Establishing TeleMedicine at an Academic Health Care System - Innovations and Opportunities
Monday, April 30
10:15 AM - 10:25 AM
Location: Innovation Zone, Booth 434
Oren Mechanic, MD MPH
Health Policy and Management/Attending, Emergency Medicine
Harvard Medical School/Beth Israel Deaconess Medical Center
Alexa Kimball, MD MPH
President and CEO/Professor of Dermatology
Harvard Medical Faculty Physicians/Harvard Medical School
In an increased effort to improve health care value, a function of reducing health care costs while maintaining high quality of care, physician groups are devising innovative ways to deliver medical care. In our presentation, we have the unique opportunity to investigate a large health care system without a formal telehealth network at a major teaching institution in the United States.
At least 50% of hospitals have some form of telehealth provided. With the exception of some notable institutions that have well-developed telehealth infrastructure, most hospital-based telehealth is in its infancy, focusing on Telestroke and Teleradiology primarily. There are opportunities, however, for non-conventional disruptive technology that can provide value to medical communities. As we know, such opportunities have been presented, deeply researched, and advocated in telehealth literature. As a health care system without a formal telehealth network or governance, we were impressed by the robust organic use of telemedicine by our physicians.
We investigated our large hospital system’s use of telemedicine on a service-specific level. As we will discuss in the presentation, there were telehealth services in place that focused on diagnosing life-threatening diseases early, decreasing wait-times for subspecialists, and treating patients following hospital discharge. Patient-to-doctor care reached psychiatric patients that otherwise would not have access to mental health services. Pre-surgical patients in community hospitals were being screened via telehealth by anesthesiologists. International physician-to-physician consultations were underway, providing expert care to patients in developing regions. We discovered intentional consequences of decreasing hospitalizations and improving access to health care. Unintentional positive consequences were betterment of primary care physician education and disease-specific knowledge.
Despite the innovation and success in providing care, we identified unified challenges, fears, and threats to implementation. As we will discuss in the presentation, these were major barriers to telehealth utilization. Parity laws and lack of reimbursement were a primary threat to continued telehealth services. Although community interest was high, some programs limited participation as a result of funding. This was specifically important for services depending on grants. Second opinions via telehealth for ECGs and dermatological concerns were lauded by referring practitioners, yet were often non-reimbursed. To circumvent lack of payment, some services are entirely patient-to-doctor fee-for-service, which unfortunately may serve only a segment of the population. With Medicare’s new Telehealth Parity Act, introduced to the House of Representatives in May 2017, as well as state-specific parity laws, there are vast opportunities to mitigate barriers to reimbursement.
With a recently proposed multi-hospital system merger for our network, there are opportunities for developing a telehealth program in order to optimize the value of medical care to our patients. Physicians will continue to innovate and provide excellent care to our populations; on an administrative level, it is our role to foster such endeavors and establish a foundation that cultivates telehealth.
- Understand the complex and disparate telehealth services provided by a large health care system without unified telehealth governance.
- Create a needs assessment within one’s own institution to discover ways to coalesce the varying telehealth services.
- Discuss the robust conventional and non-conventional opportunities unique to a large health care system.