Copyright © 2019 Allscripts Healthcare Solutions, Inc. 1 Copyright © 2019 Allscripts Healthcare Solutions, Inc. Telehealth Lessons Learned from the USA Experience Andrew Forrest Market Solutions Leader – Asia Pacific April 2019
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 1Copyright © 2019 Allscripts Healthcare Solutions, Inc.
Telehealth Lessons Learned from the USA Experience
Andrew ForrestMarket Solutions Leader – Asia Pacific
April 2019
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 2
This presentation will look at
lessons the Australian TeleHealth
Market can learn from
understanding the USA experience
and development of TeleHealth.
As the largest consumers and
market for Telehealth in the world
the USA experience can be a guide
for Australia as we begin the
adoption of Telehealth.
Introduction
PhoneVideoEmail
Use of Virtual
Health Platforms
Patient
Portals
Government
regulation/incentives
The presentation will examine:
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 3
USA Overview
Telemedicine—remote consults between physicians
Tele-ICU—the use of remote Clinicians to manage Intensive Care Services
On-demand Video services—both acute and ambulatory
Patient “Portals” for information access and sharing
“Virtual” Care services
• “Synchronous” –Realtime – Live communications (Video, Phone, Text, emails)
• “Asynchronous” – Store and Forward (digital capture of pt. Histories etc.)
• “Remote Monitoring” –Connected devices (home monitoring, fitness trackers etc.)
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02
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The USA started on the
TeleHealth Journey in approx.
2005. Since then there has
been a proliferation of
services including:
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Factors Driving Rise in Telehealth Services in USA
Consumer driven Healthcare
As technology has progressed so has the demand from consumers to have healthcare keep pace.
Demand for Healthcare “convenience”
Government regulation and the Affordable Care Act
Medicare/Medicaid “Meaningful Use”
Shift to outcome based from episodic based funding
31% healthcare organizations
use video-based
telemedicine services
34% offer remote
patient monitoring
“Thanks to technology and shifts in
financial incentives, care will begin to
move into the palms of consumers’ hands,
providing care anywhere, anytime.”
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 5
USA by the numbers
Telehealth Market Summary: USATotal $M Revenues (2016) 1,336.3 Revenue % of Region (2016) 87%
Total $M Revenues (2022) 3,203.8 Services as a % of Rev 2016 65.7%
CAGR 2016-2022 15.7% Hardware as a % of Rev 2016 21.8%
Telehealth Development High Platforms as a % of Rev 2016 12.5%
Teleconsultations Remote Patient ManagementTotal Consults 2016 (K) 4,407.4 Total Lives Monitored 2016 (K) 522.3
Total Consults 2022 (K) 11,429.1 Total Lives Monitored 2022 (K) 1,058.6
CAGR 2016-2022 17.2% CAGR 2016-2022 12.5%
Share by Setting—2016 Key Market DynamicsOn-Demand/Direct Access 23.6%
Most evolved country market across all care settings. Video consultations
being used across primary, acute and post acute care settings, and
supported by traditional providers and telehealth specialists. Telehealth
coverage and payer parity legislation helping to drive adoption. Dept. of
VA driving RPM adoption.
Outpatient/Referral 18.7%
Tele-ICU 17.9%
Surgical/Medical Support 8.8%
Transition of Care 3.9%
Remote Patient Monitoring 27.0%
USA is the largest single TeleHealth Market in the world
both by revenue/sales/expenditure and usage
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Meaningful Use
Stage 1 (2011-2012)
Eligible professionals are required to promote data capture and sharing among patients. More than 50% of patients should have online access to their health records
Stage 2 (2014)
More than 50% of the patients should have online access to their health records and 5% of the patients should use the electronic information
• The stage 2 of Meaningful Use has 17 core objectives
• An eligible provider must meet all the objectives to earn incentive
• The providers receive incentive when all the requirements are met, failure to which may lead to no incentive and even penalty
Stage 3 (2016)
This stage expects an improved outcome from the use of patient portals. Additionally, it requires eligible professionals to encourage use of patient portals
Similarly, MU stage 3 has 6 objectives, of which an eligible provider must meet at least 3
Availability of patient portals would help providers meet all these objectives
Defines the use of certified EHR’s in order to engage patients, improve quality of services and manage patient
care efficiently. Meaningful Use has three stages which were expected to evolve from 2011 to 2016:
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 7
79%
21%
Hospital Adoption Rate
Hospitals Using Patient Portal
Hospitals Not Using Patient Portal
23%
77%
Patient Usage Rate
% of Patients enrolled
% of Patients not enrolled
• High adoption of patient portals in hospitals is owing to Meaningful Use criteria
and HITECH Act. However, adoption of patient portal in patients is as low as
23% due to lack of awareness, technological obstacles and data security issues
• The adoption of patient portals is projected to rise in the future as the
awareness among patients increases and as providers encourage and educate
them about the advantages of using a portal
“Patient portal use by older patients is on the rise due not
only to chronic disease management needs, but an overall
comfort with technology. Patients in their 60s are just as
likely as younger patients to register for their patient portal,
with nearly 30% of patients over 65 reporting portal use.”
—athenaResearch (Jan 2016)
33%
22%17%
16%
12%
Reasons for Use of Patient Portals
Maintaining clinical records of patient and doctors
Maintaining patient records
Anytime access to medical history & lab results
Communication between patients, doctors and hospitals
Compliance with Meaningful Use and CMS regulations
Adoption Rates of Patient Portals & Usage Reasons
Low usage by patients offsets high adoption in hospitals
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 8
What do US Patients Want
67% Prefer email visits
Telehealth is more than just video visits and
physician offices can start with email visits as a
more economical telehealth option. Using eVisits ,
clinicians can treat patients and delegate tasks
without the administrative costs associated with
in-person office visits.
86%
Information—about everything—is at our fingertips.
We can search the Internet on any topic, and
health concerns are no exception. The need for
immediate gratification means that people will
typically turn to Google before consulting a
medical professional.
Research health before
scheduling an appointment 64%
We expect to see the number of self-scheduled
appointments to increase as consumers become
more self-reliant and physician offices seek ways
to lower administrative overhead.
Will schedule appointments
using digital tools by 2019
48%
Today’s young adults expect their providers to
offer technology that is as mobile and flexible as
they are. As a generation that grew up with the
internet, these healthcare consumers expect
convenience and accessibility.
18-24 y/o want their doctor
to offer a smartphone app 70%
Healthcare consumers recognize this task as one
that is easily automated. Prescription refills
shouldn’t involve multiple steps from them, or
their providers.
Want to request refills of
medication electronically
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 9
Former state
• No frame of reference for selecting providers
• Limited care options
• Lack of price and care quality transparency
• Limited access to personal health information
• Lack of care coordination and communication
• Paper-based and unsystematic operations
resulting in patient dissatisfaction
Future state
• Competitive health care market
• Greater convenience and accessibility to care
• Better value for care
• Greater transparency for patient health information
• Better care outcomes
• Efficient clinical workflow and business processes
• Expansion of retail access—Walgreens/Pharmacy, etc.
Barriers
Lack of understanding
and awareness of
digital technology
Data sharing capabilities (i.e.,
data existing in a single and
seamless platform)
Lack of willingness
to share data among
providers
Cyber security
concerns
Shift in patient and
workforce
demographics
Evolving
regulations
Meeting the challenges of healthcare consumerism
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 10
• USA Telehealth initially driven by Government
regulation/incentive – Australian success will
depend on government engagement
• Adoption rates will increase over time – start
slow and build
• Age demographics are wide spread—not just
Millennials—technology must cater for older
demographics
• EHR roll out increases the use of TeleHealth –
single portal/engagement platforms make it
simpler for patients—avoid multiple platforms
for the same health system—Interoperability
is Key
• Acute/Sub-Acute/Primary/Remote Monitoring
platforms – are they the same? Will they offer
similar functions/features?
• Both Primary/Community care and Tertiary
Care need to be engaged and linked
• Its not just about Patient Portals – its
about Patients!!
Lessons for Australian Healthcare
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Unsustainable and Unclear
Financing Models
• As can be seen from the USA
experience funding is
critical to the adoption and
success. Today financing for
healthcare in Australia is
fragmented across
Geographic and national line
(CSIRO – future of health
report 2018)
• Who pays for Telehealth
initiative may determine
which platform(s) are used
Funding and Financing
Telehealth Market Summary: Oceania (Australia/New Zealand)
Total $M Revenues (2016) 74.8 Revenue % of Region (2016) 16%
Total $M Revenues (2022) 167.3 Services as a % of Rev 2016 61.4%
CAGR 2016-2022 14.4% Hardware as a % of Rev 2016 24.6%
Telehealth Development Medium/High Platforms as a % of Rev 2016 14.0%
Teleconsultations Remote Patient Management
Total Consults 2016 (K) 352.2 Total Lives Monitored 2016 (K) 15.3
Total Consults 2022 (K) 762.8 Total Lives Monitored 2022 (K) 35.9
CAGR 2016-2022 13.7% CAGR 2016-2022 15.2%
Share by Setting—2016 Key Market Dynamics
On-Demand/Direct Access 11.2% Widespread use of telehealth consultations in
Australia, paid for via Medicare. Use restricted to
certain locations outside of urban areas. Significant
number of telehealth projects rolled out in New
Zealand with most DHBs using telehealth for video
consultations, although limited rollout of services
directly to patient households.
Outpatient/Referral 36.5%
Tele-ICU 3.9%
Surgical/Medical Support 21.5%
Transition of Care 14.0%
Remote Patient Monitoring 12.9%
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 12
MyHR provides a beginning platform for
single Patient record.• Virtual Platforms must integrate to provide context
for review
— “Synchronous” – Realtime – Live communications
(Video, Phone, Text, emails)
— “Asynchronous” – Store and Forward (digital
capture of pt. Histories etc)
Whether a patient is at the hospital, a
clinic, or in a virtual visit, the access to
their information should be unified and
ubiquitous. • This avoids the use of TeleHealth without context –
provides “Meaningful Use”
• Fragmented and inflexible health systems pose a
real obstacle for platform activation/integration –
can MyHR assist in this??
• Is this the role of the Tertiary and Primary EMR?
MyHR and Telehealth
“Without context it is possible that TeleHealth could potentially lead to further
fragmentation of patient care.” Winston Liaw MD UHC
Each provider could have different platforms/system that suite their needs but
do not provide consistency of care
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 13
These MBS rebates are available for:
Patient-end clinical support provided by GPs or by practice nurses and registered Aboriginal health workers on behalf of a GP specialist-end services provided by a specialist with a Medicare provider number.
MBS rebates are available for patients:
Located in remote, regional and outer metropolitan areas who access care from Aboriginal medical services.
The RACGP is of the view that there should
be no geographical restrictions on current
MBS items for collaborative third party
telehealth services. These telehealth
services should be available for anyone
unable to access their GP in person and if
there are factors other than geographical
distance (such as patient mobility) that
affect access.
Medicare and Telehealth
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 14
“In General the provision of Telehealth may require a different skill set as well as a
different level of education and management not typically found within the
traditional setting. Where possible all consult documentation should be made
available to the patients usual general practitioners”. RACGP Position Statement – May 2017
All telehealth consults should meet with the recognized standards of care in Australia
RACGP Position
On-demand telehealth services should ideally be provided by a patient’s usual GP or practice and only provided when deemed appropriate by the GP
On-demand telehealth services should only be provided by doctors with an appropriate level of education and clinical competency
On-demand telehealth services should only be provided to unknown patients when appropriate Patient notes should always be sent to the patient’s usual GP or practice
GPs should ensure they are medico-legally protected, particularly when providing on-demand telehealth services to previously unknown patients
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 15
Patient portals integrated with EMR are becoming more available—standalone patient portals have yet to
prove successful in the Australian market
Opportunities
The adoption of portals amongst patients is increasing and is expected to continue growing at a fast pace.
The major opportunities in this market include:
• Need for greater functionality—Enhancement of existing features
• Simplification of technology—Mobile applications
• Increasing usage and adoption of patient portals in physician office:
— Adoption of patient portal in small (<100 beds) and mid-size (150-300 beds) hospitals
• Compliance—Satisfying Government regulations
• Interoperability by design needs to be entrenched in regulations to avoid multiple platforms having to
be accessed by a patient
The Rise of the Patient Portal
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 16
• Australia faces some significant challenges as we
move into a Digital Health age
(technology/financial/paradigm)
• Transformation is difficult but learning what works
and doesn’t work is a good start
• We need to look globally before we act locally—just
because it worked elsewhere does not means it
provides a pathway for Australia
• Maintenance of acceptable standards is mandatory
to ensure the quality of care being provided
• For Primary health the patients usual GP should
always be provided with post consult information—
this is key for continuity of care
• Avoid the fragmentation of care by ensuring
contextual reference is always available
• Primary and Tertiary Care need to be aligned on
TeleHealth initiatives to avoid patient confusion
and multiplication/duplication of systems
• Coordination and Interoperability is the Key
Summary
Lastly its all about the patient—not the technology, the
platform or even the providers—always keep the patient 1st
Copyright © 2019 Allscripts Healthcare Solutions, Inc. 17
Questions?
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