Telehealth

Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the globe.

Telehealth is an expansion of telemedicine, and unlike telemedicine (which more narrowly focuses on the curative aspect) it encompasses preventative, promotive and curative aspects.

The use of information and communication technology (ICT) in medicine has developed over the years (see timeline of medicine and medical technology).

Modern medicine incorporates email, electronic drug prescriptions, and home monitoring of conditions by patients. Clinical trials in the UK have shown it to reduce mortality by around 47%; however, the case for telehealth is still being actively debated, with a study on a separate US project showed remote telemonitoring was associated with increased mortality in vulnerable patients.

Nonclinical uses

Benefits

Telehealth allows the patient to be monitored between physician office visits which can improve patient health. Telehealth also allows patients to access expertise which is not available in their local area.

In 2003,a study of high-risk pregnant women in rural areas of the United States reduced the state's 60-day infant mortality rate by 0.5 percent by increasing the number of low birthweight infants delivered at a medical center.[1]

In Alaska, the Alaska Federal Health Care Access Network (AFHCAN) connects approximately 180 Alaska Native community village clinics, 25 subregional clinics, 4 multiphysician health centers, 6 regional hospitals, and the Alaska Native Medical Centerin Anchorage. More than 3,000 providers have engaged in 160,000 telehealth clinical consultations since 2001. It is estimated that in 2012, the AFHCAN telehealth program saved the state of Alaska $8.5 million in travel costs for Medicaid patients alone.[2]

The UK's Department of Health's Whole System Demonstrator (WSD)[3] launched in May 2008. It is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall. Three thousand and thirty people with one of three conditions (Diabetes, Chronic Heart Failure and COPD) were included in the telehealth trial. The trials were evaluated by several universities which foun a 45% reduction in mortality rates, 20% reduction in emergency admissions, 15% reduction in A&E visits, 14% reduction in elective admissions, 14% reduction in bed days, and8% reduction in tariff costs.

Another UK trial of telehealth, this time for patients suffering from infertility, demonstrated a reduction in the cost of care of approximately 95%. The remote patient monitoring product and service used cost $800 per patient, compared to $15,000 as the average cost of a cycle of in-vitro fertilization (IVF), and showed (for suitably selected patients) the same pregnancy rate.[4]

There may also be some significant carbon reductions for the NHS to be gained from developing Telehealth and therefore reducing the need to travel (often, in the case of patients, by car) as well as encouraging healthy, sustainable behaviour through monitoring and improved communications and reducing the requirements to expand sites to meet increases in Healthcare demands.

Baby Eve with Georgia for the Breastfeeding Support Project

In Australia, during January 2014, Melbourne tech startup Small World Social collaborated with the Australian Breastfeeding Association to create the first hands-free breastfeeding Google Glass application for new mothers.[5] The application, named Google Glass Breastfeeding app trial, allows mothers to nurse their baby while viewing instructions about common breastfeeding issues (latching on, posture etc.) or call a lactation consultant via a secure Google Hangout, who can view the issue through the mother's Google Glass camera.[6] The trial was successfully concluded in Melbourne in April 2014, and 100% of participants were breastfeeding confidently.[7][8] Small World Social Breasfteeding Support Project

Criticism

Although several studies have demonstrated a positive impact from the use of telehealth and remote patient monitoring, there are dissenting studies.

A US study[9] of 205 elderly patients with a high risk of hospitalization showed a significant increase in the mortality rate over 12 months, with rates over 12 months for the telemonitoring group at 14.7%, compared with 3.9% for the usual care group (Source: Arch Intern Med 2012, online 16 April, and Pulse, April 20, 2012 - Telemedicine trebles death rate in elderly patients).

As a result, there is controversy in the UK regarding the government's determination to proceed with Telehealth despite conflicting findings from the studies undertaken.

Reimbursement for Telehealth in the United States

Reimbursement by Medicare

Reimbursement for Medicare-covered services must satisfy federal requirements of efficiency, economy and quality of care. Since 1999, Medicare and Medicaid reimbursement for all kinds of telehealth services have expanded, requirements of providers have been reduced, and grants have been given to support telehealth program adoption.

For 2014, the Centers for Medicare and Medicaid Services (CMS) does cover telemedicine services as long as the services fall into either Category 1 or Category 2.[10] As of now, these categories are defined as such:

Medicare Telehealth Coverage Areas

There are several conditions to Medicare telehealth coverage. The first being that the consumer, or individual receiving telehealth services must be physically located in an "originating site" that is eligible for Medicare coverage.[11]

State specific Medicaid Reimbursement

States have the option/flexibility to determine whether or not to cover telemedicine under the Medicaid assistance program.[12] They may also decide:

Individual states are encouraged to use flexibility granted by federal law to create payment methodologies that incorporate telemedicine technology. For example, states can reimburse the practitioner at the distant site an reimburse a facility fee to the originating site. States can also reimburse support costs like technical support, transmissions charges, and equipment. Add-on costs like those can be incorporated into the fee-for services rate or separately reimbursed as an administrative cost by the state.[13]

If a state decides to cover telemedicine, but not to cover certain areas or certain practitioners, then the state must be responsible for assuring access and covering face to face visits by recognized providers in those parts of the state where telemedicine is not available.

Reimbursement by Private Payor

Currently, 21 States have a previously enacted Legislated Mandate for Private Coverage:[14]

The state of the market

The rate of adoption of telehealth services in any jurisdiction is frequently influenced by factors such as the adequacy and cost of existing conventional health services in meeting patient needs; the policies of governments and/or insurers with respect to coverage and payment for telehealth services; and medical licensing requirements that may inhibit or deter the provision of telehealth second opinions or primary consultations by physicians.

Projections for the growth of the telehealth market are optimistic, and much of this optimism is predicated upon the increasing demand for remote medical care. According to a recent survey, nearly three-quarters of U.S. consumers say they would use telehealth.[15] At present, several major companies along with a bevy of startups are working to develop a leading presence in the field.

In the UK, the Government's Care Services minister, Paul Burstow, has stated that telehealth and telecare would be extended over the next five years (2012–2017) to reach three million people.

See also

References

  1. ↑ "Statewide Telehealth Program Enhances Access to Care, Improves Outcomes for High-Risk Pregnancies in Rural Areas". Agency for Healthcare Research and Quality. 2013-05-08. Retrieved 2013-05-10.
  2. ↑ "Telehealth Improves Access and Quality of Care for Alaska Natives". Agency for Healthcare Research and Quality. 2013-05-22. Retrieved 2013-05-22.
  3. ↑ "Whole Systems Demonstrators An Overview of Telecare and Telehealth" (PDF). 2015-05-14.
  4. ↑ Chausiaux, O., Hayes, J., Long, C., Morris, S., Williams, G. and Husheer, S. 2011. Pregnancy Prognosis in Infertile Couples on the DuoFertility Programme Compared with In Vitro Fertilisation/Intracytoplasmic Sperm Injection. European Obstetrics & Gynaecology, 2011;6(2):92-4.
  5. ↑ "http://www.inquisitr.com/1224638/google-glass-connects-breastfeeding-moms-with-lactation-help/". Inquisitr. Inquisitr. Retrieved 12 June 2014. External link in |title= (help)
  6. ↑ "Exclusive Clips Google glasses help breastfeeding mums". Jumpin Today Show. Mi9 Pty. Ltd. Retrieved 12 June 2014.
  7. ↑ "Breastfeeding mothers get help from Google Glass and Small World". The Sydney Morning Herald.
  8. ↑ "Turns Out Google Glass Is Good for Breastfeeding". Motherboard Vice Media Inc. 21 April 2014. Retrieved 1 May 2014.
  9. ↑ "A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits". Archives of Internal Medicine 172 (10): 773–779. 2012-05-28. doi:10.1001/archinternmed.2012.256. ISSN 0003-9926. PMC 3914200. PMID 22507696.
  10. ↑ http://www.cms.gov/
  11. ↑ (CMS)
  12. ↑ http://insighttelepsychiatry.com/will-medicaid-cover-my-telehealth/
  13. ↑ http://www.ncsl.org/research/health/state-coverage-for-telehealth-services.aspx
  14. ↑ http://www.americantelemed.org/docs/default-source/policy/state-telemedicine-policy-matrix.pdf?sfvrsn=38
  15. ↑ "Survey: Consumers Keen on Telemedicine". Retrieved 2010-04-26.

Further reading

External links


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