15Jan-Tw-Telehealth

AMERICAN HOSPITAL ASSOCIATION JANUARY 2015 TRENDWATCH The Promise of Telehealth For Hospitals, Health Systems and Their Communities elehealth increasingly is vital services have shown that: telehealth reflects a changing health care T to our health care delivery system, • 74 percent of U.S. consumers would landscape with a move toward integrated enabling health care providers to connect use telehealth services; delivery and new payment models. Also with patients and consulting practitio- • 76 percent of patients prioritize access spurred by consumer demand, telehealth ners across vast distances. Hospitals are to care over the need for human interac- is viewed increasingly as an efficient and embracing the use of telehealth technolo- tions with their health care providers; 2 cost-effective care delivery vehicle. gies because they offer benefits such as • 70 percent of patients are comfortable This two-part American Hospital virtual consultations with distant special- communicating with their health care Association TrendWatch series will ists, the ability to perform high-tech providers via text, e-mail or video, in examine first the promise of telehealth, monitoring without requiring patients to lieu of seeing them in person; and focusing on how telehealth is being used leave their homes, and less expensive and • 30 percent of patients already use com- by hospitals and the benefits for patients more convenient care options for patients. puters or mobile devices to check for and providers. The second part of the Telehealth has moved into the medical or diagnostic information.3 series will analyze the significant legal mainstream. In 2013, 52 percent of Telehealth has many guises, from and regulatory challenges posed by the hospitals utilized telehealth, and another remote monitoring programs used by use of telehealth technologies, including: 10 percent were beginning the process hospitals for post-discharge monitoring • licensure, of implementing telehealth services.1 to reduce readmissions, to hospital emer- • scope of practice, Consumer interest, acceptance and con- gency departments using remote video • liability, fidence in telehealth are growing as well. consultations to enable patients to receive • privacy and security, and Recent studies on the use of telehealth telepsychiatric screening. Increased use of • fraud and abuse considerations. What are Telemedicine and Telehealth? Medicare, state Medicaid programs to describe a narrower range of health • The American Telemedicine and technology advocates have used two care services, while the term “telehealth” Association (ATA), an advocacy terms, sometimes interchangeably, to has been used to refer to a broader organization that promotes the use of describe the use of technology to provide scope of health care services, including advanced remote medical technolo- health care services – telemedicine and non-clinical services such as training gies, defines telemedicine as the use telehealth. Each program or definition and education that are provided at of medical information exchanged identifies the scope of services, the types a distance. from one site to another via electronic of technologies and the locations where Various entities involved in telecommunications to improve a patient’s patients can receive telehealth services. health describe or define telehealth in clinical health status, including an Generally, “telemedicine” has been used different ways: increasing variety of applications and THE PROMISE OF TELEHEALTH FOR HOSPITALS, HEALTH SYSTEMS AND THEIR COMMUNITIES TRENDWATCH services using two-way video, email, • Medicare regulations cover a range This flexibility offered by the smart phones, wireless tools and of “telehealth” services, such as the Medicaid program has led to variation other forms of telecommunications use of telecommunications and infor- in the 51 different state laws and technology. mation technology (IT) to provide regulations that affect who can fur- • The Federation of State Medical access to health assessment, diagnosis, nish these services and how they are Boards (FSMB) defines telemedicine intervention, consultation, supervi- reimbursed by Medicaid and private as “the practice of medicine” using elec- sion and information across distance.4 payers. States differ in their defini- tronic communications, information However, Medicare does not reimburse tions or regulations, which in turn technology or other means between a for training or education and limits can create a confusing environment licensee in one location, and a patient reimbursement to a relatively small set for hospitals, health systems, physi- in another location with or without an of enumerated services when provided cians, other clinicians and insurers, intervening healthcare provider. This in rural areas. particularly when caring for a patient definition was included in FSMB’s • Medicaid views telemedicine as a across state lines. As the telehealth “Model Policy for the Appropriate Use cost-effective alternative to the more sector continues to mature, a standard of Telemedicine Technologies in the traditional face-to-face way of provid- definition may emerge. For purposes Practice of Medicine.” The purpose of ing medical care (e.g., face-to-face of this TrendWatch series, the term the model policy is to issue guidance to consultations or examinations between “telehealth” will be used broadly to state medical boards for regulating the provider and patient). The federal describe the delivery of health care use of telemedicine technologies in the Medicaid program encourages states to services, education and information practice of medicine and the appropri- use the flexibility inherent in federal via telecommunications technology, ate standards of care in the delivery of law to create innovative payment including: videoconferencing, remote medical services directly to patients via methodologies for services that incor- monitoring, electronic consults and telemedicine technologies. porate telemedicine technology.5 wireless communications. The definition of telehealth varies by state, impacting how services are paid for by payers. Chart 1: Examples of State Law Definitions of Telehealth State Definition of Telehealth California “‘Telehealth’ means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.” CAL. BUS. & PROF. CODE § 2290.5(a) (6) (2012). Missouri Telehealth is “the use of medical information exchanged from one site to another via electronic communications to improve the health status of a patient.” MO. REV. STAT. § 208.670 (2012). Pennsylvania Telemedicine is the use of real-time interactive telecommunications technology that includes, at a minimum, audio and video equipment as a mode of delivering consultation services. Pa. Dept. of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30 (May 23, 2012). Texas Telemedicine is the use of health care information exchanged from one site to another via electronic communications for the health and education of the individual or provider, and for the purpose of improving patient care, treatment, and services. 25 TEX. ADMIN. CODE § 412.303. 2 THE PROMISE OF TELEHEALTH FOR HOSPITALS, HEALTH SYSTEMS AND THEIR COMMUNITIES TRENDWATCH The Three Traditional Modalities of Telehealth Telehealth traditionally encompasses care when providers are not otherwise to a treating physician.7 three main modalities, each with available locally. This modality also is Increasingly, information from these distinct applications within the broader used for providing services to patients devices and applications will become telehealth industry. in other countries. linked to the health information managed One telehealth modality is A third telehealth modality, Remote by health care providers. For example, Real-Time, a live, two-way interaction Patient Monitoring, involves collection Apple is marketing its Health app to between a patient (or the patient’s of a patient’s personal health and medi- patients, allowing them to aggregate per- caregiver) and a health care provider cal data via electronic communication sonal health information on their Apple using audiovisual technology. Real-time technologies. Once collected, the data is devices and link those data to mobile telehealth services can be used to transmitted to a health care provider at a health applications that work with the consult, diagnose and treat patients. different location, allowing the provider Apple platform through HealthKit. At Another telehealth modality is to continue tracking the patient’s data the same time, Apple is partnering with Store-and-Forward, involving transmis- once the patient has been released to his/ providers and electronic health record sion of a patient’s recorded health his- her home or another care facility. companies to determine how the tool tory (e.g., pre-recorded videos or digital In addition to these traditional can be used in health care settings. images such as X-rays and photos) telehealth modalities, a growing number Similarly, mobile platforms, such as through a secure electronic communica-

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