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Despite EMR Hangups, Hospitals Are Embracing Enterprise Telehealth

Hospitals and health systems are increasingly moving away from small telemedicine and telehealth programs and embracing enterprise-wide platforms, even as they face issues with EMR integration and reimbursement.

Source: ThinkStock

By Eric Wicklund

- Healthcare providers are moving away from individual telehealth and telemedicine programs and migrating toward an enterprise-wide platform. And they’re doing it while battling disparities in payment and EMR platforms that can’t handle the workload.

Those are the take-aways from the 2018 annual telehealth industry survey from REACH Health, the fourth to be issued by the Atlanta-based telehealth vendor. It shows a growing interest among hospitals and health systems to build out a telehealth or telemedicine department, rather than creating small programs that are managed in different locations and by different people, as well as an interest in forging ahead with connected health despite reimbursement and integration hurdles.

The survey, taken of 411 healthcare executives in December 2017 and January of this year, finds that almost half are now using an enterprise-wide telehealth or telemedicine platform, a significant increase from the 39 percent reported in 2017. Many are shifting to an enterprise platform, with department-based programs dropping from 36 percent last year to just 26 percent in 2018.

And they’re proving their value.

“Not only are enterprise telemedicine programs becoming more common – they are markedly more successful,” Steve McGraw, REACH Health’s President and CEO, said in a press release accompanying the report. “When we correlated these approaches with participants’ achievements, we found that organizations taking an enterprise approach are 30 percent more likely to be highly successful than organizations with a departmental approach.”

READ MORE: What Telemedicine, Telehealth Resource Centers Offer to Providers

That success is specific. According to the survey, success was measured more frequently with patient-centered outcomes, and far less frequently in outcomes that affect the purse strings.

Some 69 percent reported success in providing specialist care to rural or remote patients, while 62 percent saw success in improving patient convenience and 50 percent in, respectively, increasing patient engagement/satisfaction and closing gaps in healthcare coverage. On the opposite end, just 21 percent reported success in reducing hospital admissions, 23 percent saw success in reducing EMS bypass or unnecessary ED visits, and 29 percent saw success in reducing the cost of care delivery.

When compared to how providers prioritized their services, the survey found that telehealth and telemedicine programs identified as high priority – most often dealing with access to care or patient engagement – were almost 50 percent more likely to be classified as a success as those considered a low priority.

It also indicates that health system executives or emphasizing patient access and care over initiatives that aim to reduce healthcare costs, at least for now.

While reducing EMS bypass and increasing revenues placed low on the list of telehealth and telemedicine priorities, reducing unnecessary ED visits placed much higher, at 61 percent, alongside reducing the costs of care delivery and reducing hospital readmissions (both at 53 percent). Yet all of those objectives placed below 30 percent in terms of measuring success.

READ MORE: Healthcare Execs Call Telehealth a Priority, But Are Still Reluctant


The survey indicates providers see telehealth and telemedicine as important enough to undertake even though they’re still faced with payment and integration issues. Almost one-quarter rank telehealth and telemedicine as one of their top priorities, while 48 percent rate connected health as a high priority.

The challenges of EMR/EHR integration are especially pronounced.

According to the survey, 57 percent have a telehealth or telemedicine platform that sits separate from their medical records platform, while only 28 percent have integrated their two platforms and just 16 percent are offering telehealth or telemedicine through their EMR/EHR.

When asked about EMR or EHR challenges related to telemedicine, meanwhile, almost half of those surveyed said documentation in the medical record occurs after the telehealth session is over - a process that can add to workflows and make telehealth more time-consuming and complicated that it should be.

READ MORE: Is Project ECHO the Telemedicine Model That Healthcare Is Missing?

In terms of integration, 38 percent cited problems with data flow between the provider’s EMR/EHR and the remote site, and 30 percent said telehealth-specific data has to be entered in different places within the medical record. And 34 percent said there are no discrete fields related to telemedicine within their EMR/EHR platform.

In terms of interoperability, some 35 percent of those surveyed said their EMR/EHR platform can’t adequately analyze telemedicine metrics, while 22 percent say data relevant to telemedicine and telehealth can’t be easily located within the medical record.

REACH Health officials point out that EMR/EHR challenges aren’t getting any easier for hospitals and health systems: more survey respondents rated those issues as unaddressed or partially addressed on 2018 than they did in 2016. More specifically, some 72 percent said a lack of integration with the EMR/EHR platform was either unaddressed or partially addressed, while 67 percent cited the lack of a common medical records platform in hub-and-spoke telemedicine services and the lack of native capabilities in the EMR/EHR.

Officials said the notable dependence on stand-alone telemedicine and telehealth platforms indicates providers are still frustrated with the lack of EMR/EHR integration capabilities – even as more and more providers are moving to enterprise platforms that would seem to need centralized medical records.

Overall, the survey ranked the top 20 challenges for telemedicine and telehealth programs, and found that money matters most. The top challenge identified by providers was inadequate parity laws, followed closely by Medicare reimbursement; Medicaid reimbursement ranked fourth, physician compensation ranked sixth, and private payer reimbursement ranked eighth.

As noted, EMR/EHR concerns also ranked highly: lack of a common medical records platform in hub-and-spoke models placed third, EMR/EHR integration issues ranked fifth and lack of native capabilities within the EMR/EHR ranked ninth.

At the bottom of that list was lack of executive support, listed as a challenge by only 10 percent of those surveyed. With that level of support, it’s not surprising that more than 80 percent of those surveyed expect internal adoption of telehealth and telemedicine to stay the same or increase in the coming year, while more than three quarters say the same about investment in connected health.


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