Telemedicine is the next monumental shift in the health care industry, according to a new survey from Milwaukee-based law firm Foley & Lardner LLP.
Ninety percent of national health care leaders surveyed reported that their organizations have already begun developing or implementing a telemedicine program, according to the 2014 Telemedicine Survey.
The survey included 57 health care executives from a variety of health care organization types and sizes nationwide, who were polled during September and October.
Here in the Milwaukee-area, several health care organizations are already using telemedicine.
“Telemedicine is something we see as a very growing and important area for health care providers,” said Fred Geilfuss, a Foley & Lardner partner and chair of its health transactions practice group. “We wanted to get a sense of what the industry is doing and how it’s thinking about it.”
Described as the use of medical information exchanged from one site to another via electronic communication to improve a patient’s health, telemedicine takes many forms, including real-time interaction.
Fifty-two percent of respondents currently offer real-time interaction capabilities, which is when physicians electronically confer with other physicians or provide real-time medical care interactively with patients.
An example of that is the telepsychiatry service Rogers Memorial Hospital-Kenosha started offering in August to augment its in-person psychiatry.
“We had a hard time recruiting psychiatrists to work here, so telepsychiatry opened up a whole new avenue for us to recruit psychiatrists and allowed us to expand programs,” said Kenosha clinical services manager Debra Minsky-Kelly. “There is a shortage of psychiatrists across the country, and Kenosha is especially underserved.”
As a result of telepsychiatry, Rogers Memorial Hospital-Kenosha was able to start the adult mental health and dual diagnosis partial hospitalization program. Patients from that program as well as the adult addictions program are the ones who primarily use the service, and participating psychiatrists are based in Madison, Nebraska and Nashville.
In the month after implementation, the number of psychiatric visits with patients in the addictions program increased to eight times the previous month’s visits.
According to Minsky-Kelly, the patients enjoy using this method over in-person psychiatry because they do not find it as intimidating as being in the same room as the psychiatrist.
The other forms of telemedicine, according to the survey, are remote monitoring, store and forward technology, and mHealth (mobile health).
Sixty-four percent of respondents reported that they use remote monitoring. Geilfuss said an example of this might be when a critical care specialist at a major medical center remotely monitors the condition of an intensive care patient at another hospital.
An example of store and forward technology, which is used by 54 percent of respondents, is when imaging tests are taken at one location and stored and forwarded to a physician at another location.
Lastly, 39 percent of those surveyed said they use mHealth, or patient-driven apps and online portals.
Froedtert & the Medical College of Wisconsin health network uses all four of these forms.
Froedtert’s first foray into what the health network refers to as “digital health” began about a decade ago with the virtual intensive care unit, according to Mike Anderes, vice president for digital health at Froedtert & the Medical College of Wisconsin.
The virtual ICU connects patients with a remote team of board-certified intensive care physicians and seasoned critical care nurses by voice, video and data. Each patient room is equipped with tools that provide real-time access to patient records and vital signs, and the remote team has the ability to communicate with on-site care teams.
Much like air traffic controllers who monitor hundreds of planes, the virtual ICU team is able to monitor and care for hundreds of patients.
Anderes said the virtual ICU does not replace hospital staff, but instead becomes an integral part of the team, working together to enhance patient care.
Froedtert also employs telestroke, which was implemented two years ago. It allows a board-certified stroke neurologist from Froedtert & the Medical College of Wisconsin’s academic medical center to be piped in immediately to a community hospital’s emergency department, where a patient is showing signs or symptoms of a stroke. Via video camera, the neurologist collaborates with the patient and emergency department physician to view a physical examination, use software to examine the patient’s imaging scans, and prescribe care.
This can drastically reduce the amount of time it takes to administer life-saving clot-busting medication. It can also provide valuable information for determining if a patient requires transfer to an academic medical center for an interventional procedure that removes the clot from the brain.
“Anything we can do to get the specialist to view that individual quicker can make a profound impact on the person’s long-term clinical outcomes,” Anderes said. “It’s like going to the best of the best but without having to leave the community hospital.”
Within the last six months, Froedtert’s physicians began the store and forward method of electronically sending images between providers. For example, a doctor could forward an image of a rash to a dermatologist in order to get his or her expertise.
Finally, earlier this fall Froedtert began testing the ability to do video follow-up visits with a group of general surgery patients.
Using technology in this way allows the care team to see how the patient is healing and discuss any concerns without requiring him or her to drive back for another appointment.
Froedtert implemented these digital health services, Anderes said, because “it’s the right thing to do. We have a philosophy where we want to meet people where they are. This opens up the ability to do that in a very meaningful way.”
Among the benefits of digital health, according to Anderes, are improved clinical outcomes, the opportunity to help people make better decisions about their own health, and a more engaging way for the community to participate with health systems in their care.
Helping patients to manage their health and improve the quality of their lives is also the goal of ProHealth Care’s telemedicine services, according to Tiffany Steffen, director of care management and chronic care programs.
An ambulatory telemedicine service implemented about three years ago is for heart failure patients who take home a blood pressure cuff, a pulse oximeter (the finger clip that monitors oxygen level) and an interactive scale.
The scale, which is meant to be used daily, asks a series of logic-branched questions such as whether or not they are having difficulty breathing. Depending on the answer, it will lead to a different set of questions.
The information is then securely downloaded to a website that a registered nurse monitors. Similar to Froedtert’s virtual ICU, ProHealth Care also has the EICU (electronic intensive care unit), where ProHealth Care credentialed physicians from out of state conduct consultations with patients via video camera. That has been in use for about five years.
Finally, ProHealth Care technicians monitor the heart rates and rhythms of its cardiac patients 24/7 through the use of small electronic devices patched to their chests. This form of telemedicine has long been used at ProHealth Care, as well as other health care organizations.
“I think (telemedicine) keeps patients where they need to be,” Steffen said. “Heart failure patients will never get better, but we want to manage their health and give them a better quality of life and these are things that can do that.”
A drawback to telemedicine from a hospital system point of view, however, is that it is not reimbursable, Steffen said.
According to the Foley & Lardner survey, the customary fee-for-service environment makes it challenging to be paid for medicine practiced outside the traditional spheres of interaction.
In fact, 41 percent of respondents said they are not reimbursed at all for telemedicine services, and 21 percent reported receiving lower rates from managed care companies for telemedicine than for in-person care.
Since its telemedicine services are not reimbursed, Steffen said ProHealth Care determines which patients would benefit the most from the services and continually looks into alternative ways to help patients.
Despite the reimbursement challenges, she said telemedicine is still worthwhile because it can reduce the amount of readmissions and the subsequent utilization of resources.
Overall, 84 percent of respondents felt that the development of telemedicine services is either very important or important to their organizations.
The representatives from Rogers Memorial Hospital-Kenosha, Froedtert & the Medical College of Wisconsin health network and ProHealth Care all agree. They all said they believe telemedicine is critical to the future success of their organizations.
“Access to mental health and addiction care is a huge issue in southeastern Wisconsin right now,” Minsky-Kelly said. “Without access to prescribers, our treatments are not as effective.”
Anderes believes it is 100 percent critical “to meet people where they are and to manage their conditions…to give them the right care at the right time in the right place.”
Added Steffen, “It’s a matter of efficiency. Patients are going to be expecting to get care where they are.”
