A 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: 

A 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:

Texting 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:

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:

• Make sure everyone who handles data is aware of their responsibility to safeguard it. (More on personal responsibilities and tips to stay safe here.) 
• Make the risks of data violations clear to every provider, across the continuum of care. 
• Understand how to keep your digital assets safe -- especially with common tools like email.
• Understand what to do if there is a security issue (like losing your iPhone.)
• Use tools that work effectively with the pace and complexity of medical workflow

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. 

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: