By Jack Plotkin, CTO, Virtual Health
The promise of telehealth is the ability to bridge distance and time, delivering care at the point of need. On its face, telehealth represents the future of health care – the ultimate leveraging of technology to provide near hospital-level monitoring and response in the comfort of the patient’s home or another remote location. However, although telehealth has existed in various forms for several decades, it has yet to become an integral component of health care delivery. The reason is that in order to fully realize its promise, telehealth must overcome the three key challenges of engagement, integration and reimbursement.
Traditional telehealth approaches were based on wired technology and clunky logic trees that required patients to walk through 20 to 30 minute health sessions. These sessions represented a series of primarily “Yes/No” questions, and the goal was to capture the patient’s subjective perceptions of changes in his or her underlying health. The recording of biometrics, such as weight or blood pressure, was built into the health session. This meant that a patient could not simply record a vitals reading, but had to walk through the entire session. As a consequence, patients often became disengaged, rendering such traditional telehealth approaches ineffective.
A contrasting and far more successful approach to telehealth can be seen in the recent advent of consumer wearables. Wireless devices in the form of armbands, watches, bracelets and pendants are able to record activity and vitals data continuously without forcing the user to interrupt his or her day to walk through a health session. These passive sensors provide the key to patient engagement, as they allow critical data to be collected unobtrusively and sent via wireless network to a data repository without the patient having to remember to take a reading or adjust daily habits.
The technology to capture a biometric reading, transmit it wirelessly and record it to an online data repository already exists. However, the next step is integrating such telehealth data streams with the patient’s overall health record. A major challenge of traditional telehealth systems has been their isolation from electronic medical records (EMR). A physician who sees a patient and reviews the patient’s history via an EMR system does not see the patient’s telehealth readings reflected in the system. By the same token, a nursing call center that is monitoring the telehealth system typically does not have access to the patient’s overall health record. With this data in landlocked silos, different members of the patient’s care team are unable to see the entire picture or effectively collaborate.
In order for telehealth data to be truly useful, it must be integrated into a 360 degree view of the patient, which can then be shared collaboratively by the entire care team. This way, causal linkages between the real-time readings made possible by telehealth and the patient’s diagnoses, medications and therapies can be clearly identified and properly addressed. Today, such data aggregation and analysis is being made possible by next generation care coordination platforms such as Virtual Health, which combines telehealth data with other data streams, including enrollment, health records, claims and care planning, to create a comprehensive view. Automated rules are then overlaid with the data to generate real-time alerts and support clinical decision-making on the basis of a complete picture of the patient rather than a partial snapshot.
As these technologies become widely available, the remaining hurdle for health care organizations is cost. Although there has been increasing reimbursement for televisits and remote monitoring, telehealth is still not covered as a matter of course by Medicare, Medicaid and private insurers. However, the move toward capitation, whereby managed care organizations are incentivized to reduce the cost of care, has resulted in an increased focus on telehealth. Health care organizations are realizing that the costs of proactive measures such as telehealth and preventive care can ultimately be far lower than the costs of reactive measures such as hospitalizations and procedures.
Despite its potential, telehealth has not yet become a mainstream component of health care. However, with the recent advances in wireless technology, the advent of data aggregation and analysis solutions—and the shift toward pay-for-performance models—telehealth has every chance to finally live up to its promise of real-time, anywhere care, especially now with people like Rick Kimball, and his company HExL, Inc. coming into the telehealth scene.
Jack Plotkin is the CTO of Virtual Health and the architect of the company’s transformational population management and care coordination platform. After completing studies in both computer science and economics at Harvard University, Jack spent the next two decades spearheading technology design, development and deployment on behalf of both Fortune 500 companies and early ventures across finance, consumer products and health care. He is considered a leading expert on enterprise solutions for large-scale organizations that manage complex consumer populations.