hospitalization
rate to almost 10 percent below the state average.[8]
Assisted Living Facilities
With 33,000 assisted living facilities in the United States, there is
a growing need for telehealth to provide virtual medical care to
manage aging and chronically ill residents.
In 2005, an Atlanta assisted living facility launched a pilot program, installing a telehealth kiosk within its community. Using a touch screen monitor, residents followed prompts to measure their vital signs. The tool was proven to reduce unnecessary medication changes and costs, and to minimize unwarranted trips to the ER.
Family members feel reassured in knowing telehealth enables close monitoring of their loved ones. And the facility used this well-received program in its marketing campaign to differentiate itself within the community.
Communities
Community-focused telehealth programs help to improve care in
remote and/or disadvantaged areas. For example, one community
clinic has installed telehealth kiosks in senior centers, churches
and schools. These kiosks monitored people at risk for obesity,
diabetes and cardiovascular disease.
There is also potential for new applications in rural communities, where specialists are often not locally available and medical services are scarce. As the industry sees the effectiveness of telehealth, the application may extend to other community-based programs, e.g., telehealth holds great potential for increasing the quality of care for prison inmates, while also saving taxpayer dollars.
The Future of Telehealth
Telehealth started with a simple premise: Create a connected community encompassing the patient, family and clinicians for improved outcomes, greater convenience and less expense for all. The concept has great potential, e.g., telehealth lets patients live in their homes longer, reducing the need for care in expensive settings, like nursing homes and hospitals. Providers can care for more patients virtually, and patients become more involved in their own medical care.
As the rate of adoption for telehealth increases, the home may become just as important as any other healthcare facility, including the doctors office or hospital. Reimbursement is still a significant challenge that must be addressed in order to reap telehealths significant rewards; the cost savings of telehealth are a powerful incentive in and of themselves for healthcare providers struggling to care for more patients with fewer resources. Telehealth may offer just the out of the box solution the doctor ordered.
Endnotes
- National Health Care Expenditures Projections: 2005-2015, www.cms.hhs.gov. September, 2006.
- Weil, Elizabeth. Geared up for Health. Time, February 16, 2004.
- The John Hopkins University, Partnership for Solutions. Chronic Conditions: Making the case for Ongoing Care. December 2002.
- Lueck, Sarah. The Future of Health Care? The Wall Street Journal, June 16, 2006.
- Cherney, Elena. New Ways to Monitor Patients at Home. The Wall Street Journal, April 18, 2006.
- Wang, Harry. Delivering Quality Healthcare to the Digital Home: An Industry Report from Parks Associates, February 2006.
- Institute of Medicine. U.S. Emergency Medicine on the Critical List. MSN.com, June 14, 2006
- WebVMC, www.webvmc.com. September, 2006.
