Trends in Telehealth White Paper ImportantSana

8/17/2019 Trends in Telehealth White Paper ImportantSana

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NTT DATA Americas White Paper

NTT DATA www.nttdata.com/americas

© 2013 NTT DATA, Inc.2013_05-WHP-Telehealth

Making healthcare more collaborative, affordable, and effective.

Trends in Telehealth

Telehealth is changing the way healthcare is delivered and consumed. Itgives patients the tools to manage their health, extends services to ruralareas, and enables specialists to intervene in real time. But can itovercome the barriers to adoption?

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NTT DATA

NTT DATA Americas White Paper:Trends in Telehealth

© 2013 NTT DATA, Inc.2013_05-WHP-Telehealth

EXECUTIVE SUMMARY

Telehealth is a game changer for the healthcareindustry. The current healthcare system focuses onthe diagnosis and treatment of acute disease andon emergency care. Telehealth is patient centric andconcentrates on health rather than illness. It will playan important role as the industry moves away from afee-for-service model toward more outcome-focusedcare and reimbursement. More importantly, it bringshealthcare directly into patient homes and to patientswherever they may be.

The market for telehealth is being driven by signi canttrends in healthcare, population, technology,government, and consumerism. At the same time,outdated reimbursement policy, increased availabilityof healthcare, and a shortage of providers are erodingthe barriers to adoption.

Telehealth acts as a bridge for enhancing therelationship between patient and provider and forimproving patient satisfaction and behavioralchanges by weaving healthcare guidance andtreatment into daily life. Patient behavior and lifestylechoices have a profound impact on health andwellness since most healthcare is self-care. In fact,one of the major uses of telehealth is for theself-management of chronic disease. In addition,

telehealth increases access to care in remote ruralareas which do not have specialty treatmentfacilities. As a result, many industry experts believethat telehealth holds the key to optimizingpopulation health.

One of the most important bene ts of telehealth is inthe lowering of costs as measured by reductions inhospitalizations, readmissions, and length of stays.

Confdential

© 2013 NTT DATA, Inc.

The concepts and methodologies contained herein are proprietaryto NTT DATA. Duplication, reproduction or disclosure of informationin this document without the express written permission ofNTT DATA is prohibited.

About NTT DATA NTT DATA is your Innovation Partner anywhere around the world, with operations in more than 35 countries. NTT DATA Americas emphasizeslong-term commitment and combines global reach and local intimacy to provide premier professional services from consulting, applicationservices, business process and IT outsourcing to cloud-based solutions.

Visit www.nttdata.com/americas to learn how our consultants, projects, managed services, and outsourcing engagements deliver value for arange of businesses and government agencies.

The potential for nancial saving can best be seen inthe ongoing management of chronic disease. Theapproximately 100 million Americans with chronicdisease account for 75% of healthcare expenditures.Examples of the positive impact telehealth can havecan be in the results from the US Department of

Veterans Affairs (VA) and the United Kingdom’sDepartment of Health’s Whole SystemDemonstrator program.

Telehealth systems most frequently enable real-timecommunication between patients and care providers,such as via videoconferencing; the storing andforwarding of clinical data to offsite locations forevaluation by specialist teams; and remote monitoringof patients’ chronic conditions via sensors andmonitoring equipment. Telehealth technology isevolving into wearable and even implantable devicesthat detect information such as EKG readings.

Healthcare companies seeking to integrate telehealthsystems into their technology platforms should seek anexperienced IT services partner fully versed in legacyand latest technologies and an understanding of thechanging healthcare marketplace and regulatoryenvironment. Selecting a partner with internationalcapabilities and a global view of the marketplace is

essential for healthcare companies seeking to expandtheir telehealth solutions into foreign markets.

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NTT DATA © 2013 NTT DATA, Inc.2013_05-WHP-Telehealth


TABLE OF CONTENTS

Why Telehealth? ........................................................................................................................................................................................4

Telemedicine Versus Telehealth ................................................................................................................................................................4

Primary Usages of Telehealth ...................................................................................................................................................................5

Bene ts of Telehealth ................................................................................................................................................................................5

Telehealth Industry Driversand Opportunities .....................................................................................................................................................................................7

Case Study ................................................................................................................................................................................................7

Telehealth Industry Barriersand Threats ...............................................................................................................................................................................................9

How Telehealth Works .............................................................................................................................................................................10

Telehealth Solutions ................................................................................................................................................................................11

Case Study ..............................................................................................................................................................................................14

Conclusions and Recommendations .....................................................................................................................................................15

References ...............................................................................................................................................................................................16


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Why Telehealth?

The cost of healthcare represents approximately 18%of the US Gross Domestic Product (GDP), according tothe Council of Economic Advisors and this percentageis growing. Such a nancial trend is unsustainable.Industry experts and studies continue to point towardthe promise of telehealth as a means to reduce costs

and change patient behavior to optimize populationhealth. Signi cant trends in healthcare, population,technology, government, and consumerism are drivinghealthcare providers and government agencies to adopttelehealth technology in order to improve patient care,lower costs, and reduce readmissions. More importantly,major health plans, the federal government, nationalpharmacy chains, large behavioral health systems, andvery large employer groups are beginning to leveragetelehealth to advance their strategic goals.

Telemedicine Versus Telehealth

Telemedicine and telehealthare terms that describe theexchange of medical information from one site toanother using electronic communications. The use ofboth terms has proliferated as the healthcare industryand governmental agencies seek to leveragetelecommunication technology as a means to transformthe delivery of healthcare services. According to the

American Telemedicine Association, telehealth is “the

use of medical information exchanged from one siteto another via electronic communications to improvepatients’ health status.” In short, telemedicine acts as anelectronic bridge to connect the patient and physician ata distance to provide ubiquitous access to critical care.

“Telehealth has many parallels to distancelearning in the higher education world. Thesolution is less about technology and more aboutchanging the value perception of the peopleassociated with telehealth. These include: patientadvocacy groups, medical societies, and payerorganizations that hold the purse strings toreimburse for more telehealth-related activities.Many proponents hope the proposed federalTelehealth Promotion Act, introduced in the Houseat the end of 2012, will be reintroduced and passthis year. Among other things, the proposedlegislation would create incentives to usetelemedicine to prevent hospital readmissions andwould make telemedicine a covered bene t underall federal insurance programs, including Medicareand Medicaid. Once the US government jumps onthe bandwagon, we will see a wave of telehealthacceptance much like the online degree programsat major universities throughout the world.”

Bill Boucher Vice President, Healthcare and Life Sciences,

NTT DATA, Inc.

The cost of healthcare represents approximately18% of the US Gross Domestic Product (GDP).Industry experts continue to point toward thepromise of telehealth as a means to reduce costs.


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Telehealth is an expansion of telemedicine whichencompasses preventative, promotive, and curativecharacteristics. Telehealth includes not only actualphysician-patient interactions, but education andinformation services designed to increase awarenessof diagnoses and medical conditions, treatments, andgood health practices. Telehealth supports the entirehealthcare continuum with the goal of increasing theoverall wellness of the patient. Telehealth uses video

conferencing, transmission of still images, remotemonitoring of vital signs, specialist consultations,preventive care, continuing physician and nursingmedical education, and the integration ofadministrative services.

Primary Usages of Telehealth

By bringing healthcare services to patients, whether athome or in a healthcare facility, telehealth is becoming atransformational tool for the delivery of services. As aresult, the healthcare industry is beginning to embracethe use of telehealth as part of its standard toolkit.Current telehealth industry usage can be categorizedinto four major classi cations of healthcare services:Patient care, medical education and mentoring,consumer and medical/health information, and remotepatient monitoring.

» Patient care: includes the sharing of audio, video,and medical data between the patient andhealthcare professional to develop a diagnosis,treatment plan, prescription, or advice. It alsoincorporates specialist referral services in which apatient sees a specialist via a live, remote consultor by the transmission of diagnostic images to aspecialist for later viewing.

» Medical education and mentoring: comprises awide range of continuing education services forhealthcare professionals and seminars for targetedgroups on special topics or procedures.

» Consumer medical and health information:involves the use of the Internet to provideconsumers with specialized health informationand/or peer-to-peer support groups.

» Remote patient monitoring: uses devices toremotely collect and transmit data to a monitoringstation of some type. For example, sensors areused to capture vital signs such as blood pressure,glucose levels, electrocardiogram data, or weight,which are then transmitted .

Bene ts of Telehealth

The current healthcare system focuses on the diagnosisand treatment of acute disease and on emergency care.Telehealth is patient centric. It focuses on health ratherthan illness. Telehealth will play an important role as theindustry seeks to improve quality by moving away froma fee-for-service model toward more outcome-focusedcare and reimbursement. Moreover, telehealth affords ameans for the industry to cope with forecasted increasesin healthcare demand and for offering care to remoteand rural areas. Most importantly, telehealth may holdthe key to the optimization of population health as aresult of its potential to change human behavior.

Telehealth will play an important role as theindustry seeks to improve quality by movingaway from a fee-for-service model toward moreoutcome-focused care and reimbursement.


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Changing Patient Behavior

Patient behavior and lifestyle choices have a profoundimpact on health and wellness since most healthcare isself-care. In fact, many experts believe that the patientis the biggest untapped resource in healthcare. Patientsneed to change their behavior and not simply receivevital information. Telehealth transports treatment directlyinto a patient’s home and into daily living. The

technology also allows providers and care managersto understand more fully the challenges patients faceby being able to observe a 24-hour cycle of time. Forexample, by leveraging telehealth, physicians will not

just be able to tell their patients to lose weight duringinfrequent visits, but instead monitor their progress andprovide ongoing feedback and encouragement. Suchreal or near-time observation and more frequentinteractions with patients without bringing them intoa hospital or specialty center will also enable elderlypatients to better manage their health situationswhile remaining at home.

Improving Patient Satisfaction

Telehealth represents an ef cient and cost-effectivemeans for the industry to improve rates of patientsatisfaction and for making healthcare morecollaborative. Satisfaction is directly correlated to thetime and attention that a healthcare professional canspend with a patient and to the strength of the patientand provider relationship. Both of these elements ofsatisfaction have been signi cantly eroded given therealities of current reimbursement rates and the resultingneed to see a different patient every 15 minutes.Technology can act as a bridge for enhancing therelationship between patient and provider by extending

the geographic reach and frequency of interactionsbetween both parties. Telehealth improves access tocare and supports timely treatment of emergencysituations in remote rural areas which do not havespecialty treatment facilities. Telehealth makes realtime second opinion or consultation with a medicalspecialist a reality. Of great signi cance is the factthat studies substantiate that patients with accessto telehealth have a higher opinion of the quality of

care in their community.

Lowering the Cost of Chronic Disease

One of the most essential advantages of telehealthis in lowering costs as measured by reducinghospitalizations, readmissions, and length of stays.The potential for nancial savings can best be seen inthe ongoing management of chronic disease. Thelargest cost-driver in healthcare today is chronic diseasesuch as hypertension, congestive heart failure, diabetes,and end stage renal dialysis, all of which are frequently

associated with the aging population in the UnitedStates. Remote monitoring enhances patientengagement and improves the self-management ofchronic disease. It also leads to better adherence tomedication and treatment protocols. Research and the

ndings of major long-term studies substantiate thecost bene t of telehealth and remote patient monitoring.

The largest cost-driver in healthcare today ischronic disease…. Remote monitoringenhances patient engagement and improvesthe self-management of chronic disease.


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One example is the US Department of Veterans Affairs(VA), a recognized pioneer in telehealth, which servedover 485,000 patients and completed approximately1.4 million telehealth consultations in 2012. The VAreported outcomes that included 53% fewer bed days,30% fewer hospital admissions, and savings of about$2,000 per patient on an annual basis in its hometelehealth program. At the same time, the agencyreported a mean score of 86% in patient satisfaction.

Telehealth Industry Driversand Opportunities

Major factors driving the healthcare industry towardthe adoption of telehealth include the need to expandaccess to healthcare services, positively impact thebehavior and self-care of an aging population, bettermanage costly chronic illnesses, and improve qualityand lower costs. The proliferation of smartphones andbroadband services combined with the availability ofwireless monitoring devices is further acceleratingits implementation.

An Increasing and Aging Population

The US population is increasing and is estimated togrow at a rate of 20% to 363 million people betweenthe years 2008 and 2030. Signi cantly, the population

The VA reported outcomes that included 53%fewer bed days, 30% fewer hospital admissions,and savings of about $2,000 per patient on anannual basis in its home telehealth program.

A US provider of healthcare services and leader in thehomecare market wanted to provide caregivers with amechanism that would enable them to more effectivelyplan for the care of a loved one by alerting caregivers whentheir loved one had a medical event. The phase 2 releasewill provide customers with the ability to coordinate thescheduling and calendaring of caregiver tasks.

The initial challenge was to develop a state-of-the-artmobile application that would provide user registration,user authentication, and automated subscriberevent noti cations.

As a company focused on providing innovative people-centric healthcare solutions, it was essential that

Case StudyWireless Health Monitoring System Provides a Competitive Advantage to Leading Provider of Healthcare Services

the application deliver a holistic, easy-to-use solution sothat caregivers could get the information needed andsubscribers could easily self-register using a mobilephone and without the need for a PC.

To accomplish this objective, the company retainedNTT DATA, which has signi cant experience in bothhealthcare and technology, to develop the new application.NTT DATA provided guidance and options around nativecode, a multi-platform solution and browser basedalternatives. A native coding 1 approach for functionalityand cost reasons was selected and the Apple IOS platformand the iPhone device were chosen as the platform forthe rst release.


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is aging. People 65 and over represented 12.4% of thepopulation in the year 2000, but are expected to growto be 19% of the population by 2030. This agingpopulation has increasing incidence of chronicdiseases including congestive heart failure (CHF),chronic obstructive pulmonary disease (COPD),diabetes and hypertension, and end stage renaldialysis. Treating these chronic diseases is acceleratingthe cost of care for chronic conditions. In fact,approximately 100 million Americans with chronic

disease account for a whopping 75% of healthcareexpenditures (Centers for Disease Control andPrevention). As life expectancy increases, so do thenumber of Americans with chronic disease, thus furtherescalating expenditures.

Fewer Physicians

The question is who will treat this growing pool ofelderly patients? According to the Association of

American Medical Colleges, a physician shortage inthe US was anticipated even prior to the AffordableCare Act being passed in 2010. Now this same groupestimates that there will be a shortfall of 63,000 doctorsby 2015 and 130,600 physicians by 2025. The scarcityis a result of several factors. First, a large number ofmedical professionals are reaching retirement age.Second, there are fewer healthcare professionalsbeing educated, trained, and licensed. This in turnwill intensify the continuing issue of a lack ofspecialists and healthcare facilities in rural areas.

The decision also delivered additional value to the client inproviding guidance as to how to ef ciently move a newapplication to the Apple Store.

NTT DATA engaged a multi-disciplinary team including aUser Experience Designer, a Mobile Solutions Architect,IOS Developers, and Java Developers to deliver thisapplication according to the pre-determined businessrequirements. NTT DATA employed a global onsite/offshoredelivery model to keep delivery of the application as

cost-effective as possible. As a result, NTT DATA created a holistic, easy-to-usesolution that provided this healthcare client with acompetitive advantage in their homecare market byleveraging leading-edge mobile and remotemonitoring technology.

NTT DATA helped this healthcare company to continueto progress its mission of nding innovative solutions toimprove patient outcomes while lowering healthcaresystem costs, by: » Introducing a leading-edge remote monitoring

technology that leverages mobile technologies andcommunications protocols

» Enhancing customer satisfaction through a user-friendly navigation and industry-leading concepts

» Meeting the needs of the client’s user base with aneasy-to-install, easy-to-use telehealth application

» Creating an interface with an existing user applicationthat validates users and provides application security

» Providing customers with wide-spread and easyaccess to the mobile application via the Apple Store

1 Native Coding, also referred to as native language is programming code that is written to run on a speci c processor usingthat processor’s instruction set.


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Outcome-based Reimbursement

Millions of additional Americans will qualify for Medicaidor federal subsidies to buy healthcare under the

Affordable Care Act (ACA). Under the ACA the agencywill begin docking Medicare payments to centers withhigh incidence of 30-day readmission and patients whocontact pneumonia in that same 30-day period. The actwill also result in an increasing focus on quality and

outcome-based reimbursement as opposed to thetraditional fee-for-service system. In fact, by the year2014, hospitals with high rates of readmissions couldforfeit up to 3% of their regular reimbursement asa penalty.

Ubiquity of Mobile Technology

Smartphones and mobile wireless devices are now aubiquitous element of everyday life in the United States.eMarketer, a service which closely follows the digitalmarketing, media, and commerce industries, estimatesthe number of US consumers with smartphones willmore than double from 93.1 million at the end of 2011 to192.4 million by 2016. In addition to this, the availabilityof wearable monitoring devices is increasing rapidly.

According to Juniper Research, the market for wearabledevices is expected to grow to $1.5B in 2014 and $6B in2016, up from just $800 million in 2012.

Consumers also indicate that they want telehealth. According to an Anthem market study, 74% of USconsumers indicated that they would use telehealthservices. This number is expected to increase as

boomers continue to retire and more millennialsbecome healthcare consumers.

Telehealth Industry Barriersand Threats

The healthcare industry is historically a late adopter oftechnology and this has proven to be a barrier to all newsolutions that rely on technology. A recent illustration ofthis is the acceptance of cloud technology, which theindustry has been slow to embrace. Technology thatrepresents the foundational underpinnings of teleheatlhsuch as mobility, social media, and gami cation (turninginformation into a game or contest to motivate and helpchange behavior) represent leading-edge and rapidlyevolving domains, and few healthcare organizationshave hands-on experience leveraging them. Additionally,a lack of telehealth standards hinders the interoperabilityof medical devices, such as videoconferencing andother systems.

Legality, Privacy, and Security Concerns

The healthcare industry’s reluctance to embracetechnology is not only due to a lack of organizationalagility, but also as a result of regulatory apprehensionsand the potential for legal liabilities. Hospitals andhealth centers are fearful that they will be held legallyresponsible for the treatment of patients at remote sites.

Add to this industry privacy and security concerns,which have only multiplied given the recent changesin Health Insurance Portability and Accountability Act(HIPAA). These modi cations enlarged the scope ofHIPAA coverage to include telehealth companies,

increased the maximum penalty for negligence,strengthened data breach noti cation requirements,and provided new requirements on how patientinformation can be used for fundraising and marketing.


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Limited Reimbursement

Reimbursement is another major barrier to theimplementation of telehealth. Approximately 90 millionpeople in US are currently enrolled in managed caresystems which have not yet incorporated telehealth asa signi cant means to control costs. Under the currentfee-for-service system, Medicare does not offer muchreimbursement for telehealth. In fact, the Medicare,

Medicaid, and SCHIP Bene ts Improvement andProtection Act of 2000 put constraints on thereimbursement of telehealth in Medicare. The Centerfor Telehealth and e-health Law estimates that theCenters for Medicare & Medicaid Services (CMS)reimbursed approximately $5.2 million in 2011 fortelehealth out of an estimated $558 billion in Medicareexpenditures for the year 2011.

How Telehealth Works

Telehealth improves clinical outcomes and reducesacute care hospitalizations because its process andcore technologies enable careful, 24-hour monitoring ofpatients by healthcare professionals from a remote point.Telehealth can be delivered through a variety of mediumsincluding telephone, video conferencing, fax, emails, andcomputers for data/imaging, virtual reality, andtele-robotics. However, telehealth systems can beclassi ed into three major types:

» Store and Forward, where clinical information

is captured and forwarded to another sitefor assessment

» Real-time, such as when a patient and providercommunicate live via videoconferencing

» Remote Patient Monitoring, where a patient’sphysiological data is fed through sensors to anexternal system for monitoring

From a process perspective, telehealth services beginwith a physician’s prescription. The patient is referred toa home health agency, which then installs the necessaryequipment and trains the patients in its use. Followingthe process, the patient takes their own vital signs and

answers personalized questions on a survey. Results areautomatically transferred to a website or third party. Theagency monitors the patient’s daily metrics and alertsthe patient and the care team when results fall outside ofpre-de ned boundaries.

From the technical standpoint, the basic telehealthprocess is also fairly straight forward. Sensors capturedesired physiological data and transmit it on either awired or wireless network. This data is then stored andanalyzed so it can become information meaningful tohealthcare professionals. A user interface then provides

the healthcare team with this information, which in turnsupports faster and more accurate patient diagnosis anddecision making.

Pulse oximeter data can be captured and stored and thentransmitted to specialists for evaluation.


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Telehealth Solutions

The primary uses of telehealth encompass critical care,education, and administration. In other words, patientassessments, diagnosis, consultation, and supervision;ongoing healthcare related education of healthcareprofessionals, communities, and individuals, and forpurposes such as conferences, preparations, utilization

and quality studies, etc. Examples of major telehealthapplications include the following:

Observation of Daily Living (ODL) Applications

Much can be learned about a patient’s health andwell-being by observing daily routines. Such informationif tracked through an application and stored, canbecome a Personal Health Record (PHR) that is fardifferent from traditional clinical or other kinds of healthrecords. ODL data can take the form of measures ofsleep, medication adherence, levels of physical activity,

and weight. Many groundbreaking applications in thisarea have been developed by teams at Project HealthDesign, part of the Robert Wood Johnson Foundation’sPioneer Portfolio.

One such example is the BreathEasy team, whichhas designed a mobile application for treatment andself-monitoring for patients with asthma. Patients usethe system on their smartphones to capture and reportobservations of daily living such as use of control andrescue medications, symptom levels, quality of life,and smoking. Using a dashboard with analysis and

visualization tools on the Internet, healthcareprofessionals then view the patients’ data andhealth status and can recommend treatment changesas required.

Store and Forward Applications

In this type of system, digital images, video, audio,observations of daily living and clinical data are capturedand stored on the client’s computer or mobile deviceand then transmitted securely in a batch to anotherlocation where they are studied by relevant specialists.Dermatology and pathology are two specialties that donot require the use of real-time technology and where

an immediate response is not required. Monitoring andtrending of basic vital signs for long-term chronic care,such as monitoring blood pressure, cardiac events,hemoglobin saturation, weight, and sleep patterns, istypical for this type of application.

One UK study looked at the remote monitoringof 3,030 patients with chronic conditions.Results included:

» 45% reduction in mortality rates

» 20% reduction in emergency admissions


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One example of such an application is the LatitudePatient Management System by Boston Scienti c,which can monitor implanted Boston Scienti c ICD orCRT-D devices from a patient’s home. The systemuses a communicator that can sit bedside to monitor thecardiac device and then transmits information through aregular landline phone at a time previously arranged bythe patient’s physician. This information is collected ona secure website that only a patient’s healthcare support

team can view. If needed the system can also monitorheart failure and includes: a blood pressure monitor,weight scale, device diagnostics, and a symptomself-report survey.

Real-time Applications

This category of system allows for instantaneousinteractions between both the onsite and remote party.Consequently, a telecommunications link to enabledirect two-way audio and video communicationsis required. This usually takes the form of video

conferencing or video and audio streaming over theInternet. Typical uses for real-time telehealth systemsinclude: telehomecare, telenursing, telemental health,telecardiology, and teleneurology. Real-time applicationsare often used for specialist consultations ortelemental health.

For example, for a patient experiencing a stroke with thenearest hospital or neurologist hours away, access tospecialty care and treatment such as intravenous tissueplasminogen activator, a clot dissolving medication, is

critical. Several trials of such systems have proveneffective at saving lives and preventing long-termdisability from stroke. One such study, funded by the

Arizona Department of Health Services, is currentlybeing conducted by Mayo Clinic neurologists in Phoenixwho can remotely consult with emergency departmentsat 12 rural hospitals, mostly in Arizona, that have xedtelemedicine platforms or robots (U.S. National Institutesof Health 2012).

Remote Patient Monitoring Application

In a Remote Monitoring system, the patient has acentral system that feeds information from sensors andmonitoring equipment to an external monitoring centerso that doctors or healthcare professionals can checka patient remotely. This type of application is primarilyused to monitor chronic conditions such heart disease,diabetes, or asthma. These services can delivercomparable results to in-person appointments and haveproven to provide major levels of patient satisfaction.

One use for a remote monitoring application solutionis for home dialysis patients. Such a system enablespatients to receive dialysis on their own schedule athome rather than in a center, leaving more time forfamily, work, or other activities. The treatment can evenbe done while a patient sleeps, all while vital signs arebeing safely monitored by their healthcare team. Inaddition, more recent home dialysis machines aresmaller and more portable, making travel a moreconvenient possibility.

Another example of remote patient monitoring at workis the United Kingdom’s Department of Health’s WholeSystem Demonstrator program, which was launched in2008. This study represents the largest randomizedcontrol trial of telehealth involving 6,191 patients and

Telehealth applications of the future may includea Bluetooth-enabled application to monitor vitalsigns of drivers and passengers.


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238 general practices and included 3,030 patients withone of three conditions: diabetes, chronic health failure,and COPD (British Medical Journal 2012).

The conclusive results of this study to dateare persuasive:

»

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

Wearable Devices and the Future

Even though it may at rst sound like science ction,future wearable devices will move telehealth from thehome to onto and even in a patient’s body. Thesedevices were rst developed on the consumer side ofthe market and used for tness monitoring and feedbackamong sports enthusiasts. This market is continuingto gain momentum with products such as Body Bugg,FitBit, Lose it, RunKeeper, and Nike Fuel. However, somesoon-to-be-released products currently at thebleeding-edge of telehealth technology are alreadymoving from the laboratory to the market. Some ofthis development is being encouraged by the FederalCommunication Commission (FCC), which recentlyallowed for more intensive use of a spectrum for theuse of Medical Body Area Network (MBAN) devices.These are miniaturized body-worn sensors that collectpatient-speci c information including EKG readingsand respiratory function.

One example of such technology is a wearable device,called First Warning System, which is designed to beworn for 12-24 hours to detect breast cancer. The devicewill enable doctors to see changes in cellular structureover a period of time instead of within a staticmammogram. Another instance of this type of wearable

hardware can be found at the University of Californiain Los Angeles (UCLA). Researchers at UCLA havedeveloped a Smart Insole that contains a sensor whichcan analyze the gait of patients. Other researchers atOregon State University have invented a bandage-sizedsystem-on-a-chip that is powered by ambient radiofrequency waves from cell phones and other RF devices.In addition, Ford is now collaborating with Microsoft,Healthrageous, and BlueMetal Architects to developa Bluetooth-enabled In-Car Health and Wellnessapplication to monitor vital signs of drivers

and passengers.Scientists at Stanford University have alreadydemonstrated a device that is small enough to literallyswim through veins, and the US Food and Drug

Administration recently approved a tiny digestiblemicrochip that can be added to pills to allow providersto monitor if patients are following their medicationprotocols. On March 14, 2013 Samsung introduced thelatest model of their smartphone, the Galaxy S4. Thissmartphone includes health sensors that are integratedwith a built-in app called S-Health, which can track

steps, food intake, and even sleep with an addedaccessory. Other options which will be availableinclude a wristband, scale and heart rate monitor.This is the rst smartphone to incorporate bothhealth sensors and applications and is a harbingerof things to come.


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The US Department of Veterans Affairs (VA) was anearly adopter of telehealth services and is one of itslargest and most successful user organizations. In 2012

the VA provided care from 150 Medical Centers and750 Community Based Outpatient Clinics to 485,163patients via 1,380,431 telehealth consultations.

Approximately one-third of these patients reside in ruralareas and have limited access to healthcare withouttelehealth services. The VA’s telehealth services aregrowing at an annual rate of 70%.

Telehealth services at the VA support both patientsand caregivers and enables patients to receive careat home or within their local community. It isaccessible on a variety of platform and devices andsupports greater patient self-management. In fact,the VA permitted 41,483 patients to live independently

in their own homes rather than within an institutionalcare environment.

The VA’s telehealth services can be divided into threemajor categories: Clinical Video, Store and Forward,and Home. Clinical video supported 145,192 patients in2012 using 44 specialties by leveraging real-time videotechnology to link hospitals and clinics. This is doneusing 6,600 video conferencing units connecting viadirect dial Internet protocol. The Store and Forward

telehealth services from the VA services 255,729patients in 2012 by enabling the viewing and analysisof clinical images at sites located close to patients.

This area is focused primarily on tele-retinal imaging,teledermatology, and telepathology. The Homesegment optimized care for 116,729 patients in 2012while remaining in their own homes. Its focus is chroniccare and acute care management and health promotionand wellness.

The VA has documented substantial and impressivebene ts to both patients and the agency by usingtelehealth services. The VA reported outcomes thatincluded 53% fewer bed days, 30% fewer hospitaladmissions, and savings of about $2,000 per patienton an annual basis in its home telehealth program.

At the same time, the agency reported a mean score

of 86% in patient satisfaction.Telehealth is a signi cantly different means than whatthe VA previously used to provide patient care to itsconstituents and it has been transformational for theagency. In 2012 8.9% of Veterans received portions oftheir care from telehealth services. In short, telehealthhas helped the VA to provide the right care, in the rightplace, and at the right time.

Case StudyThe US Department of Veteran Affairs (VA) Improves Patient Care and Reduces Costs by LeveragingTelehealth Services


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Conclusions and Recommendations

Telehealth technologies are beginning to mature andpieces of the telehealth puzzle are coming together.However, companies must build a telehealth system thatcan t within their existing technology platform today, aswell as support their technology roadmap and thatof their customers’ tomorrow. To minimize the risks of

leveraging emerging telehealth technology, it isrecommended that companies look for an experiencedpartner with an understanding of the changinghealthcare environment from the provider, payer, andlife science perspectives.

An effective partner should also be fully versed inthe both legacy and the latest technologies such asmobility applications, user experience design concepts,using HL7.

Moreover, it is essential for healthcare companiesseeking to introduce their telehealth solutions intoforeign markets to choose an IT services partnerwith international capabilities and a global view ofthe marketplace.

Telehealth is a transformational tool for the delivery ofservices and the industry is beginning to embrace theuse of telehealth. Now is the time for leading players in

the healthcare industry to move down the learningcurve and begin to leverage telehealth to advancetheir strategic goals and stake out a position in thisimportant new market.


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American Telemedicine Association. May 2, 2013. www.americantelemed.org.

Boston Scienti c. Cardiac Rhythm Center. January 2, 2013. www.bostonscienti c.com.

Centers for Disease Control and Prevention. “Rising Health Care Costs Are Unsustainable.” Centers for Disease Controland Prevention, Division of Population Health. Washington, DC, 2011.

Center for Telehealth and e-Health Law. 2013. www.ctel.org.

Council of Economic Advisors. The Economic Case for Healthcare Reform. Presidential Report, Executive Of ce of thePresident. Washington, DC, 2009.

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References

Trends in Telehealth White Paper ImportantSana

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