With coffee in hand this week, I opened the morning paper to see the image of a beautiful baby girl, her mother standing over her ICU crib. The heart-wrenching story documented how the mother took her daughter to the local hospital for care. The emergency physician, upon seeing the child, contacted the local pediatrician who suspected Meningococcemia, a disease that could have caused the child’s death within six hours.

Columbia Memorial Hospital used the Oregon Health Network (OHN) to connect to the Oregon Health Sciences University Telemedicine Pediatric Emergency physician for immediate consultation. Because of the live video connection, the OHSU specialist was able to diagnose and provide treatment recommendations immediately. The story ends with the mother describing how she believed that connecting to the regional center was instrumental in saving her child’s life, a gift that she obviously treasures.

[Related: OHN's Leveraging the 12 best practices for health IT to improve care and reduce costs.]

Today, telemedicine delivery and telehealth education stories are becoming more commonplace. However, challenges of implementing telemedicine programs remain great due to the existence of proprietary programs, equipment and technology networks that often lack compatibility, standardization and common clinical protocols. This may begin to change with the Patient Protection and Affordable Care Act (PPACA) and CMS’ Triple Aim goals.

Triple Aim goals align well with the goals of existing telemedicine and telehealth initiatives in the United States. Because of conflicting payment structures and competition, it is not intuitive to health delivery organizations across the continuum of care that it is in their community’s best interest to implement Triple Aim goals. However, patient-centric health will not improve until whole population health measures and shared community strategies are in place. Many, including Donald Berwick, MD, currently the Administrator for CMS, believe that telemedicine and telehealth technologies will play a strong role in this transition from silos of care to coordinated communities of care.

Even without immediate implementation of the Affordable Care Act, pressure to reduce healthcare costs is bringing regional leadership together to identify community-wide approaches that incorporate coordinated patient transitions from one source of care to another. Simultaneously, individual health systems are working to identify how they can extend patient care services beyond their own walls. As a vital health delivery resource, telemedicine and eHealth is unfortunately at the periphery of many of these conversations.
Until recently, metrics for telemedicine programs have been generated to support the needs of individual programs and networks. In the past year, California Telemedicine and eHealth Center contracted with EdithForge to bring together national telemedicine leadership to develop a standard set of telemedicine metrics and evaluation tools. The metrics evaluate networks, practitioners and programs for throughput, provider satisfaction and utilization, site utilization, and patient outcomes data. This is slated for completion later this year.

Growing Interest in telehealth and other eHealth Initiatives
• In the past three years, EdithForge Consulting has seen an influx of regional health care systems seeking advice about how to leverage telehealth technology to meet their health delivery and financial goals. Common requests include:
• Financial sustainability plans that support program development and growth.
• Meeting with regional health partners who want to build patient-centered medical homes to support local health care delivery.
• Valuation of connecting to regional health initiatives including OHN, HITOC, and OCHIN and CMS demonstration projects.
• Development of outreach programs to serve patients in their local (urban) facilities.

[Government Health IT feature: Telehealth heads toward the mainstream.]

Telemedicine and other eHealth care strategies require internal and external considerations not commonly considered in direct patient health care delivery. These oversights include the following assumptions:
• There is little or no reimbursement or payment mechanism for telemedicine.
• The network configuration meeting internal technical and security standards will also be compatible with other networks.
• Consumer grade technical equipment will meet medical grade standards for telemedicine delivery.
• The existing model of onsite clinical visits works for patients.
• Telemedicine and telehealth programs can thrive as single implementation programs.
Remote health care delivery requires considerations not common to onsite delivery models. Five essential elements in the strategic growth and development of telemedicine programs are:
1. Telemedicine and telehealth delivery strategies must be tied to the organization’s strategic drivers (strategy, goals and plan) and aligned with senior leadership.
2. Structure telemedicine as a business line complete with infrastructure that will allow any provider to utilize telemedicine ubiquitously in their ongoing practice.
3. No one-off programs. Resist the temptation to call an individual telemedicine program your enterprise level solution, because it is not.
4. “Who are you going to call?” Groups like Oregon Health Network, HIE initiatives and Beacons are conveners of regional health care initiatives that provide the secure connectivity needed to answer the “who are you going to call?” question.
5. Money in your pocket. Increasingly health plans are paying when billed for remote patient consults. Medicare/Medicaid continues to support rural access, which fits well with health system outreach strategies.

Telemedicine and telehealth delivery is no longer about testing to see if the gadgets, technology and networks work, or to survey providers and patients to measure their satisfaction with the convenience. It’s about using technology innovations to enhance the clinical moment, allowing patients to receive continuous care in their home or local community, allowing health care systems to discharge patients to a transition team that will follow their care for the next stage of returning to health. It’s about connecting across the distance to build collegial relationships that allow providers to trust one another and upgrade the acuity of care in a remote community so patients are appropriately triaged and transferred to an emergency department.
 

This article orignially appeared in the Oregon Health Network's newsletter. Vanessa Leigh McLaughlin, MPH, is founder of EdithForge Consulting. Chrisopher Thoming, MD, is a physician at Northwest Acture Care Specialists.