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Is Telemedicine Cost Effectiveness Hard to Measure?

Posted by Lawrence Kerr on Thu, May 18, 2017 @ 06:43 AM

telemedicinecosteffectiveness.jpegA couple of decades ago, we started one of the first telemedicine programs in the country — a pilot program at a school-based health clinic.

Using clunky cameras and imperfect software, we were able to electronically connect passionate nurse practitioners with a pediatrician. For cases that would normally necessitate the parent leaving work, and taking the child out of school for an in-office visit, the nurse practitioners were able to quickly resolve most issues and get kids back to class.

At that time, the questions we got were of functionality: Are the cameras high resolution enough to convey the rash? Is telemedicine safe? Can a case really be communicated outside of an in-person conversation? Of course, times have changed. In 2017, telemedicine’s efficacy, logic, and impact has been demonstrated repeatedly. Every smartphone has a camera with dramatically better resolution than you’d ever need — and every pocket has a smartphone. Many patients are familiar with this kind of communication and are even demanding it.

The concerns have shifted from questions of functionality (will this work?) to questions of cost-effectiveness (will this make us money?)

So we were curious to read a recent research report called, “Cost-Utility and Cost-Effectiveness Studies of Telemedicine, Electronic, and Mobile Health Systems in the Literature: A Systematic Review."

The biggest takeaway of the report is: "There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures."

In other words: it's not proven whether telemedicine is cost effective because there haven't been large scale studies completed.

Of course, we've found with many hospitals, clinics, and providers, that the ROI of using iClickCare is substantial, positive, and almost immediate. The demands of value-based pricing and the exigencies of the modern healthcare system make telemedicine almost indispensable for many providers and hospitals.

But we agree that more comprehensive, sophisticated studies are needed. 

So if you are someone who is considering using telemedicine for healthcare collaboration and care coordination, then you don't need a randomized study -- you want to know if the ROI will be adequate for you. In fact, the above study pulls out some important considerations when it comes to analyzing whether telemedicine will save you money in addition to improving care.

We recommend keeping three things in mind when looking at the cost effectiveness analyses of telemedicine:

  1. 1. Different kinds of telemedicine have different rates of Return on Investment. Different forms of technology need to be separated and then tested. Videoconferencing technologies and Store-and-Forward technologies both have roles in improving health. They each require totally different approaches and resources -- and have different ROIs.

  2. 2. Different approaches to delivery sites have different costs. Mobile and fixed-site use varies dramatically when it comes to the cost of devices, as well as the economic benefits of the programs. To further confuse things, the technology is evolving rapidly and can significantly affect any cost calculation.

  3. 3. Cost effectiveness is a macro-economic issue. Even very robust studies tend to not reflect the bigger dynamics at play in our megalith of a healthcare system. Overall, the cost effectiveness of telemedicine will vary the most depending on the macro-economic and policy decisions being made at a large scale. That said, a given healthcare provider or hospital system can see immediate, positive benefits to using telemedicine if expensive hardware isn't involved. While the overall trend waits for the nation, we see providers and hospitals finding phenomenal ROI in the meantime. 


To learn more about what we believe is the highest ROI, most cost effective, variety of telemedicine, download our Hybrid Store and Forward Quick Guide: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: cost effectiveness, telemedice reimbursement,, telemedicine law, care coordination

9 Telehealth Facts You Need to Know as a Healthcare Provider

Posted by Lawrence Kerr on Mon, Aug 29, 2016 @ 07:30 AM

advisors.jpgA group of professionals got together recently -- and they identified some can't-miss trends for any healthcare provider in long term care or who cares for older populations.

The Presidents' Council of Advisors on Science and Technology is an advisory group of the nation's leading scientists and engineers. They are appointed by the President to augment the science and technology advice available to him from inside sources, thus influencing policy. And they recently created a report on technology and older age: Independence, Technology and Connection in Older Age. It is the second of two reports to the President about the topic of technology and graceful aging. The first was about technology for hearing assistance. Three areas are examined: social engagement, cognitive function, and physical ability.


The 9 findings of the report that we think are most important for every provider to know:

  • Caregivers are critical in technology adoption and use.
  • Technology supports older adults who remain in the workforce by choice or necessity.
  • There is cross support from those with disabilities.
  • There are many products available, for instance 24,000 assistive devices and 1200 products for long-term care.
  • Mobile devices are especially crucial for the care and support of older populations and in long-term care. (It is clear that mobile devices are increasingly woven into the fabric of our daily lives, irrespective of age. Just ask someone over 50 if they have grandchildren and see how quickly they get their smartphone out of their pocket to show just how cute their grandkids really are.)
  • Technology can support specialty consultations in being obtained. (PCAST notes store-and-forward for scans and medical images, but fail to see the bigger picture of rich multimedia communication.).
  • Home monitoring allows earlier intervention as well as earlier hospital discharge.


The report also identifies some important barriers to the use of technology for older populations and in long-term care, including: 

  • Technology needs social and human support.
  • Professional licensure is a barrier.
  • Reimbursement is a barrier but is changing with each legislative cycle.
  • Broadband is a prerequisite.


We have faced these challenges and have both technology and workflow solutions to them. That's actually why The Federal Telemedicine Working Group led by the Health Resources and Services Administration (HRSA) gave iClickCare early support. They believed that iClickCare uniquely had the potential (and we will argue still uniquely) to be self sustaining based on its directness and simplicity. 

Ultimately, we believe deeply in the power of technology -- specifically, telemedicine-supported healthcare collaboration -- and we believe that obstacles can be overcome.

That said, of all of the challenges identified, we believe that social and human support is the most challenging and the most deserving of investment and study.

It is "easier" to cheat and risk HIPAA fines; it is "easier" to do nothing; it is "easier" to avoid change. The opportunity is to support people in investing in what's slightly less easy in the short term, but infinitely easier and better overall. 

We're happy to talk with you to explore whether telemedicine could be a powerful tool in your organization -- just set a time with us here:

Tell Me More About iClickCare

Tags: healthcare collaboration, medical collaboration, long term care, telemedicine, telemedicine law

Joint Commission Rejects Secure Texting for Healthcare Collaboration

Posted by Lawrence Kerr on Wed, Jul 27, 2016 @ 06:00 AM


iphone-5s-backside-picjumbo-com.jpgTexting is one of the easiest ways to communicate. 

That's why so many of our colleagues know texting is in direct violation of HIPAA but text about (and with) patients, anyway. 

At different points in time, The Joint Commission on Hospital Accreditation has looked like it was in support of "secure texting" -- but a recent decision reverses that stance and makes any texting a violation.

Initially, texting was not approved for healthcare collaboration by the Joint Commission. They issued this statement in 2011: "[It] is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting... This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record.”

On May 1, 2016, the Joint Commission revised its position and stipulated components. It announced that health care organizations may allow orders to be transmitted with certain standards in place.

Then in June, it disallowed texting again, with a plan for more study. Standards will be developed by the Joint Commission and CMS.

To us, with the risks and consequences of running afoul of HIPAA, we believe that it's simply too risky to do any texting with Patient Health Information (PHI). 

When there are simple tools like iClickCare that meet criteria for electronic orders as well as healthcare collaboration -- and have never been disallowed -- it just doesn't make sense to risk it. iClickCare also uses texting, but only as a secure notification of a request for collaboration. The order follows once the collaboration is started.

As we have noted frequently, texting and emails are illegal. Secure texting helps to keep PHI secure, but does not help coordinate care or collaborate on behalf of he patient.

Be careful. HIPAA penalties don't take into account intentions -- only regulations. 

 

Our HIPAA checklist is free, and could help you protect yourself. Get it here:

 

ClickCare Quick Guide to HIPAA Checklist and Toolkit

Tags: healthcare collaboration, medical collaboration, telemedicine law, HIPAA, HIPAA secure images, PA

Pro Tips For Individual Healthcare Providers To Stay HIPAA Safe

Posted by Lawrence Kerr on Thu, Nov 19, 2015 @ 07:30 AM

hippasafedevices

 

The truth is that HIPAA is a big deal if you're in the medical field, period. When we talk about healthcare collaboration and telemedicine, though, people can be even more concerened about cyber security dynamics.

There are concerns at the institutional level, of course. But  for individual healthcare providers, it can feel like we're burdened by the responsibility to protect PHI from HIPAA breaches, without the tools or information to do so effectively.

So we were interested to hear the insights offered recently by Michael Kaiser, executive director of the National Cyber Security Alliance. 

Here are some of his best tips for staying cyber-safe as an individual healthcare provider:

We encourage providers to innovate and care for patients, despite the bureaucratic deluges that sometimes feel as thought they'll drown us. But it doesn't have to be hard to stay HIPAA-safe, even when using a telemedicine tool -- and it is important. 

One thing many providers do is bring a smartphone or other device from home, into the medical context. You can download our white paper on staying HIPAA safe with BYOD (Bring Your Own Device) policies here:
iClickCare IS BYOD Secure

Tags: HIPAA, HIPAA Collaboration, Telemedicine and HIPAA, HIPAA secure images, healthcare collaboration, telemedicine law, workflow

Expanded Telemedicine Reimbursements in New York State!

Posted by Lawrence Kerr on Wed, Jan 07, 2015 @ 09:34 AM

Good news for supporters of telemedicine, innovators in medicine, and providers concerned with good and efficient care: New York State... new legislation is putting forth strong reimbursement and regulatory support for telemedicine and telehealth in the state.

New York State's Governor Cuomo just signed a new law that allows NY providers to bill for live video/audio, store-and-forward, and remote patient monitoring from private insurers and Medicaid. The new rules go into effect on January 1, 2016.

Since we wouldn't expect anything else from formal legislation, well, there are some grey areas and confusing parts. That said, the bill represents strong and unequivocal progress for telemedicine. The key points include:

  • The main thing is that multiple categories of telemedicine and telehealth must be covered by private insurers and Medicaid:
    • Types of telemedicine and telehealth include (but aren't limited to): 2-way real-time audio/video, store-and-forward telemedicine (this would include iClickCare, which is a Hybrid Store-and-Forward® telemedicine platform), monitoring of patients' conditions, education, medication management, etc. 
    • Eligible providers include hospitals, home care and hospice agencies, licensed physicians, PAs, dentists, nursing, midwives, podiatrists, optometrists, ophthalmic dispensers, psychologists, social workers, or speech language pathology and audiologists.
  • There are no restrictions on the patient or the origination of the telemedicine consult.

As a New York State based telemedicine company, we're thrilled!  In particular, we're pleased that the law, as it does in so many other states, explicitly supports Hybrid Store-and-Forward telemedicine, which is what iClickCare is so passionate about.

If you're not sure what Hybrid Store-and-Forward® telemedicine is, though, or are comparing your options with other telemedicine tools, get our Quick Guide: 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: telemedicine law, regulatory issues, telemedice reimbursement,

Is the Telemedicine Era Actually Finally Here? Why?

Posted by Lawrence Kerr on Tue, Nov 25, 2014 @ 10:17 AM

telemedicine is coming resized 600

Most people I talk to don't know what telemedicine is.

But they will in 2-3 years. A recent Economist article looked at the strong signs that telemedicine is gaining momentum at individual, hospital, and governmental levels.

The article traces the evolution of telemedicine, which we've experienced at ClickCare. You might be surprised to know that as early as 1924, Radio News documented a doctor seeing a patient via a television link. In the mid-90s, we ourselves were using bulky cameras and a network of enthusiastic nurse practitioners to connect pediatricians to in-school nurses' offices. And today, we've seen an exponential increase in the comfort, trust, and excitement around telemedicine.

So what are the forces that are pushing telemedicine to the fore? We see a few key pieces:

  1. Governments, often the slowest part of the system, are under pressure caused by budget constraints, chronic disease, an aging population, and regulatory issues. Telemedicine is now seen as a solution to these intersecting problems.
  2. There is increasing recognition that an approach to telemedicine and medical collaboration must address changing our practices as providers, not just changing our technology. “If you have a chaotic system and add technology, you get a chaotic system with technology,” says Peteris Zilgalvis, a health official at the European Commission. We've always insisted that it's better to invest in people and software, not expensive hardware -- and our behavior and workflow is key to this. Behavior and workflow are interrelated. An intrinsic and nourished desire to collaborate begins a constructive workflow. A workflow, dictated but not embraced, does not start the process. An empowered workflow can move the process along much more strongly. The provider with the right behavior, needs the right workflow to accomplish his goals.
  3. Reimbursement is no longer a barrier. 21 states mandate that telemedicine be reimbursed at the same rates as face-to-face care. This trend is one that's headed in a single direction: reimbursement for telemedicine is more widespread, more systematic, and more comprehensive every year.

So, like most "overnight successes", this one is taking decades. But the long-in-coming telemedicine era may actually be on its way.

Curious about telemedicine? Download our Quick Guide:

ClickCare Quick Guide to Telemedicine

Tags: telemedicine, collaboration, telemedicine roi, healthcare collaboration, telemedicine law

Can I Integrate My EMR or EHR with Telemedicine?

Posted by Lawrence Kerr on Wed, Feb 19, 2014 @ 09:01 AM

emrphoto resized 600

 

When our colleagues get excited about the possibilities of using telemedicine to streamline and improve the ways they care for patients, one of the first questions they ask is:

"Can I integrate an EMR with telemedicine?"


The short answer is yes.

It is 100% functional, 100% efficient, and 100% HIPAA-compliant to integrate any EMR with any telemedicine system simply by cross-referencing the EMR in the telemedicine system; or by cross-referencing the telemedicine consult in the EMR. We, and dozens of our ClickCare users, have found this to be a simple, low-tech way of effectively integrating the two platforms.

However, if a provider perceives that they must have an automatic, high-tech way of integrating the two platforms, then the answer becomes trickier. Here's why:

Medicine becomes more standardized, regulated, and homogenized every day. When I started practicing, I used to accept eggs from backyard chickens, or the promise of a refresh on my housepaint, as payment from folks without insurance.

As the years went on, it became disallowed for me to take payment in this way… and the expectation of all providers working in exactly the same way became status quo. Some standardization is good, and protects us in crucial ways, but I think we all have a sense that the baby (of creative and passionate medical care) often gets thrown out with the bathwater (of mistakes and inefficiency.) I see this kind of standardization is the way offices are laid out, "tips" on how to greet patients, and rule after rule about managing charts and records.

Another place I see this is in the ways that EMRs seem to be running healthcare providers, rather than the other way around. The EMR market is extremely competitive, with 4,800 different EMRs on the market in 2013. That competition means that EMR providers have an incentive to "edge out competitors" by advocating for extreme integration. It's like going to the salon, getting a great cut, and then hearing from the salon owner that in order to maintain the cut, you need shampoo, conditioner, and gel that cost $180 and all happen to be from their salon brand. EMRs have an incentive for telling you that all technology you use has to be provided by them. 

EMRs and EHRs are fantastic for storing patient information and making it available when we all need it. But telemedicine is not primarily for the storage of information. Telemedicine is for collaboration, problem-solving, teaching, and communication. So consider ignoring the EMR/EHR manufacturer when they say that absolutely everything has to come from them. Use a telemedicine tool that works for you, in the way that works for you, and cross-reference to the EMR/EHR.

We may not be able to "fix" medicine, but each of us can fix the way we interact with the tools available to us, making our lives as providers happier, and the care for our patients better.

Curious about telemedicine options? Get our quick guide: 

 

ClickCare Quick Guide to Telemedicine

 

 

Image courtesy of juhansonin on flickr.com, used under Creative Commons rights.

 

Tags: telemedicine, Telemedicine and HIPAA, telemedicine solutions, EHR, EMR, telemedicine technology, ehealth, telemedicine law

4 Tricks for Getting Reimbursed for Telemedicine

Posted by Lawrence Kerr on Fri, Jan 31, 2014 @ 07:49 AM

 

piggybank resized 600

Many people have been hearing telemedicine success stories and want to start using using technology to collaborate and connect with providers and patients.

Most folks use telemedicine to improve patient care and maybe make their lives as providers a little easier. However, those motives don't get around the fact that we all need to be paid for the work we do.

Reimbursement for telemedicine is a crucial part of making the practice sustainable. But it's not always easy to know how to make that possible when the political climate and reimbursement policies are constantly changing.

So here are 4 tips and resources to make sure you're paid for telemedicine:

  1. Just do it and worry about reimbursement later. Many of our colleagues have found that when they put collaboration and patient care first, the reimbursement ends up taking care of itself. So pay attention to reimbursement -- but if in doubt, just go ahead and care for the patient or collaborate with telemedicine and let the details sort themselves out later.
  2. Use the right codes. We've assembled a list of codes you can use to bill for telemedicine-related time. This is always changing, but keeping an eye on the right codes increases reimbursement significantly.
  3. Make sure you're billing for everything you can. Many providers don't know that in addition to patient-related time with telemedicine, you can also bill for time spent collaborating, and even charge a remote site facility fee. 
  4. Be smart about pre-authorizations. Always check if the patient’s insurance company needs a prior authorization. If so, text the pre-authorization information and patient insurance plan to the consultant.

 

Need guidance on telemedicine options? Get our guide for free:

ClickCare Quick Guide to Telemedicine

 

 

Image courtesy of 68751915@N05 on flickr.com, used under Creative Commons rights.

Tags: collaboration, iPhone medical apps, telemedicine law, accountable care, telemedicine roi, compliance

How Secure are Your Medical Photos on the iPhone?

Posted by Lawrence Kerr on Thu, Jan 16, 2014 @ 08:34 AM

iclickcare iphone visit pic 300dpi 2 copy copy

 

Increasingly, taking photos is a part of our lives. We snap photos when we're out at dinner or on a trip. And we certainly want to take a picture when we see an interesting case or need to remember or share something about a patient.

With the significant fines and punishments for HIPAA violations, however, medical photography on your iphone or smartphone brings up a several HIPAA compliance and security issues:

  • If your phone gets lost, all photos on your camera roll are insecure
  • Once a photo is on your phone, it is tempting to email or text it, both of which are in conflict with HIPAA.
  • Photos on your camera roll may be susceptible to access by apps that are not HIPAA compliant.

So what is a person to do? It seems ridiculous to choose not to use technology in service of patient care. Here is the good news: you can and should use your iPhone or other smartphone for medical photography. In fact, we think that medical photography is a simple, powerful way to improve how we care for patients and make our lives as providers a little easier.

So here is a checklist to make sure that your medical photos are secure and useful:

  • Understand HIPAA. You don't need to drive yourself crazy, but a little understanding of the fines and penalties goes a long way 
  • Never put patient photos into your regular camera roll. Sometimes smartphone apps (with the exception of iClickCare) pull from your camera roll-- even sharing pictures without your knowledge. And even if that doesn't happen, your camera roll only has one layer of security -- the login password on your smartphone. So when dealing with patient photos, we recommend using a secure app like iClickCare that doesn't ever save photos to your camera roll. You'll know your pictures are safe, and used only for your purposes. 
  • Use some overall security strategies so you don't have to worry. When your technology is more secure overall, your photos are more secure, too. 
  • Don't email photos. Email is never a secure way to collaborate. 
  • Use apps that are explicitly HIPAA-secure. When you do collaborate, only use collaboration platforms that explicitly promise HIPAA security.

 

Security issues aside, we all want our medical photos to be a little bit better. Get the first chapter of our book on iphone photography for free:

 

medical photography introductory chapter

Tags: clickcare, HIPAA Collaboration, HIPAA, HITECH, Telemedicine and HIPAA, clinical photography, medical photography, telemedicine law, HIPAA secure images, best medical apps

4 Surprising Reasons Telemedicine Is Thriving

Posted by Lawrence Kerr on Tue, Jan 14, 2014 @ 09:07 AM

phonebooth resized 600

 

Telemedicine practitioners can feel isolated. They are often among a handful of people in their immediate practice or hospital who are using telemedicine to perfect care, improve outcomes, and make their lives easier. 

The truth, however, is that healthcare providers using telemedicine are part of a large, growing, and thriving community. When we started working in this field almost two decades ago, telemedicine was rare. Now, however, the most committed, innovative healthcare providers all use telemedicine in one form or another. 

Telemedicine is actually thriving. Here are 5 reasons why: 

  • Politics are catching up. As this article details, parity laws are going into effect in several states. Also, the Telehealth Modernizaion Act -- to establish a clear definition of telehealth -- is on its way to going through. "Telehealth is a major contributing factor to increased health care quality, convenience, and lower costs," said Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio)
  • Telemedicine is reaching critical mass. Research and Markets is predicting 18.5 % growth in global telemedicine in the next 4 years. 
  • New providers are more familiar with technology. For some of the same reasons as we highlighted in our discussion of concierge medicine, and as this article discusses, new providers are adopting practices like telemedicine at higher rates.
  • Providers are using smartphones in their practice. According to Verizon, "38% of physicians with smartphones use medical apps on a daily basis, and that number is expected to increase to 50% this year. Two-thirds of healthcare providers said that implementing or improving their use of mobile technologies is a high or mid-level priority during the next 12 months."

We're thrilled to know that providers are connecting better, people are collaborating, and patient care is improving as telemedicine becomes more widespread.

 

If you're looking into the options, get our Quick Guide to Telemedicine here:

ClickCare Quick Guide to Telemedicine

 

Image courtesy of thomaslevinson on flickr.com, used under Creative Commons rights. 

Tags: telemedicine, medical collaboration software, telemedicine law, accountable care, ACO, telemedicine roi, telemedicine solutions, patient satisfaction, affordable care act, concierge medicine

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