Mediaplanet: What advice can you give to healthcare providers looking to catch their organizations up with 21st century capabilities?

Nesim Bildirici: Healthcare providers must adopt technologies for effective management of chronic diseases and greater clinical efficiencies.  This is driven by two major trends. First, chronic diseases affect 133 million Americans, and their ranks are growing. Healthcare providers must restructure treatment models to provide more care for these patients at home.  Second, the emergence of value-based purchasing will require healthcare providers to deliver quality care at a reduced cost, in an environment where there is a significant shortage of clinical resources.

MP: What would you say is the number one “game changer” that telehealth brings to the table?

Chronic diseases affect 133 million Americans, and their ranks are growing. Healthcare providers must restructure treatment models to provide more care for these patients at home.

NB: The major benefit is that telehealth monitors in the home alert clinicians when a patient’s condition is deteriorating, sometimes before the patient realizes it. Clinicians can quickly assess the cause of the problem and adjust the patient’s care plan. By catching a problem early before it becomes a full-blown crisis, many trips to the emergency room and unplanned hospital stays can be avoided.  These technologies also empower patients to share the daily health challenges they encounter with their clinical teams and receive meaningful feedback and support to improve their quality of life. 

MP: What type of patient will benefit most from telehealth solutions?

NB: People with chronic conditions such as asthma, diabetes, COPD, heart failure, coronary artery disease, high blood pressure, kidney disease, certain cancers and certain psychiatric disorders generally benefit the most from telehealth. In addition to early warning of an impending crisis, remote patient monitoring identifies long-term trends, helping clinicians and patients reverse those trends. In essence, it helps people with chronic diseases become ‘better’ patients.

MP: How does remote patient monitoring work?

NB: Patients monitor blood pressure, heart rate, weight, blood oxygen, blood sugar, airway flow, temperature and ECG in their homes.  The readings are sent by Bluetooth to a smartphone, tablet or cellular gateway that uploads the readings to a password protected, HIPAA-compliant website. Patients also report signs and symptoms over the telephone or by text message. Medication dispensers remind patients when it is time to take their pills, and alert their doctors and nurses if they miss a dose. All of this information is reviewed by doctors and nurses remotely, via the Internet. Like lab reports, readings that are out of range are flagged.  Full-service telemonitoring companies such as AMC Health provide the end-to-end support for patients and clinicians that is a vital component of successful telehealth monitoring.

MP: Can telehealth help reduce hospital admissions?

NB: Several studies of telehealth have shown dramatic reductions in hospital admissions and readmissions. Automated telephone calls identify gaps in care such as a patient not filling a prescription or scheduling a follow-up appointment. Care managers then resolve these problems. This program was shown to reduce the risk of hospital readmission by 44 percent. Other programs have shown dramatic reductions in hospitalization for heart failure, diabetes, COPD and asthma.

MP: How does a patient know if telehealth is the right option for them?

NB: A patient who has repeatedly gone to the emergency room or been admitted to the hospital for a chronic disease is usually a good candidate for telehealth. In addition, patients who are unable to control their blood pressure, blood sugar, cholesterol, weight or other measures can benefit from remote patient monitoring supervised by a clinician. In a study in the Journal of the American Medical Association, pharmacists used blood pressure telemonitoring to adjust medication and counsel patients who had uncontrolled hypertension. The telehealth group had 50 percent more patients reach the goal than the control group.  Patients who have difficulty traveling to a doctor’s office also find real benefits in telemonitoring. Snowstorms, health problems that limit mobility, work and family obligations can all present travel challenges that telemonitoring can address.

MP: What telehealth advancements are on the horizon?

NB: We will see an explosion of smartphone apps that turn the phone into a clinical sensor. Smartphones can now monitor blood sugar, ECG, airway flow, temperature and other functions. With video, clinicians can make virtual home visits, at lower cost and greater convenience for the patient. With low-cost sensors in the home, smartphones and tablets will monitor daily activities, including sleep, gait, movement around the home and the outside world, etc. Further down the road we will see wearable, even ingestible, sensors and smart bandages that will detect an infection.

MP: Is remote patient monitoring as effective as in-person meetings?

Patients who are unable to control their blood pressure, blood sugar, cholesterol, weight or other measures can benefit from remote patient monitoring supervised by a clinician.

NB: Remote patient monitoring involves more than video visits. It enables patients to monitor a variety of biometric parameters at home. Doctors and nurses review these readings and call patients who need support. This can be a home nursing visit, an office visit or, occasionally, a trip to the ER. Remote patient monitoring will never replace all in-person visits, but it is highly effective in the majority of clinical encounters. The immediacy of a video visit can improve outcomes, because a patient does not need to wait days or weeks for an office visit.

MP: Is telehealth a tool that all physicians are using, or is it only for specialty physicians?

NB: All physicians and nurses charged with improving outcomes in chronic diseases can benefit from telehealth. It is impractical to call or visit every patient every day, but remote patient monitoring can help meet the Triple Aim — now a standard in U.S. healthcare — of better care, better health and lower costs. Unfortunately, our healthcare payment system does not provide many incentives for preventive care, even though it saves a tremendous amount of money in the long run.

MP: How will the Affordable Care Act affect the implementation and future of telehealth?

NB: The Afforable Care Act is radically changing the alignment of incentives for those who treat or pay for the care of people with chronic illness. Providers have traditionally been paid to deliver services, regardless of the outcome. Physicians and hospitals are now either being penalized for the costs of higher utilization or will lose out on shared savings under new collaborative structures like ACOs or Bundled Payment demonstrations. Telehealth will help them improve outcomes and reduce costs, both of which will support increased use of remote patient monitoring.