mHealth programs are like chocolates or presidential candidates – no two are alike, and some might look great on the outside but fall short of expectations. That’s why a healthcare provider looking to make that jump needs to look inside as much as outside for inspiration.
“A lot of the problems are with a fear of the unknown,” says Shawn Valeta, director of telehealth for the Medical University of South Carolina, which has had an extensive telehealth platform for more than a decade. “There’s so much out there; you have to sit down and think about what you really want to do with it before you start.”
Backed by some $50 million in investments from the state over the past two years, MUSC has a solid telestroke and behavioral telehealth program and has plans to grow its school telehealth program, provide telehealth services to jails, build a platform for large employers and get into remote patient monitoring.
MUSC’s school program might well be a model for the rest of the health system’s endeavors. Valeta says the health system began by identifying schools in the state’s poorest regions, where kids with any sort of health issue went straight to the nearest emergency room. By linking with those schools, MUSC gave children and their parents – and school staff – a quick and convenient link to healthcare, reduced absenteeism, improved morale and reduced the strain on local hospitals.
The program began with three school last year, Valeta said. It’s now in 20, and MUSC plans to double that total by next year.
“It’s a non-traditional use, but we saw a value to it that other might not have,” he says. “It’s a direct-to-consumer service that may hold the most promise for us now.”
To target those markets, Valeta says MUSC uses a “smart triage” philosophy: where’s the best location for a consumer, be it a student, employee, harried housewife or someone with a chronic condition, to access healthcare, and “match the patient’s need with the appropriate resources.”
“Telehealth used to always be about distance and time, but now it’s about maximizing efficiency” for both patient and provider, he says. “To do that, you need to make things more user-friendly. You don’t even think about the technology for a while – that comes last, and the people and the processes come first.”
“Sometimes I think we’re doing the opposite of what other people have done by being open and collaborative and building on networks and relationships,” Valeta says, “but it’s worked great for us.”
Just one state away to the south, Rena Brewer looks out over a Georgia-based telehealth network that spans three states and is starting to branch into Central America, and she also sees a system that relies more on relationships than technology.
“We don’t just provide equipment or a network – we’re there to hold hands,” says the new chief executive officer of the Global Partnership for Telehealth, a charitable non-profit overseeing the telehealth networks in Georgia, Alabama and Florida. “Across the country we’re seeing telehealth growing, and that’s because (healthcare providers) are finally starting to realize it’s a cultural thing … and it takes time to get things worked out.”
Brewer joined the GPT just this month, after serving for years as the director of the Southeastern Telehealth Resource Center, one of 14 federally funded centers (12 regional and two national) scattered across the country to provide guidance to local healthcare providers and others interested in launching and sustaining telehealth programs.
Over the past decade, she says she’s seen many projects fail.
“Technology can be very intimidating, and many people make the mistake of thinking that’s where you have to start,” Brewer says. “Some hospitals just can’t get past that initial loss of revenue, so they lose interest or fail to push back. … They don’t realize that you don’t have to buy the Cadillac – you look at what you have and what your community really needs the most, you manage expectations and you create relationships.”
Brewer sees growth in school-based telehealth - more than 70 schools in Georgia alone are connected to the network, as well as dozens of schools in neighboring states and a few colleges. She also sees value in developing behavioral telehealth programs, and in pushing the platform into skilled nursing facilities (‘There could not be a more perfect place,” she says). Farther afield, she notes that the GPT now provides telehealth services to an orphanage in Guatemala, and hospitals within the organization are providing free teleconsults overseas.
Closer to home, Brewer expects hospitals to partner with local physicians and clinics, creating community health networks that treat consumers not just when they’re in the hospital, but once they get out and go home.
“You need to start looking at populations,” she says. “You identify those most likely to go into the hospital and you (connect with) them at home. You follow them when they get out of the hospital” and you connect with them at home.
“You don’t start off expecting revenue,” Brewer concludes. “You start off building up networks, figuring out what you can do. Then you stick with it.”
Both MUSC and the GPT are partners with Avizia, a Reston, Va.-based developer of telehealth platforms. Mike Baird, the company’s CEO and Alan Pitt, its chief medical officer, see three factors supporting the growth of telehealth – legislative interest, consumer demand, and the electronic medical record.
“Software is leading the trend,” says Baird. “EMRs haven’t been great at integrating” with telehealth platforms and mHealth devices, “but it’s becoming an evolution. Healthcare is pushing that forward, is demanding new ways to integrate.”
“The EMR is an operating system that isn’t deep,” adds Pitt, “so it needs apps to be more functional. That’s where telemedicine comes into play.”
Nowadays most health providers have an EMR, or at least parts of one. Baird and Pitt say the EMR can be made more useful (perhaps even meaningful) by making it a horizontal platform, rather than a vertical one. “Create a platform with a wider set of connection points and a greater number of users and uses,” says Baird.
Pitt sees a shift in how health systems are approaching care coordination. Whereas they once created external business partnerships, they’re now bringing everything back into the fold “bringing resources back to the bedside,” he says. Fee-for-service care is giving way to role-based care, with the healthcare provider providing the link to all those roles.
“Business models change dramatically when you’re not fixing people to a place, be it patients or doctors,” Pitt says.
But there are challenges. Hospitals generally have poor strategic roadmaps, says Pitt, and aside from the organizations with telehealth directors or chief innovation officers (a rare but growing C-suite position), few have someone on hand to “own” telehealth. In addition, the industry as a whole isn’t mature enough yet for health system to simply pick up the technology, plug it in and make the best use of it.
“A lot of the platforms out there are point solutions, which just lead to niches,” says Baird. “Hospitals need to be looking for platforms to build off of … that also have the flexibility to build off their own tools and their services.”
Health systems are not only using telehealth to branch out – they’re using the technology and processes to improve the experience inside the hospital.
One health system making the most of its telehealth platform is Ochsner. The New Orleans-based system launched its own Digital Medicine Program last year, building off its Epic EMR platform, and has been using mHealth and telehealth for several years. It’s using iOS devices, Apple’s HealthKit platform and the Apple Watch, and has an innovation lab and accelerator (InnovationOchsner) to create new connections between technology and healthcare.
Recently the health system unveiled the “Optimal Hospital” initiative, an effort to combine and expand all of its mHealth and telehealth initiatives in the inpatient setting. Doctors are using mobile apps and devices to access patient records and other data, and nurses are using devices and apps at the bedside for everything from medication administration to making sure they have the right patient. In addition, patients are outfitted with wearable monitors that continuously track vital signs, which are automatically sent to both the EMR and the care team.
“We’ve seen higher levels of patient satisfaction using iOS devices over the more traditional methods of care and, overall, the patients are more engaged in their healthcare decisions,” Richard Milani, MD, the health system’s clinical transformation officer and chief medical officer of InnovationOchsner, said in a press release. “These are important factors which have a crucial effect on health outcomes in helping patients live more fulfilling lives.”
“Our goal is to empower our patients so that they are more informed and fundamentally involved in their own healthcare, whether it is through the inpatient or outpatient experience,” he added. “Optimal Hospital is designed to optimize processes, patient assessment and outcome predication while also improving safety, quality and the overall patient experience.”