- Lawmakers and expert witnesses joined together in a Senate brainstorming session addressing how to bring telehealth and greater connectivity to more needy patients across the nation. In a hearing titled “Advancing Telehealth through Connectivity,” Senator Roger Wicker (R-MS), Chairman of the Subcommittee on Communications, Technology, Innovation, and the Internet gave telehealth advocates the chance to express their ideas about needed improvements for infrastructure development and meaningful deployment of remote care services.
“Advancing telehealth through connectivity is a timely topic for the Committee this year, as we look at ways to modernize our communications laws,” Wicker said. “I hope today’s discussion will serve as an educational forum on the progress we’ve made, as well as an opportunity to identify ways we can ensure all Americans have access to these great advancements in patient care and delivery.”
Witnesses including American Telemedicine Association (ATA) CEO Jonathan D. Linkous, Dr. Kristi Henderson, DNP, NP-BC, FAEN Chief Telehealth and Innovation Officer University of Mississippi Medical Center, and Chris Gibbons, MD, MPH Distinguished Scholar-in-Residence at the Connect2HealthFCC Task Force added to the discussion.
“Although forms of telemedicine have been in existence for forty years, its use has recently skyrocketed,” Linkous said. “For example, this year over 125,000 patients who suffer stroke symptoms will be diagnosed by a neurologist in an emergency room using a tele-stroke network. Tele-ICU is being used for 11 percent of the nation’s intensive care beds to help oversee almost 500,000 critically ill patients this year.
“About one-million patients with an implantable pacemaker or suffering from an arrhythmia will be remotely monitored,” he continued. “New technology and innovative applications to deliver healthcare using mobile devices are announced every day, promising even greater access to patients, regardless of their location.”
Despite the rapid expansion of telehealth as a care access tool, the nation’s telecommunications infrastructure is not sufficient to encourage more widespread adoption, Linkous said. The FCC has committed hundreds of millions of dollars in infrastructure development funds to the telehealth problem, yet real progress is lacking.
“Congress needs to step in and help the Commission finally turn their program into a shining example from the embarrassment it is today,” Linkous said, adding that the passage of two telehealth bills currently making their way through the legislative process would expand the list of organizations eligible to receive funding and consider an organization’s needs, not just its geographical location, when considering telehealth access.
Dr. Gibbons, who serves as Associate Director of the Johns Hopkins Urban Health Institute in addition to his role at the FCC, agreed that infrastructure improvements such as more reliable broadband internet access would greatly increase the scope and possibilities of telehealth for serving vulnerable populations. “Recent estimates suggest that broadband-enabled health information technology (health IT) can improve care and lower costs by hundreds of billions of dollars in the coming decades, yet the United States remains behind some advanced countries in the adoption of such technology,” he said.
“In a broadband-enabled health future, access to physicians, specialists and high-quality health care will no longer be driven by geography. Three-hour drives to see a maternal-fetal medicine specialist, cardiologist, or diabetologist could be a thing of the past. Through telehealth, broadband connectivity can be a force multiplier, helping to address real concerns about provider shortages. Telehealth can also be instrumental in meeting the health needs of our military veterans in rural areas where access to VA facilities is difficult (or distant).”
The Connect2Health Taskforce is currently working towards these goals by promoting sensible rulemaking and effective policies, encouraging the spread of internet-enabled technologies that are fully accessible to people with disabilities, and engaging a wide range of stakeholders to identify barriers, opportunities, and strategies to expand telehealth to additional patient groups.
Other organizations, including the University of Mississippi Medical Center, are doing their part to demonstrate just how effective telehealth can be to underserved populations, added Dr. Henderson. A worsening shortage of primary care physicians is hitting rural areas particularly hard, she said, even as the need for better chronic disease management drives up costs and takes millions of lives.
“More than 75% of health care costs are due to chronic conditions, nearly $7900 for every American with a chronic disease,” she stated. “One in five, or 2.6 million Medicare patients are readmitted to the hospital 2 within 30 days of discharge due to chronic conditions, which generates costs of over $26 billion each year. In Mississippi alone, seven of the leading causes of death in 2011 were chronic disease-related,” she pointed out.
Seventy-two percent of Mississippi’s hospitals are in rural areas and are experiencing the shortages of resources that make critical access care so challenging, Henderson said. The state has an extremely high proportion of residents living below the poverty line, and half of them take advantage of Medicare or Medicaid coverage for their healthcare needs. Telehealth has been instrumental in helping beleaguered healthcare providers address these difficult circumstances, and has a long history in the state.
A recent diabetes pilot saw better-than-expected results when patients were paired with tablets and chronic disease management coaches. The pilot started “with the ambitious goal of managing 200 uncontrolled diabetics through aggressive in home monitoring and intervention,” she said. “The centerpiece of the partnership is a population based health care model that leverages telehealth technology delivered over state-of-the-art fixed and mobile broadband connections.”
“For the first time, these patients have access to a team of professionals dedicated to their care – ophthalmologists, endocrinologists, pharmacists, nutritionists, diabetic educators and nurses. Many of our patients have never used a computer and some can’t read beyond a sixth grade level. Despite these challenges, our patients are thriving.”
All 85 of the patients enrolled in the study have lost weight, consider their diabetes under control for the first time, and report better daily health, Henderson told the Committee. “While our goal was for 75% of patients to reduce their hemoglobin A1C levels by 1% in the first year, study results show that after only six months, the average reduction in A1C levels among participants is almost 2%. In addition, with the exception of one patient who needed to be hospitalized at the time of enrollment, none of our participants have gone to the ER or been admitted to the hospital for their diabetes.”
While pilot programs and case studies are producing similarly meaningful results across the nation, “In my view, the greatest challenge and the largest threat to the widespread advancement of rural telehealth lies in thinking too small,” Gibbons said.
“If we allow ourselves to believe that the value of telehealth is only to connect patients, doctors, and hospitals – a critical need to be sure, but not the end in itself – we will certainly reap tangible benefits, but we could miss the transformational possibilities that broadband health connectivity can offer our nation. I commend the Committee, and Chairman Wicker in particular, for tackling these critical issues and for recognizing that the future depends on what we do today.”