When I was at that the American Telemedicine Association Conference #ATA18 earlier this year one of the speakers was taking about the lenses to use to help us make decisions. She felt the if we looked at healthcare, specifically technology in healthcare, through the a specific 4 part prism we would find better solutions. Those 4 point were whether or not something was Accessible, Affordable, Reliable and Relational. If a new product, service or piece of technology couldn’t compete on those four pillars than it likely was bring no value to patients, physicians or the healthcare system as whole.
Accessible, Affordable, Reliable and Relational have become a mantra for me. I try to apply it to any decision now within healthcare. If I am involved in creating a new policy, I want to ask myself, how will this policy affect a patients ability to Access care? Will it it improve it? If it doesn’t then it might not be the right decision. Can patients afford it or can the healthcare system afford to provide it? Is it an unfunded requirement of physicians and advanced practitioners who may be required to do more work without any compensation? Does it strengthen the bond between a patient and their doctor?
What lenses are conspicuously absent for this set of 4? The insurance company and other payors. They do not factor much in this and they tend to dissuade Access with narrow networks, the prevailing sentiment among patients and physicians alike is that insurance is neither affordable or reliable. And who feels like they have a good relationship with their insurance company? In addition, the Direct to Consumer healthcare market will continue to grow and that is the population of people who would be most interested in the topics I write about.
In future posts, especially Health App of the Month, there will be an addition to every article. The ability of an app or service to be Accessible, Affordable, Reliable and Relational will be evaluated. Would love to hear any feedback on this from my readers.
If you have ever had a negative experience with technology in a medical office, ever felt so upset at the intellectual speed bumps of an EMR, frazzled by the dozens of mouse clicks required for even the simplest task or felt isolated as a patient when your doctor spends your whole appointment looking at their computer, you may be wondering “how did we get here?” What happened that caused medicine to value the input of data more than any other aspect of a medical encounter? To find those answers and many more, I recommend reading “The Digital Doctor” by Dr Robert Wachter.
I just recently finished reading this book and can’t stop thinking about it. This book is not the love letter to healthcare technology that I thought it would be. Originally published in 2015 with the latest edition published in 2017, “The Digital Doctor” tells the story of healthcare technology, with specific focus on electronic medical records, has taken over modern American Medicine. Dr Wachter interviewed 100 individuals and weaves their personal stories of the impact of changing healthcare policy on how patients receive and physicians provide care.
While technology and electronic medical records have the potential for improving medical care, Dr Wachter paints the picture that too much dependence on technology that is not quite good enough is a recipe for disaster. Several chapters of the book are explains, from numerous points of view, how a long patient could receive a dose of medicine that was 39 times too high. How could the electronic medical record have led a physician to the wrong dose calculation, how could the pharmacist not realize the error and how could the nurse give a patient 39 tablets when one was what was required? The story is fascinating and the subtle role that technology played in this mistake at every single phase is almost terrifying.
Dr Wachter goes into a lot of detail about other components of healthcare technology like Personal Health Records, Patient Portals, Open Notes and Social Connectivity. For anyone out there who uses EPIC for their EMR, like I do, there is a whole chapter dedicated to the behemoth Wisconsin company. If nothing else, you will appreciate the story of Charm the horse and probably think of nothing else the next time you log into EPIC.
You can find the book on Amazon here and you will not be disappointed. I do not participate in any affiliate marketing, this is just my opinion. I do feel that any one who wants to change the future must understand the past. For those like me who want to impact positively our digital and connected healthcare future, The Digital Doctor is a must read.
Hoping To See Your Doctor Via Telemedicine? Here’s A Quick Guide
by: Steven Findlay, Kaiser Health News
Tucked into the federal budget law Congress passed in February was a provision that significantly expands the use of telemedicine — long a hyped health care reform, and now poised to go mainstream within five to 10 years.
“There’s much broader recognition of the benefits,” said Mei Wa Kwong, executive director of the Center for Connected Health Policy, a research group that promotes telemedicine in Sacramento, Calif. “The law is the latest to make telemedicine more accessible. But we still have a ways to go before most consumers are aware of the option.”
The new law allows Medicare to cover telemedicine services for people who have had a stroke and those who get kidney dialysis, either at home or at a dialysis facility. It also permits Medicare Advantage Plans — private plans that enroll a third of Medicare beneficiaries — to offer telemedicine as a covered benefit.
Separately, as of Jan. 1, Medicare began allowing doctors to bill the government for monitoring certain patients remotely using telemedicine tools — for example, tracking heartbeat and rhythm, blood pressure and blood glucose levels.
Telemedicine, also referred to as telehealth, uses computers — and their display monitors, software and capacity for data analysis — to deliver virtual health services.
In the easiest-to-understand example, a patient is in one location and has an e-visit with the doctor in another location. They are connected via a secure video link. Proponents say that more sophisticated monitoring is on the horizon and that virtual encounters will become more commonplace.
As acceptance and adoption of telemedicine expands, so does coverage. All private health plans, Medicare, state Medicaid programs and the Department of Veterans Affairs now cover some e-visits — albeit with restrictions. More health centers and hospitals are launching virtual health centers. And websites offering virtual “doctor-on-demand” services are proliferating.
Concerns exist, however. Doctors worry that they may get paid less if insurance reimbursement is lower for e-visits than in-person appointments, or that e-visits could undermine the doctor-patient relationship by reducing valuable face time. They point out that for some ailments, like strep throat, it’s best if doctors or other health providers see the patient.
Health economists, meanwhile, are concerned that e-visits could add to costs rather than constrain them — if, for example, doctors and patients abuse e-visits by scheduling them unnecessarily because they are quick and easy. Also, insurers may be motivated to push doctors to do more e-visits instead of in-person visits to save money. And for some people, access to proper equipment or internet access can be difficult.
“The potential for abuse is there,” says Dr. Robert Berenson, a Medicare expert at the Urban Institute. “We will need to prevent gaming and misuse of the system. But, generally, helping people avoid unnecessary doctor’s office and hospital visits is a good thing, if we do it right.”
Here’s a briefing on telemedicine basics:
Q: Are e-visits available from most hospitals and doctors?
Not yet. But access is increasing. Ask your doctor, clinic or hospital.
In some cities, medical centers are setting up telehealth “hubs” to handle patients. For example, Penn Medicine in Philadelphia launched its Connected Care center in February with 50 full-time employees, 24/7 access to care and a program to treat chronically ill patients at home. Some of the center’s e-visit services are open only to Penn Medicine employees, but other services are available to anyone, with a focus on residents of Pennsylvania, New Jersey, Delaware and Maryland, said Bill Hanson, vice president and chief medical information officer at Penn Medicine.
Similarly, Mercy Virtual in Chesterfield, Mo., a St. Louis suburb, serves patients throughout the Midwest, and those treated at Mercy Health’s network of 44 hospitals in five states. Launched in 2015, Mercy Virtual provided care to 750,000 people in 2017 with a team of 700 doctors, nurses and support staff.
Other medical centers with virtual health programs include Avera Health based in South Dakota; Cleveland Clinic in Ohio; Dignity Health in San Francisco; Intermountain Healthcare in Utah; and Kaiser Permanente, a managed-care health system in California and elsewhere.
Kaiser Permanente reported last year that 21 percent of its 110 million patient interactions in 2015 were e-visits. Officials there predict that by 2020 e-visits will exceed in-person visits. (Kaiser Permanente is not affiliated with Kaiser Health News, which is an editorially independent program of the Kaiser Family Foundation.)
Q: What restrictions do health plans, Medicare and Medicaid put on e-visits?
Health plan coverage varies, but most private insurers cover e-visits, and 34 states and the District of Columbia require that they do. A few states still require that a patient relationship be established with an in-person visit before the provider can bill for an e-visit. Check with your insurer about its policies.
Medicare’s coverage of e-visits is more restrictive. First, e-visits must take the place of an in-person visit. Second, with exceptions allowed under February’s budget law, Medicare largely restricts e-visits to those that occur in rural areas that have a shortage of doctors and/or hospitals. And third, most e-visits can’t occur when the patient is at home. They can be done from a variety of other locations, such as a rural health clinic, a dialysis center or skilled nursing facility. A bill in Congress would loosen that restriction.
In contrast, almost all state Medicaid programs cover e-visits in the home. But restrictions still apply. For example, only 22 states cover remote patient monitoring for Medicaid enrollees.
Q: Do I need special computer equipment?
No. E-visits and other forms of telemedicine are done over commonly available computers, laptops, tablets and smartphones — and are typically encrypted to protect privacy. Specialized equipment is usually needed for remote monitoring, such as blood pressure or heart rate. One vexing barrier: broadband availability in rural areas. Also, millions of low-income and older Americans still lack Wi-Fi in their homes.
Q: What services can I get through telemedicine?
Most e-visits are for primary care or follow-up services, such as assessing symptoms or checking on people who have had a medical procedure. But a growing number — no one keeps national statistics — cater to people with chronic conditions who are being monitored at home, said Kwong.
Dermatology e-visits are becoming especially common. You can send a close-up photo of a skin rash, mole or other problem for an immediate assessment. Psychotherapy by e-visit is also expanding.
Sometimes an e-visit may provide an initial medical assessment for an injury, wound or illness that is clearly not life-threatening. Some cities are testing ambulance services that use telemedicine to triage whether people need a trip to the hospital.
Q: Will I save money if I do an e-visit instead of going into the doctor’s office?
E-visits are generally less expensive than a trip to the doctor, but you may not see the difference if your insurance covers both with only a small copay or no copay. If you have a large deductible, however, an e-visit may mean you pay less out-of-pocket for that encounter.
Some states require insurers to make equal reimbursements for in-office and telemedicine consultations on simple matters.
Q: Are there downsides or risks with telemedicine and e-visits?
There’s no evidence so far that your risk of being diagnosed wrongly or treated inappropriately is any greater with an e-visit compared to an in-person visit.
While attending the annual conference for the American Telemedicine Association last week, I had a chance to catch up with one of my previous Health Apps of the Month. MySugr is now offering a package with a connected blood glucose meter and needed testing supplies to get started with their App. You can check them out at mysugr.com and read my article on them from last year.
regeneration. Everyone tends to revere spring, things are new and the cold dark winter is ending. For me the winter coincided with a a rather trying period of time in my real day job. While I love writing and blogging and learning everything I can about Digital and Connected Health, my day job doesn’t really involve a significant amount of that field. Recently there have been numerous work priorities that involved a significant amount of my time and what time was left I dedicated to my family. So my site here has been sitting fallow for a little while.