Why Telemedicine Should Be Integrated With EHRs, ACOs
Telemedicine expert Rashid Bashshur says mobile health technologies must integrate with EHRs to make accountable care organizations work.
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A veteran observer of telemedicine says that it's time for the various technologies grouped under that rubric to be integrated with mainstream medicine so that patients can receive the appropriate care from the right provider at the right site of care, while reducing waste and duplication of effort.
"If properly constructed, a full-service telemedicine network would provide the foundation for a successful ACO," he wrote. "It would introduce the necessary organizational change in the delivery process rather than simply making the old system operate electronically."
In an interview with InformationWeek Healthcare, Bashshur defined telemedicine as "as a system of care where the providers and the recipients of care are not in the same place at the same time," but use IT to communicate with each other. However, he added, certain aspects of mobile health technology, such as fitness and wellness apps that patients use on their smartphones without interacting with providers, would also fit into the same category.
In his commentary, Bashshur said there is a need to develop "telemedicine systems that incorporate and integrate the core elements of healthcare reform, namely, EHR [electronic health record], MU [meaningful use], HIE [health information exchange] and ACO."
How would he integrate telemedicine with EHRs? To start with, he noted in the interview, a healthcare provider who has a virtual encounter with a patient via telehealth should create an EHR for that patient. Then the information can be ported over to a personal health record (PHR) that the patient can view on a portal that also allows communication with the provider. The physician can use an HIE to share that information with other providers caring for the same patient.
When mobile and home monitoring comes into play, the situation becomes more complex, he said, because the sheer volume of data can easily overwhelm providers. Part of the solution, he stated, lies in "how well the electronic record is organized. There are some systems that allow you to go to the key points you're after, and others require you to read through a lot of other stuff. There are ways the EHR can be organized to simplify the search process."
But it's still difficult to separate the relevant from the irrelevant information in a huge data stream. Today's EHRs are incapable of doing that (although EHR vendor eClinicalWorks promises a new feature to address that challenge in the near future). So some providers -- the University of Michigan Health System included -- have nurse care managers sift through the incoming monitoring data to detect changes in patients' conditions. At UMHS, for example, the nurses are supposed to call patients with congestive heart failure if they gain more than three pounds in a day.
But it's not clear whether nurses are always watching the data or interpreting it correctly, Bashshur pointed out. Automation, he said, could improve the process "by reducing individual variations in judgment. It shouldn't be what this nurse or that nurse thought at that particular time. It should be a standard protocol that is applied uniformly. And second, when there's a red signal, it should provoke an action. Something should be done."
In the bigger picture, he said, ACOs and other organizations that do population health management need full-service telemedicine networks to engage patients in managing their health and improving their health behavior. That's critical, he said, if you want to keep people healthy and spend less on healthcare.
Telemedicine networks, he said, could be used to provide preventive care and patient education, as well as for diagnosing and treating non-serious conditions in telehealth consults. With telemedicine, "you don't have to bring everybody in for small problems. You can sort them out before they come in." If patients need to be seen, a specialist at an academic medical center like UMHS can bring them in, he added. Otherwise, he or she can handle the problem remotely and refer them back to the primary care physician in their community.
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