In the past weeks, the Office of the National Coordinator of Health Information Technology (ONC) published an ambitious, lucid, and fairly comprehensive roadmap to IT interoperability across the country. It follows a 2014 commitment to interoperability and "proposes critical actions that the public and private sector need to take to advance the country towards an interoperable health IT ecosystem over the next 10 years."

The key components of the roadmap are:

• Establishing standards and "rules of engagement."
• Creating the conditions for good, safe, seamless sharing of electronic health information for “small” (individual patient), “big” (population level and beyond) and “long” data (wrapping around the individual and telling their health story over time).
• Motivating the use of those standards through appropriate incentives.
• Aligning states in policy, payment, and other levers.
• Making data more portable and transferrable.
• Creating a trusted environment for the collecting, sharing and using of electronic health information. 

Quite honestly, we're incredibly excited to see this kind of conversation happening at the governmental level. For so many years it seemed that the government was willfully ignoring health IT and telemedicine.

When managed care, care coordination, and PMPM payments are such big focuses, there must also be constructive conversation about IT interoperability.

To achieve this, however, the health IT community must expand its focus beyond institutional care delivery and health care providers, to a broad view of person-centered health. This shift is critical for at least two reasons:

1. Health care is being transformed to deliver care and services in a person-centered manner and is increasingly provided through community and home-based services that are less costly and more convenient for individuals and caregivers.
2. Most determinants of health status are social and are influenced by actions and encounters that occur outside traditional institutional health care delivery settings, such as in employment, retail, education and other settings.

This shift requires a high degree of information sharing between individuals, providers and organizations. It is vital that a high degree of interoperability exists between many different types of health IT, such that systems can exchange and use electronic health information without special effort on the part of the user.

The goal of this shift is to a nationwide learning health system—an environment that links the care delivery system with community and societal supports in "closed loops" of electronic health information flow, at many different levels, to enable continuous learning and improved health. This kind of system allows individuals to select platforms and apps to share and use their own electronic health information to meet their needs without undue constraints.

In other words, we need to remember that healthcare is about people. And people have human lives with human complexities that happen outside of institutional settings. To do coordinated care well, that's the reality of the context. And that's why we support medical collaboration that uses hybrid store-and-forward telemedicine® as a key part of health IT. It's the most efficient path to keeping the patient at the center of the technology -- and allowing interoperability to emerge from that center point.

If you're curious how health IT and telemedicine can actually contribute to that kind of person-centered approach, watch our 60-second primer:

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

I live in a beautiful rural area, which is great -- unless you are trying to grow a vegetable garden.

It seems like the country would be perfect for vegetables, but I've found that when gardening where I live, wildlife becomes a daily battle, with deer seizing upon produce with the stealthy precision of Navy SEALs. I had always seen more proficient gardeners with pro-built custom fencing solutions and felt that I obviously couldn't choose one of those. I could build that myself! It's just a little fencing and I could see what they were trying to achieve with each component. Plus, the all-in-one solution cost $600.

Anyone that's ever tried a home improvement project knows where this story is headed: $540 of materials, nine days of work, and three trips to Home Depot later, I had tried to replicate the all-in-one solution, cut myself with the fencing, had to return all the materials, and eventually just bought the all-in-one solution.

Now, the DIY version is not always worse. I make bread and cheese at home, and my wife sews. But usually the cobbled-together solution is better when you don't care as much about the outcome as the process. For instance, when you include the books, materials, and resources that I've bought to make my homemade bread, it certainly doesn't come out cheaper than the stuff from the bakery. But I love the process, so it makes sense to do.

Every day, we're under increasing pressure to cut costs while improving outcomes: more and more is demanded, with fewer and fewer resources. In that context, many people have come to us looking for ways to save money on care coordination tools, platforms, and protocols. You know that you really need an efficient solution to prevent readmission and manage care of your patients, but you don't want to waste resources.

So when is an all-in-one system worth it? And when does it make sense to create your own care coordination system?

These are some of the common functions that Accountable Care Organizations and managed care organizations tell us they need in a care coordination platform (whether telemedicine or not):

• Make your information technology network very secure and impenetrable from the outside. Be sure that files on the network cannot be seen by everyone.
• Find a way to prevent transmission of pictures or taking of pictures. (We have found this to be a frequent answer, and while secure, does little to coordinate care.)
• Use a checklist so that nothing gets dropped.
• Enable both provider-to-provider communication as well as patient-to-provider communication.
• Send secure messages between providers
• Archive unique cases for teaching to medical students and residents.
• Create a patient portal so they can understand the course of treatment and engage in options.
• Integrate with EMRs and EHRs
• Manage admissions and discharge.

These are all functions that can be handmade, homemade, or patched together using existing tools. So when hospital systems and managed care organizations come to us to ask, we always tell them the same thing: if you're excited about the process of piecing together your own care coordination / medical collaboration / telemedicine system, then go for it! But if you're looking for the most efficient and effective outcome,  you may be better off with the pro-built system (iClickCare is one option) that has it all included already. Just as I would have been with the vegetable garden fencing. 

If you've been doing cost comparisons of telemedicine systems for care coordination, maybe our guide to one all-in-one system can help:

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

Often, telemedicine is seen as the domain of the advanced, the technologically savvy, and the well-to-do. People assume that something so "sophisticated" as e-health, remote visits, or telemedicine-supported medical collaboration couldn't work for their clinic, their context, or their patients. 

In fact, we've had the experience that, as with many disruptive technologies, telemedicine has first benefitted the under-resourced, the underserved, and the marginalized. Our journey with telemedicine started in the late 90s, at one of the poorest elementary schools in our county. Originally, we were just looking for a simple way for kids -- whose parents couldn't miss hours of work and still pay the bills -- to get specialized medical care. We ended up using early digital cameras and distance learning lines to piece together a telemedicine program, in what would eventually become an early version of iClickCare.

All of which is to say that in our experience, telemedicine can be a simple thing. It can be a human thing. And it can certainly work in under-resourced environments.

So when we saw a recent article over at Fierce Health IT about how prisons are increasingly adopting telemedicine, it made perfect sense to us. Prisons, of course, have different parameters than most care settings. And they may even have different goals in the care of their patients. While they manage their lives, in a sense they are also providing managed care. But we all share common challenges in providing good, safe, efficient care for our patients -- and telemedicine is a great tool for many of us.

So here are 3 reasons that prisons use telemedicine and that you might want to consider it, too:

• Telemedicine removes downsides of travel. For prisoners, the ride to the hospital or to a specialist can be an expensive endeavor and present risk of escape. And while most patients don't have the escape-avoidance challenge, travel to faraway specialists and providers can be costly, mean missed work and school, and be highly disruptive of the healing process.
• Telemedicine saves money. We've repeatedly seen high ROIs (both financially and in terms of quality of care) for organizations and providers that adopt telemedicine practices. As Dr. Michael Moore experienced: "During a 3 month period, 70 patients were treated solely using iClickCare with an overall healing rate of 93% and an estimated savings of $24,000 in transportation costs alone." The prisons are seeing the same impacts, which is why these programs are increasingly common across the country.
• Telemedicine can make both the patient's and the provider's lives easier. Beyond just cost savings, the trauma and "run around" of caring for a chronic condition -- managing schedules, managed care, coordinating appointments, waiting for consults, and sharing information -- can be exhausting for both patient and provider. Telemedicine, especially a hybrid store-and-forward model that doesn't demand everyone be available at once, can make everyone's lives easier.

If you're wondering if Hybrid Store-and-Forward Telemedicine is right for you, get our free Quick Guide:

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