Case study illustrates how telehealth achieves triple aim

A major barrier to launching telehealth programs is convincing healthcare providers that the initial investment of technology and infrastructure will pay off, said Kathy Wibberly, PhD, director of the Mid-Atlantic Telehealth Resource Center at the University of Virginia.

“The question of how to get that initial investment money is more of a challenge for providers than how to get reimbursed,” she said.

To paint a picture of the benefits of telehealth—including improvements in care delivery, better health outcomes and lower costs—a team including Wibberly and Joe Tracy, vice president for telehealth services at Lehigh Valley Health Network, developed an in-depth “typical patient” case study to present at the Mid-Atlantic Telehealth Resource Center Summit in Fredericksburg, Va. on March 31.

They both spoke with Clinical Innovation + Technology about the case study, which illustrates what happens to a patient in a world with or without telehealth. The scenario deals with Mr. Doe, a man living in a rural setting with high blood pressure (BP) and non-insulin dependent diabetes who smokes, eats poorly and fails to adhere to medications or comply with nurses’ orders.

While the no-telehealth journey is costly both financially and personally to the patient and his family, the use of telehealth translates to the avoidance of hospitalizations and their costs, according to the case study.

In the scenario without telehealth, Mr. Doe is rushed to the local hospital emergency department (ED) after collapsing, and the physician believes he had a stroke. After many tests, including a CT scan, Mr. Doe is transported via helicopter to an urban vascular surgeon, where his CT scan is redone because the imaging CD is lost. Stroke is ruled out, thus Mr. Doe is referred to a cardiac specialist, where he is admitted to the cardiac intensive care unit and undergoes an angioplasty. Eventually he is discharged with extensive follow-up instructions, and the man’s family struggles to take care of him as his behavior worsens due to depression--leading to failure to make follow-up appointments. The total bill: about $60,000 with more to come.

In an alternative world with telehealth, Mr. Doe is equipped with remote patient monitoring tools (RPM), which track his weight, BP and pulse oxygen saturation. When his weight jumps four pounds, he avoids an ED visit as he quickly undergoes a medication intervention through his regular physician. Instead of traveling miles to specialists, he receives telehealth services for rehabilitation, behavioral health, diabetes education, as well as for radiology and cardiology consultations at his local provider. His CT scans are uploaded into an imaging cloud and shared with specialists electronically.

The case study also analyzes the impact of his illness on his family, and how telehealth services at an elementary school, as well as ready interpreter access, helped them better care for Mr. Doe.

“Every piece happens somewhere, but very rarely do you see it all put together in one case,” said Wibberly on the web of telehealth services that can keep patients healthy and out of the ED. “None of it is fictional, it is all happening, and we want to communicate that all of this can happen in a virtual integrated home.”

In a world without telehealth, “you are working blindly,” said Tracy. For those living in rural settings, access to specialists is limited, and often patients are transferred via helicopter, which costs more than $25,000.

Telehealth can translate to real savings. For example, Tracy said that in his telestroke program at Lehigh Valley Health Network, images uploaded to the cloud allow physicians to evaluate stroke cases—replacing the need to burn CDs and helping eliminate the possibility of a duplicate procedure. “All in all, you’re speeding the ability to evaluate patients in the emergency room.”

Patient engagement is critical to improve outcomes, and telehealth allows for real-time engagement as individuals can immediately see relationships between bad diet and blood pressure just by accessing their data. “You see that after a pound of pork, your blood pressure goes up. Prior to RPM, you’d feel bad and see your doc, but you couldn’t remember what you ate,” said Wibberly.

Also, nurses evaluating RPM data in a call center immediately learn when a patient is at risk for a serious episode. In the meantime, such nurses are actively reaching out to patients who lapse in participation, said Tracy.

Telehealth will get much better and easier to use. No matter how remote monitoring is done—whether through a call center or by self-monitoring data feeds through a smartphone, the technology will transform care, Tracy said.

“You’ll see things tying telehealth more into EHRs, and docs will have a lot more information on you going forward,” he said. Rather than vitals taken at one point in time during an annual checkup, physicians will be able to access a mobile device to obtain six months’ worth of continuous data and trends, he said. “mHealth is nothing but growing.”

“One of the challenges is that technology is growing faster than the policy can keep up with it,” Wibberly added. Businesses are cropping up that may not adequately comply with HIPAA, leaving the door open to lawsuits and other problems. “It will bring the industry to a grinding halt if we don’t get ahead of this game.”