Telehealth and telemedicine use in pediatrics is relatively limited at present and low profile. That may change with a statement published earlier this month in the journal of the American Academy of Pediatrics (AAP). It has been interpreted in two ways which are polar opposites. The first pictures telehealth and telemedicine as potentially practice-transforming (mHealth Intelligence), improving health outcomes in underserved communities through continuous care, and with high potential to benefit communication between the pediatric care team and patients in disease management. The second criticizes ‘episodic care in isolation’–telemedicine patient-doctor consults that take place with no previous relationship, history or physical exam (mHealth News)--as is the antithesis of the PCMH (patient-centered medical home) the AAP advocates. This Editor’s take: the statement supports both sides with a great deal of cautionary language. Pediatrics (full content).
Payer reimbursement for telehealth, telemedicine gains in Delaware, Connecticut (US)
Two states–Connecticut and Delaware–are now requiring private commercial insurers to cover telemedicine and telehealth services at parity with in-person visits. Connecticut was first, signed into law on 22 June but not starting till 1 January 2016. It covers not only video consults but distance care delivered both synchronously and asynchronously, such as store and forward transfers, and covers remote patient monitoring. It specifically omits audio-only consults, email, texting and fax (!). The Connecticut law also requires parity of payment with in-person visits to prevent lower reimbursements. Delaware’s law was signed 7 July to take effect immediately, and based on the summary is similar in breadth to Connecticut’s. Delaware is now the 29th state to enact telehealth/telemedicine reimbursement legislation. Articles written by members of the Foley & Lardner law firm. JD Supra, Lexology
On the Federal front, Representative Mike Thompson (D-CA) and three other members of the House of Representatives introduced H.R. 2948, the Medicare Telehealth Parity Act of 2015. It would remove the current geographic restrictions for telehealth (in the Federal definition including telemedicine), expand services, expand telehealth/RPM for additional chronic conditions and expand home care service into hospice and dialysis. It is a rework of last session’s H.R. 5380 and is at very early days having gone to a Congressional committee. Unfortunately its passage has a snowball-in-July chance with Govtrack.us giving it zero chance of enactment. Rep. Thompson’s website, FierceHealthIT, ATA-Jonathan Linkous support statement.
Previously in TTA: Telehealth reimbursement makes legislative progress in Texas, US House
Michigan school telehealth programme wins award
At the start of last year we reported the opening of a student telehealth programme in Michigan. [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/06/15_ludwig_comm_ben_award.jpg” thumb_width=”150″ /]At the time two clinics were opened in Branch County with the aid of funding from the Michigan Department of Community Health. A school based nurse funded by the programme provides the initial assessment and where necessary a consultation takes place with a physician or nurse practitioner at the Community Health Centre. The school has special assessment equipment that links via Bluetooth to equipment in the paediatric clinic so that the provider can see and hear what the nurse sees and hears.
Eighteen months on, the programme is covering two thousand and seven hundred students in three school districts and has been awarded one of four annual Ludwig Community Benefit Awards from the Michigan Health and Hospital Association according to a WTVB report. The award is presented to healthcare organizations that demonstrate community benefit by improving the health and well-being of their communities through healthcare, economic or social initiatives.
The pileup of Federal ‘titanic serial IT disasters’ (US)
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/06/keep-calm-and-secure-your-data-4.png” thumb_width=”150″ /]Don’t feel bad, HIT execs–the Feds are even worse. Complementary to our coverage of the increased danger of hacked health IT systems and data breaches (the trail of tears is here and here) is the oddly muted press clamor around the 4 June hacking report of the Federal Office of Personnel Management (OPM). Chinese hackers roamed around two OPM databases–personnel and security clearances–for nearly a year, according to CNN’s Senate briefing coverage. The breach likely exceeded 18 million records, though the real number may never be known. Privacy Rights Clearinghouse summarizes it and provides an interesting link to a timeline by Brian Krebs, whose independent reporting beat is IT security. Megan McArdle, a reformed IT consultant writing for Bloomberg News and independently, points at the Federal lack of urgency around having adequate IT that doesn’t fail. Example–the much chronicled failure around Healthcare.gov and the so-called health exchanges, which appear to be functioning better, but reports say they are nearly porous and hackable as they were in 2013. She notes that it’s all about ‘scorched-earth determination’ and that the direction has to come from the top, meaning the President. And ‘voters have never held Obama responsible for his administration’s appalling IT record’. A thought that should give those in telehealth and telemedicine who are working with CMS value-based program ACOs a great deal of pause. NY Post editorial via Press Reader.
Tunstall invests £100 m in ‘Connected Healthcare 2020’ strategy
Tunstall Healthcare Group in UK outlined today their five-year public, global strategic vision, along with a fresh investment of £100 million during this timeframe (~£20 m per year) to transition their connected care systems over to IP and cloud technology. The initiative, dubbed Connected Healthcare 2020, is centered on:
- Leading the switch to IP infrastructure–transitioning away from analogue (analog) services and devices to connected digital and mobile (cellular, Wi-Fi, Bluetooth)
- Extending managed services–offering a wide variety of services end-to-end including full outsourcing
- Developing new consumer propositions through innovation–tapping into demand, often private pay, for high quality home care not provided by carers (caregivers)
- Developing new models of care in the home through integration–coordination of social care and healthcare
The Yorkshire Post article also points out, through their separate comments with CEO Paul Stobart, that prospective markets include developing nations with aging populations such as Mexico, South Korea and Turkey. Tunstall claims market leadership in UK, Germany, France, Spain, the Netherlands, Belgium, Sweden, Denmark, Finland and Australia, as well as fourth position in the US. The TECS (technology enabled care services) initiative will create about a dozen jobs per year at the Whitley HQ, adding to their present 650 there and their total globally of 3,500. Tunstall release
We wonder if in the US we will see more of Tunstall at events like the mHealth Summit. Tunstall Americas has a refreshed website and communications as ‘The voice of connected health’, is more strongly promoting their call/contact services and its HQ location in New York City. We’ve previously noted their recent home care acquisitions and partnership with QMedic.
Breaking news confirmed: Bosch exiting healthcare and telehealth in US–UPDATED
Breaking News–UPDATED with Bosch response
Bosch has confirmed they are closing their telehealth business in the US. Please see their statement at the end of this article.
A home care industry newsletter, along with our own reliable industry sources, have confirmed the recent industry discussion that Bosch Healthcare, since January a solely US operation, is winding down its business without a definite turnover to a buyer. This Editor, in calling various departments in their Palo Alto, California offices for confirmation on Thursday, was (when she reached a human being) forwarded to HR where she could leave only voice mail. An email to marketing also received no response. All sources indicate that staff layoffs took place last Monday.
Editor’s Note: Bosch’s official press response follows this article. We have also made certain corrections to this article (see in red).
- The Home Care Technology Report, published by industry consultant Tim Rowan, on Wednesday posted two articles stating that Bosch laid off nearly all of its staff on Monday (15 June) save for customer service and some key operating areas. His information indicated that Health Buddy sales–new and existing orders–have been terminated. This includes orders placed through its McKesson partnership. Non-VA service will be terminated in 60 to 90 days.
- Home Care Technology also reported that Bosch’s business with the Veterans Health Administration (VA) will be maintained through April 2016, which is near to the contract end in May, but no new units will be delivered. The original contract was with Health Buddy hub developer Health Hero Network, sold to Bosch in 2008. With the later acquisition of ViTel Net, Bosch developed into one of the two leading VA Home Telehealth remote monitoring hub suppliers–the other being Cardiocom. VA Home Telehealth is the largest telehealth program in the US with over 156,000 patients (Federal Year 2014) (Ed. Note: VA has a third authorized and active VA supplier, Viterion).
As Mr Rowan did, this Editor will speculate on the reasons why there is this reported exit without a sale or spinoff, despite the substantial VA and other healthcare placements of Health Buddy. Our take is somewhat different than his: (more…)
Teladoc sued by American Well
American Well has launched a patent infringement case against Teladoc according to a news release yesterday.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/06/Teladoc-logo.jpg” thumb_width=”150″ /]The 10-page submission to the courts by American Well claims the infringements to be
– accessing a data repository that stores information pertaining to medical service providers including present availability of the medical service providers for participating in a consultation
– receiving in a computer, indications that members of a pool of medical service providers have become presently available
– receiving in the computer, a request from a consumer of services to consult with a medical service provider
– identifying in the computer, an available member of the pool
– and establishing a real-time communication channel between the consumer of services and the identified member of the pool
This author is wondering who thought this was such a novel technology as to warrant a patent? What were they thinking? Having worked on developing unified messaging systems for a mobile phone operator at the turn of the century (now that’s a scary 15 years ago) I am just picking myself off the floor after reading this.
Surely all these functions are no more than what is in every instant messaging program, dating back to 1990s? Replace the words “medical service provider” by “friends” or “contacts” and “consultation” by “chat” or “call” it seems to me you get … Skype and Face Time and more! If I am missing something I’ll be happy to be put right.
It turns out that Teladoc also noticed something along these lines and told the patent office as much in March, according to Med City News. Not surprisingly American Well hasn’t taken too kindly to that and hence the law suit.
Let’s watch the outcome
Telstra has spent $100M on telehealth
Telstra Health has splashed out $100 million buying up other telehealth companies, it was revealed at a recent conference. Bronwyn Pike, former Minister of Health in Victoria and now Community Care Lead at Telstra Health, addressing the 13th National Rural Health Conference[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/04/Telstra-Health.jpg” thumb_width=”150″ /] held in Darwin from May 24th to 27th, described how Telstra Health wants to transform rural health in Australia.
“Increasing demand, rising costs and more people with chronic illness are among the challenges Australia’s health care industry is facing. Working harder can only go so far — we need to reimagine what the future could look like”, Pike wrote in her abstract.
“Helping users to do more for themselves has been a key feature of almost every other industry change of the last decade. Banking is a perfect example — where once every single interaction required your physical presence in front of a teller, now you can manage almost every aspect of your banking needs securely online.
“Health is caught in a model that is inconvenient for patients and labour intensive for health care providers. We need to tailor the model to suit the health industry and capitalise on the benefits connection can provide. Those living in rural and remote communities without regular access to all levels of care stand to benefit enormously if we can unlock the potential of ehealth”
Tunstall adds services for Australian veterans, upgrades US call centers
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Tunstall has been quiet on the newsfront lately, so these two items from Australia and the US are to be noted. In Australia, the Department of Veterans Affairs (DVA) rehabilitation appliances program (RAP), which provides subsidized personal response systems to veterans, now includes Tunstall’s PERS, iVi fall detector pendant, PIR movement sensor and GPS watch. The program requires that veterans be evaluated for need by a qualified health provider. Tunstall has participated in the RAP program since 2002. Pulse+IT (Australasia) In the US, a significant part of Tunstall’s purchase of AMAC were medical answering service operations in Long Island City, NY, Pawtucket, RI, and Newington, CT. A $10 million upgrade of their 24/7 service includes CRM for healthcare providers for after-hours, overflow support, appointment reminders, insurance verification and help desk services. Release
Telehealth reimbursement makes legislative progress in Texas, US House
In Texas, telehealth reimbursement as part of the state Medicaid program passed their House resoundingly (120 to 5!) and moved to the state Senate. (In Texas, if your bill makes it through the scrum that is their House, the Senate moves expeditiously.) HB (House Bill) 2641 would authorize Texas’ Health & Human Services Commission (HHSC) to extend reimbursement for home telemonitoring (telehealth) services under the state Medicaid program from September this year for four years. Health care providers in Medicaid would be reimbursed for review and transmission of electronic health information. The caveat of course is that it is ‘feasible and cost effective’–it is designed to be expenditure neutral. The bill also includes extensive stipulations on health information exchanges based on national standards (ANSI) as well as amending the health and safety code for immunizations and other health conditions. The ‘criminal offense’ pertains to protected health information breaches as a misdemeanor. Telehealth inclusion in Medicaid is positive as this state insurance plan serves the poorest and often sickest, as well as many federal Medicare ‘dual eligibles’. Texas, being a large state, also sets trends (including the most reluctant to adopt cross-state telemedicine licensure.) Text of HB2641
Would that telehealth reimbursement have the same chance in that large, exceedingly deliberative body called the US House of Representatives. HR2066, the Telehealth Enhancement Act of 2015, is similar to a bill that expired in committee in the last session. It was introduced (more…)
Home telehealth now focused on the ‘superusers’ of healthcare
A noticeable trend in telehealth has to do with focusing less on the generic virtues of at-home vital signs monitoring for routine patient care and more on managing specific high-cost populations to avoid or reduce costs. Some of the impetus in the US has come from new regulations by CMS (Center for Medicare and Medicaid Services) intended to move Medicare fee-for-service (FFS) patients into a reimbursed chronic care management (CCM) model. Banner Health is Arizona’s largest private employer (which does say something about Arizona as a retirement haven) and since 2006 has been experimenting with remote monitoring since 2006. Starting in 2013 Banner piloted Philips‘ post-discharge program now called ‘Hospital to Home’ as Banner iCare, combined with Philips Lifeline PERS, but made it available to those only with a stunning five+ chronic conditions–the top 5 percent that is reputed to account for 50 percent of healthcare spend. Banner combined the tech with intense support by a multi-layered care team. At ATA they announced the following results with the initial cohort of 135 patients, now up to 500:
- 27% reduction in cost of care
- 32% reduction in acute and long term care costs
- 45% reduction in hospitalizations
The article in Forbes is a bit breathless in profiling the program and the ‘superusers’ of healthcare (with a windy but false analogy from John Sculley) but provides a level of detail in the program that most articles do not. One wonders how Philips makes money on supplying what is at least $2,500 worth of kit, with peripherals that must all be Bluetooth LE. It’s also not stated, but the TeleICU and TeleAcute programs also appear to be Philips’. Video
Indian Health adopting telemedicine in Southern California for diabetes treatment
Tribal-owned Riverside-San Bernardino County Indian Health, which serves nine tribes through seven health centers in the ‘Inland Empire’ of California, is adopting telemedicine to reach Native American patients and reduce their rate of diabetes. According to an Indian Health spokesperson, Native Americans constitute the largest diabetic population in the world and are 177 percent more likely to die from the disease. In San Bernardino County alone, 13 percent of adults are diabetic, and nearly 80 percent are overweight or obese. The initial program brought endocrinologists serving other Western tribes in on video consults with doctors in Indian Health clinics. Later rollout of the program will include pulmonology, cardiology, gerontology and dermatology. The market potential for telehealth remote patient monitoring–better information and analytics for clinicians, self-monitoring training and education for patients–could be substantial here for companies willing to invest time, learning and to build relationships. California Healthline. FierceHealth IT
Short takes for a spring Friday: wounds, babies and ‘frequent fliers’
Starting off your spring weekend….WoundMatrix, which uses generally older model smartphones to take pictures of wounds which are uploaded either to their own or to a destination clinical platform, with proprietary software that helps a clinician analyze the wound remotely and then to track healing progress, has gone international with Honduras’s La Entrada Medical and Dental facility run by non-profit Serving at the Crossroads, and in Rwanda in the care of nearly 1000 patients by the Rwanda Human Resources for Health Program, established by their Ministry of Health with the cooperation of several American universities. At ATA they also announced a new release of software. Release (PDF attached)….A BMJ (British Medical Journal) article critiquing the surge in what we call ‘telehealth for the bassinet set‘ scores the Mimo onesie (Rest Devices), the Owlet sock and the Sproutling band as taking advantage of concerned parents. It’s too much continuous monitoring of vital signs that can vary and yet be quite normal, and no published studies on benefit. A reviewer did find that Owlet is in clinical tests at Seattle Childrens and University of Arizona. MedPageToday (BMJ requires paid access)….A surprise from Philips, which we in the US associate with the Lifeline PERS. They have quietly moved into telehealth focusing on post-discharge programs that target the most costly patients, often dubbed ‘frequent fliers’ based on their frequent stays in hospital. The ‘Hospital to Home’ telehealth pilot with Banner Health in Arizona, dubbed for them the Intensive Ambulatory Care (IAC) program, focuses on the top 5 percent of complex patients which are the highest cost and most care intensive. IAC results among 135 patients over six months reduced hospitalizations by 45 percent, acute and long-term care costs decreased by 32 percent and overall cost of care by 27 percent. However, is this program continuing–or transitioning their patients? iHealthBeat, PR Newswire
ATA trend #1: Is a sustainable RPM infrastructure fact or fiction?
Guest columnist Dr Vikrum (Sunny) Malhotra attended ATA 2015 last week. This is the first of three articles on his observations on trends and companies to watch.
The advancement of remote patient monitoring is a visible trend from the American Telemedicine Association’s 2015 meeting, with care moving from the doctor’s office and being shifted to the patient’s home. A more diverse range of data is being collected for patients to facilitate more informed decision making at the patient visit and after the patient is away from the practice. As information is being collected and monitored on a more comprehensive basis, we have seen creative modalities to view a broad array of data points that would typically have been collected in a doctor’s office with the hopes of early diagnosis and preventive care, versus reactive care.
Patient autonomy has now come to the forefront and network infrastructure is being built to support that shift. Wearables, implantables and home based lab/ urine diagnostic kits are becoming smaller, cheaper, less invasive, wireless and cloud-based so that patients can be monitored without interfering in day to day living. (more…)
10th Anniversary Article 1: The Next Ten Years of Telecare
This year, on the 10th Anniversary of Telehealth and Telecare Aware, we have invited industry leaders nominated by our readers to reflect on the past ten years and, if they wish, to speculate about the next ten. Here is the first article, with a UK focus, by Dr Kevin Doughty.
Many of us are frustrated at how little progress there has been in the deployment and acceptability of telecare during the past decade. Yet, despite warnings that an ageing population was about to bankrupt the NHS (and health insurance schemes elsewhere in the world), and that access to social care for older people was being withdrawn at such a rate that it could only be afforded by the wealthiest in society, our health and social care systems have just about survived.
But this can’t go on, and in England over the past 12 months: (more…)
When remote monitoring ends, what happens to patient outcomes?
They do not maintain improvement, just as we thought. A just-published study fills a significant gap in telehealth knowledge. The study published in the Journal of Medical Internet Research (JMIR) analyzed the long-running Partners HealthCare-Massachusetts General Hospital Connected Cardiac Care Program (CCCP) for patients with heart failure. They matched 174 patients participating in the 120-day program between January 2008 and August 2012 with an equal number of control patients, all with heart failure, previously hospitalized and receiving care at MGH. The program patients were provided with a ViTelNet monitoring hub plus devices–a digital weight scale, a blood pressure cuff and meter, and a pulse oximeter–as well as receiving patient education plus unscheduled education intervention from nurse care coordinators when results trended out of pre-set ranges.
During the 120 day program, the program patients (predictably) had consistently lower hospitalization rates versus the control group at the 30, 60, 90 and 120 day marks, though the differential narrowed over time. But after program completion, in the study’s follow up eight months after the end of the four-month program (see one year below), the program group’s hospitalization rates increased to exceed the control group’s. Mortality rates remained lower though not statistically significant:
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