11 Telemedicine Tools Transforming Healthcare

We haven't figured out how to teleport patients into medical offices. But telemedicine technologies link patients and clinicians in ways Ray Bradbury would admire.




What's fueling the healthcare industry's interest in telemedicine? Better mobile technologies and more mature electronic health records (EHRs) and clinical decision support (CDS) systems lead the list. Also, as the baby boomer generation ages, medical expert shortages arise in many specialties.

This interest in telemedicine, which Jonathan Linkous, CEO of the American Telemedicine Association, defines as "the delivery of any healthcare service or transmission of wellness information using telecommunications technology," has the potential to transform the way medical care is provided in many areas of the country. The term "telehealth," on the other hand, is often used interchangeably with telemedicine, but doesn't necessarily involve clinical services. It can include patient education or mobile health apps that engage patients in their care, for instance.

Telemedicine isn't a separate medical specialty, but can be deployed by a variety of medical providers and specialties. For instance, dermatology and radiology are medical specialties that tap into telemedicine technologies, including digital imaging and high-bandwidth communication, to remotely view patient medical images--such as photos of skin lesions or CT scans--for diagnosis and treatment recommendations.

Telemed technology can also be used to monitor patients with chronic conditions, enhance nursing call centers, and provide remote consultations for patients in rural areas or off-hours.

While Medicare has been slower to change reimbursement policies to accommodate telemedicine care, private insurers and state Medicaid payers have been more progressive in covering many services, and that's pushing more doctors and hospitals to provide them, said Linkous in an interview with InformationWeek Healthcare.

When it comes to monitoring patients with chronic conditions, mobile and home-based devices that connect via the Web to clinicians increase the likelihood that patients experiencing problems will be spotted early. Clinical systems that remotely collect patient readings can generate alerts to physicians or nurse case managers indicating that prompt intervention is needed to prevent complications or a serious emergency situation from developing. These could range from a diabetic patient with irregular glucose readings or sudden weight gain in a heart failure patient, for example.

The National Institute of Health reports that 25.8 million Americans--more than 8% of the U.S. population--have diabetes. So, telehealth applications, such as the one being planned by diabetes care leader Joslin Diabetes Center and telemedicine tech provider American Well, have a large potential audience of patients who may become users.


American Well provides telemedicine services that enable patients and physicians to consult remotely. As pictured here, patients and doctors can see each other via webcam, as well as communicate by text, email, or phone. The service can provide patients with medical consultation off hours, with specialists who are in short supply, and to help monitor chronic conditions.

American Well and Harvard's renowned Joslin Diabetes Center recently announced their intent to collaborate to extend Joslin's expertise to diabetes patients using American Well's Online Care technology.

American Well also collaborates with other partners, including the U.S. Department of Veteran Affairs, drug store chain Rite Aid, and health insurer Blue Cross Blue Shield, to deliver telemedicine services to various patient populations, including those seeking mental health services, common acute diagnoses, and specialty medical consultations from remote places.

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Independa, which provides telehealth services via a cloud-based care management platform, recently added support for Telcare's Blood Glucose Meter into its suite of remote monitoring applications and sensors for elderly patients. Independa said Telcare's BGM can be particularly handy for elderly diabetic patients who are on the go, travel, or are "snowbirds" who live in different parts of the country during various seasons of the year.

Glucose readings taken by the Telcare cellular glucometer, shown here, are automatically transmitted to Telcare's central server, with no need for cables or a smartphone. The Independa integration has Telcare securely transmitting the data to Independa's cloud-based caregiver Web app. That app provides a gateway for designated clinicians or caregivers to access the patient's readings via a dashboard on their computers. Clinicians and caregivers also receive alerts when readings hit specific thresholds set for each patient in the Independa system, allowing earlier intervention to prevent diabetic complications from developing.

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TeladocConnect, another telemedicine service, lets patients and clinicians communicate 24 hours a day, seven days a week, through telephone or secure online video, giving physicians the flexibility to offer a higher level of personal service. When patients request a consultation with their primary care physicians, the physicians are alerted and can respond. If the physician is unavailable, the consultation request is routed to Teladoc's national network of U.S. board-certified physicians, which acts as an extension of the physician's practice and gives the patient access to physicians in their state. While the program is available nationally, patients and doctors from the same state communicate via the services to abide by state licensing rules for physicians, said a Teladoc spokesman.

Each Teladoc consultation includes a comprehensive review of a patient's electronic health record. If a Teladoc-network physician performs the consultation, the consultation record is provided to the patient's primary care physician, providing continuity of care.

For patients, the service is a more affordable and convenient alternative to costly urgent care and non-emergency ER visits. For providers, the service also addresses access, patient volume, and reimbursement challenges.

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Tele-ICUs and tele-stroke systems represent two of the hottest telemedicine applications, according to Jon Linkous, CEO of the American Telemedicine Association. Electronic ICUs, or tele-ICUs, are helping hospitals in regions where there are shortages of intensivist physicians to provide 24 x 7 critical care to patients, using remote monitoring technologies. Tele-stroke applications, on the other hand, are helping hospitals link remote neurologists to ERs so that patients suffering strokes can be diagnosed more quickly and accurately, and receive interventions earlier to help prevent lasting disabilities.

The Department of Veterans Affairs, OSF Healthcare Systems, and Inova Health System are among the many healthcare providers that have deployed tele-ICU technology in recent years.

Visicu eICU technology from Philips, pictured here, has been deployed at many hospitals in the country. Philips says its e-ICU product enables health systems to transform critical care with an integrated, enterprise-wide approach that leverages scarce critical care resources, integrates clinical decision support, and standardizes evidence-based care across the enterprise.

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It's important to improve patients' engagement in their own care to achieve better outcomes. Telehealth tools can help, including those that deliver educational and other important information to patients, whether they're at home or in a clinical setting like a medical waiting area.

GetWellNetwork recently announced its interactive patient care and educational resources are available on the iPad. Previously, the GetWellTown offerings--which include a comprehensive library of pediatric education videos from KidsHealth, were available mainly to hospitalized patients.

Now with the GetWellNetwork iPad offering, interactive patient care and educational resources are accessible to outpatients and families in a variety of care settings. For example, Children's of Alabama is using the iPad offering to let patients and families access medical treatment videos and information in specialty clinics, emergency rooms, outpatient areas, and neonatal intensive care units.

Meanwhile, the vendor's [email protected] product provides hospitals with a digital platform to engage patients from home using mobile devices, the Web, and cable TV after they've been discharged from the hospital and are recovering. That enables patients to remotely review discharge instructions, care plans, and information about their medications.

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At-home patient monitoring is one of the most common uses of telemedicine. VitalPoint, from CJPS Medical Systems, is a standalone, single unit, 4.5-lb device that can monitor multiple vital signs, including blood pressure, blood oxygen saturation, pulse rate, weight, glucose level, prothrombin time and ratios, temperature, fluid status, and electrocardiogram data, and provide the caregiver with the ability to remotely monitor patients' conditions using their laptop or cellphone. The physiological data finds its way into the unit, pictured here, through peripheral medical devices--some wired and some wireless.

Features include a large touch screen and design that's easy for patients, from pediatric to geriatric, to use. The device also provides users with audible reminders of scheduled activities; clinicians' messages; and detailed illustrations and clear voice prompts that guide them through vital signs measurement activities and non-emergency symptom reporting. The product can connect via phone lines if patients don't have Internet access in their homes.

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In addition to telehealth products and services geared to chronically ill patients and those with other medical issues, some offerings suit people looking for tools to stay fit. In other situations, patients may have recovered from a medical problem and are trying to stay on track.

Sensei Wellness Plus is a telehealth product that targets the key risk factors and lifestyle management related to cardiovascular disease. Sensei Wellness Plus' aim is to transform a mobile phone into a virtual coach, providing personalized, timely, and specific guidance as a seamless part of an individual's activities.

The product was named winner of the Novartis Health 2.0 Cardio Engagement Innovation Challenge at HIMSS12. The challenge was to create a game-changing way for patients to better manage their cardiovascular health through an interactive tool that would motivate and empower people.

Sensei Wellness Plus provides a brief assessment of an individual's cardiovascular risk and then creates a personalized program providing encouragement, education, and guidance on nutrition, weight management, fitness, and condition-specific self-management for those with hypertension, high cholesterol, and diabetes.

For clinicians, the product also supports population health management, connecting healthcare consumers with healthcare providers.

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Avaya's Telehealth and Home-Care Delivery products use video communications to enable homecare nurses, rural hospital workers, and others to gain faster access to specialists and physicians located anywhere. This enables home-based caregivers, as well as individuals receiving care at home, to interact with a physician by selecting a link from an e-mail and initiating a videoconference. The offering is based on Avaya One Touch Video, pictured here, that enables voice and voice/video sessions between agents, experts, or other enterprise resources and end users who have access to an Internet-connected PC, tablet, or mobile device, using a browser with a Flash plug-in or mobile application.

Avaya also partners with other vendors to provide telemedicine tools for hospital and other care environments. For instance, Avaya's partner GlobalMed works with customers to create mobile medical carts that fit their unique needs and specialties. GlobalMed features open architecture products that work with all major videoconferencing systems for remote clinical consultations and other telemedicine activities.

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Tele-radiology, which allows remote radiologists to view medical images, including X-rays, CT scans, MRIs, and diagnostic tests, is one of the most common types of telemedicine activities. Tele-radiology can allow specialists to view images any time of day for hospitals without radiologists onsite around the clock, as well as for consultative work.

Among the products supporting tele-radiology is Viztek's Opal-RAD picture archiving and communication system (PACS), which offers multiple tools that cater to the telemedicine radiology practice. Those tools include Turnaround-Time (TAT), shown here, which gives radiologists easy visibility to monitor time commitments, ensuring reports are read and signed within any contractually agreed time.

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Many telehealth offerings tap into consumers seeking convenience in managing their health and wellness. These can include tools to help monitor physical activities and calories burned, and tools to help patients trying to book appointments with clinicians.

ZocDoc is a free service that enables patients to search for doctors, sort by location, specialty, and insurance accepted; read verified patient reviews; and instantly book an appointment online. By revealing the "hidden supply" of doctors' appointments (including the 10 to 20% cancelled at the last minute), ZocDoc, available as an app on iPhone, Android, and BlackBerry smartphones, helps patients get faster access to healthcare. In fact, according to the vendor, 40% of ZocDoc patients book an appointment that takes place with 24 hours, and 60% within three days. ZocDoc says its service is used by more than 1 million patients each month, offering more than 5.5 million available appointments at any given time.

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VA Division Saves $742,000 With Telehealth

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Private health insurers are starting to cover telemedicine services for their members. Telehealth products and services vendor Consult A Doctor recently announced availability of MyHealthPlan 24/7, a new cloud-based telemedicine platform designed to support health plans in reducing costs and meeting market demand for more affordable, efficient, and immediate access to quality healthcare.

MyHealthPlan 24/7 gives payer organizations the ability to offer their members on-demand access to their provider networks or, alternatively, Consult A Doctor's national network of on-call physicians. Benefits for employers, health groups, and members include 24/7 physician access, patient portal, and mobile application.

There are also potential benefits for providers because offering telemedicine services can--under the right circumstances--translate to additional revenue, enhanced care management, and flexibility in when services are offered.

RECOMMENDED READING:

Global Telemedicine Market Headed For $27 Billion

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Major Telemedicine Roadblock Could Clear With Proposed Bill

Roomba Maker Sets Sights On Telemedicine

VA Division Saves $742,000 With Telehealth

Telemedicine Tackles Diabetes Epidemic

IT-Enhanced Medical Homes Aren't A Quick Fix

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