Joseph G Seay, Former SVP & CIO, Community Health Systems
Telemedicine has been the “next big thing” for a very long time. Not only are the original paradigms: specialist consultations, second opinions and remote support bring deeply skilled or specialized care to the patient – rather than bring the patient to the specialist. As such,many new models are also possible. Any bed can become an ICU or CCU bed, monitored remotely by a highly skilled team of clinicians. Intelligent, communication enabled medical devices can support robust, real time clinical charting, adding tremendous detail, transparency and access while reducing nursing effort. Personal wearable devices and home testing tools can collect and communicate health status data to drive a dizzying array of services: patient feedback, proactive interventions, therapy adjustment, patient compliance, after surgery recovery and many more. Digitized clinical images can be communicated to radiologists anywhere in the world in real time for primary diagnosis, diagnosis confirmation, specialized evaluation, and treatment plan consultation. Image service marketplace/clearing houses can be established to make radiology consultations fast, assure that every report is from an appropriately skilled expert, and is provided by the lowest cost provider. Similar initiatives can be expected in pathology, dermatology and other specialties that are focused primarily on diagnostic competency.
“Vision and leadership will be the key to determining the winners and losers as inevitable disruption takes off”
Enabling technical standards, technologies, infrastructure, and security are now largely available and sufficiently mature to handle the practical mechanics to work reliably and affordably. Finally, reimbursement policy and practice are getting over the “novelty” of paying for a medical service that does not involve the physical “laying of hands” that has been such a deeply held paradigm. Everyone is learning to cope with the remaining barriers to interstate medical practice created by state licensing regulations – although reciprocity is starting to mitigate even this barrier to progress.
What is left is creating the business and operating models to turn a capability into a sustaining business strategy. How can this new capability be leveraged strategically by hospitals to build market share? What other enabling process, metric and marketing software and investment will be required to turn Telemedicine into something more valuable than an occasional professional consultation vehicle?
As with any dialog based service, it takes at least two to tango! Providers, physicians and hospitals, in underserved communities must design their menu of medical services, and then consider how to establish effective partnerships with a broad array of specialists capable and competent to act as effective clinical partners focused on serving the patient. This implies adoption of a strategic view of telemedicine, replacing the tactical, opportunistic, or response driven approaches that have characterized telemedicine thinking up to now.
There are more and more disruptive models entering the marketplace focused on enablement of “line of business” telemedicine services. Tele radiology has been well established for years. Psychiatric evaluations, dermatology consultations, tele-pharmacy services, and other specialty focused “carve-outs” are coming to market every day. Now is the time for the leaders to consider choices in a broader context.
Should technology enabled, service focused opportunities be pursued? Will it be more beneficial to establish a deeper relationship with a well-regarded tertiary care or teaching/research facility to provide “clinical back up and support” for local practitioners and patients being served? This second approach could include a partnership that will help preserve appropriate local patient service, enhance the community provider reputation for quality of care, improve patient access to high quality care, reduce the cost of care to providers and patients and support the viability of local care delivery. CIOs need to proactively analyze and discuss with operating executives the cumulative, long term costs of pursuing a “best of breed”, incremental telemedicine operating strategy. Consideration must be given to comprehensive clinical data sharing, practice integration, workflow, quality assurance, billing support and operating metrics that help proactively assure quality of care and attentive, focused service delivery. Clinical language, charting standards, medical order content, formulary standards, therapy practices, equipment compatibility, and many other aspects of care may be revisited as providers move from a “stand alone”, autonomous clinical care model to one that is increasingly viewed as a sophisticated partnership between a highly skilled, general service clinical team and a specialized, broadly capable and sophisticated team of practitioners to provide an effective, distance care partnership.
Tertiary care centers must commit to investing in the technology, operational support and clinical practice competencies to become effective partners in“tele-care”. This suggests a departure from current practice which often results in a patient being stabilized, then transported for sophisticated, specialized care, then becoming a permanent patient of the tertiary facility and medical staff. Proactive team training between dedicated telemedicine specialists and the general practitioners at remote facilities may be key to assuring trusted, respected, and collaborative relationships.
HIT vendors will be challenged to open clinical data access, enable administrative and clinical workflows, and support patient engagement across software product borders at levels of high performance and integration. Patient identity, care team definitions, HIPAA compliance enablement, billing management (and simplification for the patient?) are few of the activities inside the walls that must be revisited if effective clinical care delivery partnerships are to be established.
Patients and families’ concerns will need to be addressed. Why will my loved one be better served receiving care locally with remote support? Why not just take them ASAP to the big facility and the array of skilled specialists that may be needed for the best outcome? How can confidence and trust be earned when members of a care team are far away? It is one thing to have an imaging read remotely by a faceless but skilled radiologist; it is another to have a more comprehensive care management experience for a complex condition.
Telemedicine is finally here. It is practical, reliable, reimbursed and open for transformation of patient care and care delivery. Access, affordability, convenience, quality and sustainability can all benefit from a carefully crafted, thoughtful approach. Vision and leadership will be the key to determining the winners and losers as inevitable disruption takes off.