Tag Archives: telehealth articles

Impact of Telehealth and Remote Patient Monitoring



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]

The Intersection of Healthcare and IP Contact Center Technology



By Steve Kowarsky

The delivery of health-related services and information via telecommunications technologies is sometimes known as telehealth or telemedicine. Interest in this trend is fueled by the growing emphasis on improving healthcare systems globally. Telehealth encompasses much more than home monitoring systems and video conferences with doctors. In some telehealth patient monitoring studies where patients used only a telephone to report their health status, the results were better than those in studies that relied on remote devices.

Such findings underscore a growing trend in healthcare applications enabled or greatly enhanced by the use of an IP contact center platform. IP contact center technology can be a critical tool for providing patients with unprecedented and cost-effective access to superior healthcare services.

The following are just a few of examples of this rapidly evolving family of applications.

Health Coaching: Health coaching is one application that can be streamlined with an IP contact center platform. In health coaching applications, professional health coaches work with individuals to increase adherence to regimens associated with disease management, dietary plans, or exercise programs. According to the Wellness Council of America, one dollar invested in health coaching yields three dollars in savings. This statement is supported by the market experiences of many large providers who have already turned to health coaching to reduce costs and improve the health of their clients.

With an IP contact center-based health coaching application, the productivity of coaches is optimized in two ways. First, the platform can automatically dial participants in the program and only connect calls to coaches when a participant answers the phone. Predictive dialers eliminate the need for coaches to waste valuable time repeatedly dialing numbers that are busy, are not answered, or are picked up by an answering machine or voicemail.

Second, for both inbound and outbound calls, scripts guiding the conversations with clients can be automatically and instantly tailored to the individual participant based on data stored in other back-end applications, such as EHR (Electronic Health Record) or CRM (Customer Relationship Management) system. In this way, any coach can deliver the same high level of service.

An IP contact center platform can also benefit coaching applications by its ability to make staffing geographically transparent. Coaches can be located anywhere: in a centralized contact center, across multiple centers, at home, or even in different healthcare facilities. In sum, the right IP contact center platform can enable the health coaching provider to boost the productivity of coaches, improve their job satisfaction by eliminating routine tasks, improve their return on investment, and, most importantly, ensure the best possible service levels for clients in the program.

While these benefits are certainly significant, perhaps even more impressive are the potential impacts of an IP contact center on device-free remote patient monitoring.

Remote Patient Monitoring: Conventional remote patient monitoring (RPM) relies on a wide variety of devices that either automatically upload data telemetrically or that require a patient to call in and report on read-outs from a device. The benefits of RPM are significant. In a 2009 report, the New England Healthcare Institute projected savings of $6.4 billion annually in the United States if RPM were used for the management of congestive heart failure. Somewhat ironically, the report also indicated that RPM devices themselves are one barrier to achieving these savings.

Fortunately, a new approach called device-free RPM that does not rely on any patient devices, except for a telephone, is now being explored. Most notably, a study was sponsored by the Iowa Medicaid Enterprise, as well as a number of other healthcare entities in that state. The study involved 187 chronic heart failure patients who were asked to respond to an automated, telephone-based questionnaire each day. If a patient did not call by a certain hour, the system initiated a call to the patient. A care coordinator monitored responses via exception reporting and personally followed up, if necessary. Hospital admissions were then compared for this group in the 12-month study period to the 12 prior months. Results were nothing short of profound: heart failure admits were down 89.8 percent during the study and all cause admits were down 60 percent.

With results like these, device-free RPM may well become the key application to underscore the enormous opportunities possible with IP contact center-based healthcare. The contact center is the ideal infrastructure for supporting the interactive voice response (IVR) system required to administer the questionnaires, route the responses to the appropriate caregiver based on responses, and initiate outbound calls by care coordinators when specified conditions are met.

At the Intersection: Health coaching and device-free RPM only represent the tip of the iceberg for the endless possibilities at the intersection of IP contact center technology and the healthcare industry. With an IP contact center platform, many types of healthcare applications can be delivered over any electronic media channel by live healthcare representatives and/or automated contact systems. Employees and systems can be distributed across a region or across the globe, linked together virtually over the IP network.

IP contact center technology enables intelligent queuing and routing of inbound and outbound telephone calls, Web chats, and emails, while also supporting full interoperability of healthcare applications with EHR, CRM, scheduling, billing, and other business applications. With the right multi-tenant technology, healthcare providers can create and support any number of virtual contact centers of any size on a single platform with unified transaction recording, reporting, and administration.

Any kind of reactive or proactive patient-provider interaction can be supported over any type of communications channel. At the same time, such technology enables each healthcare application, location, or entity to maintain complete autonomy and to implement the full security required by health information privacy regulations.

Healthcare providers are increasingly discovering that IP contact center technology can be a critical tool for providing patients with cost-effective access to superior healthcare services and a better overall patient experience. This, the intersection of healthcare and IP contact center, is improving the cost, quality, and availability of care.

Steve Kowarsky, executive vice president of CosmoCom, is one of the architects of the company’s growing presence in the healthcare industry. CosmoCom’s unified, all-IP contact center suite enables businesses to quickly, easily, and economically fulfill the most complex customer interaction management requirements of today and tomorrow.

[From the October/November 2009 issue of AnswerStat magazine]

Using IVR to Improve Post-Discharge Patient Care



By Gary Hannah

Recent studies have shown that twenty percent of patients experienced adverse events following hospital discharge. Most commonly, these events are related to adverse drug effects, therapeutic errors, and nosocomial infections, those that are a result of treatment in hospital and secondary to the initial condition. One third of these events led to at least temporary disability, and three percent led to death. Other recent studies have estimated that between 44,000 to 98,000 deaths per year in the United States were related to hospital-related errors, many of which were preventable. In an era where regulations are holding healthcare facilities liable if these events are not adequately mitigated, hospitals are wondering how they can conduct effective post-discharge follow-up with patients when budgets and human resources are already stretched thin.

The good news is that one-third of these events can be prevented with proper post-discharge patient follow-up, and speech technology solutions can assist hospitals in providing consistent quality of care and patient assessment.

Best practices show that follow-up is important and if it is done often, it is the hospital nursing staff that is tasked with the responsibility of following up by telephone with patients who have been discharged. It can take as many as five calls to reach a patient, meaning nurses are spending inordinate amounts of unproductive time. This makes an already costly endeavor even more expensive and adds even more to a nurse’s already overloaded workday. Manual collection of data is not only time consuming, but it also often results in inaccurate data stored in disparate systems. This ineffective system relies on the independent analysis of data to recognize trends and determine the need for and specifics of any required medical intervention.

However, the fact remains that the proper follow-up process is imperative to ensuring top-quality patient care. What alternative is there to having RNs making these calls, and how can hospitals ensure that their nursing staff’s time is put to best use?

An interactive voice response (IVR) system, previously only associated with telemarketing or customer-service automated systems, can automate the post-discharge patient follow-up by using customized rules and call scripts to gather important data from the patient, ensuring that scarce nursing resources are used only where personal follow-up is required. Natural voice recognition speech technology has advanced to the point where the systems can determine with great accuracy the confidence levels of responses based on various terms and the positive or negative connotations of the particular words. Business rules can determine the course of action for the call, whether the patient is transferred to a live attendant at a medical call center, a notification is sent to a nursing station and pertinent callbacks can be conducted by a medical professional, or data is merely collected for statistical trends and patient satisfaction analysis.

A recent study showed that the incorporation of an IVR reduced nurse workload by eighty-eight percent and enabled nurses to focus their follow-up efforts on just those patients who truly required their attention. Surprisingly, the same study showed high patient acceptance rates for the new system, with two-thirds of patients expressing a preference for the automated system. With the automated system, patients felt that they could be more honest as there was no immediate judgment or bias associated with their responses.

An IVR can fit seamlessly into any health facility’s IT and phone systems, providing details on patient calls to help mitigate adverse events, as well as reduce liability. One-quarter of post-discharge emergency department visits, re-admissions, and deaths are due to adverse events. If these secondary care requirements are reduced, hospitals will enjoy tremendous cost savings and be able to allocate resources only to those in need.

In addition to post-discharge patient monitoring, the IVR can assist in a wide range of healthcare situations. Patients and nurses alike can respond to telephone surveys to indicate satisfaction levels, an important performance indicator for healthcare facility executives and an integral business variable in pay-for-performance situations. In pandemic scenarios, large groups can be monitored and statistics gathered to help predict outbreak models and treatment strategies. Ongoing monitoring of patients with chronic conditions like diabetes, reminder systems for elderly patients to take the proper amount of medication at the proper time, and outpatient monitoring for addiction management programs and rehabilitation can all be conducted using an IVR.

When choosing a solution, ensure that the IT footprint is minimal, that the vendor offers technical support, and that adherence to all privacy and compliance regulations relevant to the facility and healthcare jurisdiction are strictly enforced. Depending on the needs of the facility, the infrastructure setup, and IT resources, a hosted solution might be a better fit. A range of options exist with a range of prices and a healthy, due diligence process will help to find the right solution for every environment and telephone triage model.

As healthcare facilities move to an electronic health model, adopting technology solutions for everything from the identification of patients to point-of-care bedside diagnostic tools, the institution of an IVR to conduct patient follow-up makes good sense from both cost and patient-care perspectives. IVR does not replace the need for medical professionals and medical call centers; however, IVR improves processes and enables the most effective use of hospital and personnel resources.

Gary Hannah is the founder, CEO, and president of Vocantas Inc., a developer of advanced speech technology solutions that recently launched its CallAssure product line, an interactive voice response system optimized for the healthcare environment. The company also has products for the utilities, emergency preparedness, and customer service markets. For more information, visit www.vocantas.com.

[From the August/September 2008 issue of AnswerStat magazine]

The Medical Call Centers’ Role in Telemedicine



By Peter Lyle DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStat

AnswerStat magazine was present at the recent American Telemedicine Association (ATA) 2008 Annual Meeting. The event was held April 6-8 in Seattle Washington. Over 2,200 attendees were treated to a plethora of educational and informative presentations, as well as a packed trade show with more than 160 telemedicine vendors.

In addition to covering the event, AnswerStat magazine sponsored a half-day, educational session, entitled “The Medical Call Centers’ Role in Telemedicine.” Peter DeHaan, publisher of AnswerStat, served as the event’s moderator.

The course faculty included a stellar group of industry experts, including:

  • Peter Dehnel, MD, medical director at Children’s Health Network Triage Service in Minneapolis MN
  • Carol M. Stock, JD, MN, RN, principal at Carol M. Stock & Associates in Seattle, WA
  • Lois Scott, RN, BScN, MN, vice president for McKesson Canada, from Moncton, NB, Canada
  • Marlene Grasser, RN, regional sales director for LVM Systems, Inc., which is based in Mesa, AZ

Dr. Peter Dehnel started the day’s instruction with his presentation, “From Telephone to Telemedicine and Beyond…” In covering his topic, Dr Dehnel looked at the past in order to understand the present and envision the future.

Among many other talking points, he used two gripping analogies to give perspective. First, he asked us to recall a 60s muscle car. Although impressive and enviable at the time, it no longer possesses the same panache. As such, our industry is changing. Our industry must change. There are cost increases to manage and new technologies to embrace.

Secondly, he used the relative safety of air travel to point out that six sigma is not enough; one hundred percent accuracy is essential – both in air travel and in healthcare. Standardization can be implemented to result in increased reliability and greater accuracy.

Next up was Carol Stock who covered “Legal, Regulatory, and Licensure Compliance for a Successful Medical Call Center.” Carol pointed out that laws often lag behind technology and the current reality in which call centers find themselves. This requires diligence and thoughtful planning in how we implement technology today in the absence of guiding regulation. For call centers that handle calls from multiple states, nurse licensing – a state-by-state requirement – offers an added challenge that must be addressed. She also discussed HIPAA and call recording legalities, as well as emerging technologies, such as live nurse chat.

The “Evolution and Future of Telehealth Contact Centres: An International Perspective” was presented by Lois Scott. Lois enlightened attendees on correcting the myths of the Canadian health system. She also described how telenursing (both over the phone and through video) can greatly increase effectiveness and reach. In this regard, Canada leads the way, given its population is greatly dispersed over a large geographic area. This development is especially important given the growing shortage of nurses; it is a trend that will find worldwide adoption.

Marlene Grasser concluded the session with pragmatic direction in technology selection for medical call centers. Her presentation was entitled, “Decision Support Software for the Healthcare Contact Center.” Among many other topics, she discussed key call center differentiators, including triage, referrals, survey tools, and disease management. She concluded with guidance on selecting and using call center management tools, an often-overlooked element of successful call center management.

The international assemblage of attendees was then treated to an insightful Q and A opportunity that allowed all four speakers to respond to questions and comments from the audience. The entire set of presentations was well-received and highly-rated.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time.  Read more of his articles at PeterDeHaanPublishing.com.

[From the June/July 2008 issue of AnswerStat magazine]

Moving Telehealth Forward Through Benchmarking



By Julie P. Cartwright, RN MBA

What tells us whether we made a good decision or if we are headed in the right direction along a defined path? Some would say we do so by measuring results. We look at maps drawn from the explorations of others. We compare the outcomes of our own experiences with the experiences of others. We set goals, and when we achieve them we know we made the right choices. Knowing where we are going in the practice of telehealth nursing is no different.

What is telehealth? The American Academy of Ambulatory Care Nurses (AAACN) Telehealth Nursing Practice Special Interest Group defined telehealth practice as a wide range of services delivered, managed, and coordinated by all health-related disciplines via electronic information and telecommunications technologies. The term telehealth represents the provision of health care beyond diagnosis and treatment to include services that focus on health maintenance, disease prevention, and education.

Within that framework, the subset of telehealth nursing has emerged. Telehealth Nursing, also known as telenursing, focuses on the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing. Telehealth nursing is a broad term encompassing practices that incorporate a vast array of telecommunications technologies such as telephone, fax, electronic mail, Internet, video monitoring, interactive video. Telehealth nursing is continually evolving. Telehealth nursing interventions encompass various types of nursing other than direct, hands-on patient care. Components of this practice, guided by nursing standards, include assessment, triage, consultation (such as information, advice, and symptom management), disposition, surveillance, and follow-up. Some established components of telehealth nursing are currently telephone nursing and tele-homecare.

Telehealth nursing has come into it’s own as a practice specialty and is recognized with its own certification exam offered by the National Credentialing Council (NCC). Have we been effective in moving a nursing practice modality, traditionally practiced hands-on and during face-to-face encounters, to the less traditional mode of Telenursing? In order to know that, we need to explore where Telenursing has been and where it is going.

One approach was to develop a web-based data collection tool that could address this gap in knowledge. As the practice strives to achieve quality programs, it continues to search for data on successful performance. In 1999, an AAACN colleague and I joined forces and developed a benchmarking survey tool (TBS-TelehealthSurvey) that was designed to do that.

TBS established an ongoing database that has attempted to capture the breadth and depth of telehealth practice. What the survey reveals is that there were so many more variations on the telehealth theme than it could possibly differentiate between in order to keep its promise. The promise was to make apples to apples comparisons. What was discovered in this process is that there are many different varieties of apples: Macintosh, Golden Delicious, and Granny Smiths, to name a few. Some apples are good for cooking and some are good for eating. So it goes with telehealth programs. Some telehealth programs are disease management focused, others community services focused (traditional telephone triage models), and some are marketing focused. The definitions, terms, and base of valuation changes over time and what was a “Macintosh” in 2001 may have become a “Granny Smith” by 2003. The biggest finding, however, was the challenge of relevance of aggregate data to individual varieties of telehealth programs. The more blended the data, the less relevant it becomes to individual program decision-making. That is why we at HMS Northwest (HMS) feel it is a time for change.

We have evidence of changes in gathering data, reporting of data, and managing data with other benchmarking providers for the call center industry. One example is that of Jon Anton’s work with BenchmarkPortal. BenchmarkPortal limits its core survey to that of 37 key questions. This process mainly identifies the source of the information (demographics) and key operational indicators. BenchmarkPortal then uses “one minute surveys” and audit processes to capture in-depth information for a specific target, client, or objective. HMS has also moved to conducting client specific audits that have met with great success. Audits are done on an individual basis identifying a specific type of “Macintosh” from among its clients and resources outside of telehealth that best matches the situation.

HMS dedicated TBS to serve the practice and in conjunction with AAACN, continues to support its original goals. Those goals are:

  • To document what is happening in the industry
  • To add to the body of research building within the industry
  • To contrast and compare reality in the field to the professional understanding of the work
  • To provide a venue for you to obtain peer group comparisons

The process establishes a record of the telehealth benchmarks (measurements) reported by various organizations/programs, from a single provider triage program to a large multi-state call center. The data collected permits differentiation among the types of services, populations, and resources to allow evaluation, exploration, and comparison of similar organizations or activities. In addition, by combining, the top reported performance benchmarks, best practices (that is, the top achievable levels of performance), are identified. This process is defined as the sharing of performance information to identify operational and clinical practices that lead to the best outcomes.

As HMS continues to move this initiative forward, it plans to look at new approaches in data collection and reporting. We have been asked to contribute relative findings and correlations found among the data collected as a regular feature in AnswerStat. Look for “A Piece of the Puzzle” in the next edition of AnswerStat. Please let us know if you have a specific request, we will try to address it in future publications.

Julie P. Cartwright is a Certified Call Center Auditor (CCCA), an RN, and holds an MBA. She is president and CEO of HMS Northwest Inc. in Port Angeles, WA.

[From the Fall 2004 issue of AnswerStat magazine]