The people we know who run long-term facilities are fantastic folks. They're creative, caring, and clear-eyed. The need to be, too, because the pressures they face in providing long-term care grow every day:

• Access to specialists is shrinking.
• Regulatory parameters get stricter (and sometimes less logical) every day.
• New changes with the Affordable Care Act create both pressure and uncertainty.

Even when everything is going smoothly for the patient, costs can be difficult to manage. But when a patient needs to be brought to a visit with a medical provider, or a series of visits with medical providers, costs can really soar.

Of course, studies have repeatedly shown that telehealth can help bring down the cost of these types of incidents. For instance, the January 27, 2001 article in the Journal of Gerontological Nursing showed that for a rural nursing home, telehealth reduced the cost of the consult by half. 

In our experience, however, the cost of the consult is negligible when compared to the full set of costs incurred when someone in long-term care gets sent to the ER or the doctor.

These are a few examples of the problems with a "let's just send her to the doctor or the ER" approach: 

• Patients often experience pain, frustration, and discomfort when traveling to receive care.
• Aides need to attend, often shaking up schedules and complicating care for other patients.
• Concommitant issues like dementia can be exacerbated when a patient is removed from her routine and home.
• The family must also attend (or be excluded from the information and decisions at the visit), causing:
• Missed work.
• Distraction and stress.
• Travel.

What benefits have you found in using telemedicine in long term care? What costs are you beginning to notice when it's not used? We look forward to learning from your experience in the comments below.

And for our review of the options, pros, and cons of telemedicine options, get our Quick Guide here:

Image courtesy of bestrated1 on Flickr, used under Creative Commons rights.

When it comes to using technology -- for medical collaboration, communication, meaningful use of medical records, or any other crucial function -- there are a lot of considerations that come into play.

In our relationships with current and prospective iClickCare users, we've seen decision parameters run the gamut from savvy to uninformed. And we were intrigued to see a recent report on key features that home health agencies look for in software, from Software Advice, a company that reviews medical software. In 385 interactions with home health software buyers, they found:

• 97% of buyers prefer a cloud-based system over an on-premise solution.
• Field support (mobile and remote access) was the most requested feature to better track care in the patient’s home.
• First-time buyers want the benefits of going digital, and top reasons for purchasing included improving efficiency (58%) and “going paperless” (35%).

We think that this orientation toward cloud-based, efficient, adaptable systems that allow remote access is right on.

This is a smart way for home health agencies -- any group, really -- to make the most of their technology dollars, comply with regulatory issues, and positively impact patient and provider satisfaction. That's one reason we had concerns about a report that Time Warner Cable and the Cleveland Clinic are collaborating on a pilot project installing video conferencing hardware in patient's homes to lower hospital readmissions. This kind of focus on expensive hardware installations can actually make outcomes for patients worse. By not using simple software, cloud-based systems that can be accessed from anywhere, and leveraging hardware that providers already have (like the smartphone in their pocket), a lot of resources tend to be wasted. For that reason, we recommend keeping the following things in mind in any big health IT investment: 

• Keep hardware investment to a minimum. Always see whether you can use existing hardware -- whether computers, smartphones, or other resources -- and invest your dollars in good software and systems. Hardware can easily go obsolete, while software can be updated.
• Make sure it's easy to use. Medical providers have enough on their plate without having to learn complicated systems or having to operate completely new hardware. Look for something that leverages what people already know... and demand a well-designed, easy-to-use interface.
• Prioritize flexibility and collaboration. Some systems can only be used or shared with providers that are "in the network." Look for a service that allows you to get consults and support from any provider, regardless of their status with your service.
• Invest in systems that can be used from anywhere. As the study above shows, savvy buyers are looking for cloud-based services (SaaS) that can be accessed from anywhere -- that kind of flexibility tends to pay off in the long run.

Telemedicine is often associated with very remote areas, access to super-specialized providers, or cutting-edge technology. However, some of the most heart-wrenching and interesting uses of telemedicine have been with ordinary people in ordinary circumstances.

In particular, I've seen how telemedicine can make Assisted Living Communities more efficient and more resident or person-centered. 

Assisted Living is often part of a transition from full independence to full support: a person finds a midpoint between living at home and skilled nursing care. Of course, the lines are blurry -- home care, independent living, assisted living, and full support care like memory care or skilled nursing. What all of these care services have in common, though, is the prioritization of excellent care and the maintenance of a patient's lifestyle and independence.

Traditionally telemedicine has served Assisted Living by technological replacement of human visits and by home monitoring. Significant gains in health have been documented by monitoring weight, medication adherence, blood pressure and activity. Medical collaboration tools like iClickCare bring another level of support. Tools like these can have a significant impact on senior care by enabling simple, secure care coordination and collaboration with the family, the resident (often a senior), and their caregivers and providers. HIPAA compliance is a given.

The creativity and commitment of Assisted Living providers is astounding -- and for that reason, they are innovating evermore ways of using telemedicine in their practice.

Here are just a few of the ways that Assisted Living Communities use telemedicine to improve care and decrease costs and hassle:

• Measuring key patient indicators like weight or blood pressure without the resident having to leave their home
• Efficient, remote collaboration with team members, specialists or key providers from nearby hospitals or practices
• Aides and nurses, even family members, for more background history and also private pictures or video clips
  
• Decrease in ER and OR visits due to surgeons and other providers evaluating remotely whether a procedure is required
• Several kinds of provider "touch points" on a single case, since geriatric issues often involve more than one specialty