By George Tilley
Telehealth is integrating into the mainstream of healthcare delivery at an accelerating rate, as many telehealth ideas that were once just concepts are now showing signs of promise for their clinical effectiveness and cost-efficiency. Patients, care providers, payers, and governments are exploring its use as a supplement or replacement for more traditional healthcare services.
Our healthcare systems are being stressed to the breaking point as costs and demand continue to grow, being driven by our rapidly aging population. Many are looking for solutions. The push from the Center for Medicare/Medicaid Service (CMS) under the Affordable Healthcare Act and payers is to explore alternative approaches, particularly for lower cost options, such as those offered by telehealth. Whether it is an illness prevention measure, such as maternal health and employee wellness programs, or complex continuum of care initiatives, such as those focusing on chronic diseases and hospital readmissions, telehealth offers a solution.
Capitalizing on this trend, virtually every technology company is rushing to the market with devices to monitor glucose levels, blood pressure, medication adherence, weight, and other common issues. The potential is great, but it is not without concerns. Pilot projects to deploy them proliferate; however, few have mastered the intricacies of delivering healthcare services remotely to large populations. A comprehensive approach is required.
For many, the challenges have included:
- Lack of trained clinical personnel with the specialized skills set required to remotely monitor a patient’s biometrics and advise them accordingly
- Failure to provide a 24/7 response to alerts from these devices
- Lack of cost-effective systems capable of escalating responses to the patient from an automated message, to a health service representative, to a nurse, and to a physician
- Inability to deal with co-morbidities or to respond to patient concerns outside of regular support hours or separate from the condition being monitored by these devices
- Insufficient professional and management staff to oversee the operating systems and communications/information infrastructure and to be able to scale up the pilot projects into successful operations.
Some state-of-the-art medical call centers have long had the ingredients necessary to address some or all of these critical concerns. Partnerships between nurse advice line service providers and equipment suppliers are beginning to meet the need.
A key ingredient for a successful program is the clinical guidelines used for remote patient monitoring. Some use models seeking to extend care from institutions to home-based settings. Device manufacturers, likewise, use models that were adapted from those used for face-to-face encounters; however, they may not be well-suited. More appropriate are those specifically designed for telephone nurse triage, such as the Schmitt/Thompson protocols. If remote patient monitoring is to achieve its full potential, this clinical issue need to be addressed.
In another initiative, the Government of Canada, through its Atlantic Innovation Fund, is supporting a program to develop clinical protocols specifically for remote patient monitoring. InfoClin, with the assistance of experts from McMaster and Memorial Universities and other leading clinicians from the US and Canada, began developing clinical protocols for the remote management of congestive heart failure, diabetes, and chronic obstructive pulmonary disease last September.
In addition to these initial three diseases, work is underway with key stakeholders in the mental health field to identify service gaps and opportunities that can be remotely monitored and supported by health professionals. Also, a maternal health initiative provides new moms with regularly automated messages, nurse coaching, and monitoring during pregnancy and following delivery.
All of these clinical guidelines need to be embedded into decision support software in preparation for use by teams of health professionals throughout the world. With the rollout of these protocols targeted at remote patient monitoring, a new resource can be offered for clinicians. Such clinical protocols are the key components to a successful comprehensive telehealth system.
George Tilley is the business manager with Fonemed North America. He has thirty years of experience, primarily in an executive capacity in the Canadian healthcare system, which has given him a firsthand appreciation for the challenges of the healthcare system and the opportunities that telehealth offers.
[From the August/September 2012 issue of AnswerStat magazine]