Kaiser Permanente's Dr. Yan Chow: Workflow is the barrier for telehealth

By Neil Versel
07:25 am
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Kaiser Permanente Yan ChowUnderserved communities in the U.S. stand to benefit greatly from telehealth and mobile health technologies, but only if clinicians adjust their workflows to include remote care, payers start offering the right financial incentives for providers to do so and the technology infrastructure is in place to support digital outreach, attendees at a conference heard last week.

"It all boils down to workflow," Jeff Russell, director of vertical market sales for online videoconferencing technology company Vidyo, said at the Health Technology Forum Innovation Conference Friday in San Francisco.

"It's never the technology that's the barrier. It's the workflow," agreed Dr. Yan Chow, director of Kaiser Permanente's Innovation and Advanced Technology Group.

One reason why workflows do not support telehealth is because payers traditionally do not reimburse for such services, Chow noted. "For many specialties, they're still thinking traditional care. That's how they're paid," he said.

That is changing, however. Tapan Mehta, global healthcare lead for Cisco Systems, reported seeing a "significant picking up" in telehealth usage in the last 12-18 months, in no small part because of the wider availability of reimbursements.

The new Medicare policy of not reimbursing hospitals for preventable hospital readmissions within 30 days of discharge of patients with heart attacks, congestive heart failure and pneumonia, as part of the gradual shift in general toward bundled payments, also has prompted some providers to invest in telehealth services, panelists noted.

The growing national primary care physician shortage is another concern, one that likely will worsen in the near term as millions of currently uninsured Americans gain coverage under the Patient Protection and Affordable Care Act starting next year. Telehealth and mobile health certainly can help, but providers and vendors alike still are looking for the most appropriate use cases and grappling with reimbursement issues as they innovate.

"Teledermatology is a winner. Telemental health is a winner. Telestroke is a winner because of the urgency in caring for stroke patients as quickly as possible," Chow said. Telehealth also is helpful for monitoring patients with congestive heart failure at home, according to Chow, but beyond these areas, the benefits remain unclear.

One problem: Home and even in-hospital monitoring devices turn out a lot of data, and IT systems and clinician habits usually are not set up to process the additional information. "Physicians already have too much data," Chow said.

Additionally, medical research on the efficacy of various telehealth services has been inconsistent, according to Chow, but part of that may stem the fact that researchers often evaluate telehealth with traditional quality metrics such as length of stay, something that might be irrelevant in a discussion of remote, home-based care. "Today, the literature is starting to change," applying different measuring sticks, according to Chow. "When you change the metrics, then the business case changes."

With telehealth, Chow sees an opportunity for large, tightly integrated organizations like Kaiser to extend their brands. "It allows us to build different relationships with our health plan members other than just a crisis advisor," he said.

Chow believes mobile networks have already surpassed the PC as a means of extending healthcare capacity in underserved communities. Mobile provides visibility into what patients are actually doing — not just what they say they are doing — and it enables connectivity.

Marty Coressel, CEO of Telsano, creator of an online dashboard for tracking patient health via wireless medical devices and for patient-provider communication and winner of a $20,000 prize in a Qualcomm Life developer contest, suggested that physicians start to incorporate mobility into care plans for this very reason.

Coressel said he would like to see doctors, upon diagnosing chronic diseases like hypertension, send links to online videos about proper management of the condition to patients' smartphones. He also is pressing health insurers to preauthorize home medical devices — wireless blood pressure cuffs for hypertension — for newly diagnosed patients. "We'll be able to track that [data] back into the EHR," Coressel said, which, if properly presented in the workflow, will enable clinicians to deliver more effective care.

Telehealth may not save money right off the bat, however. Cost is "somewhat of a trailing factor that will come," said Coressel. A more immediate impact is on access to care, he said, noting that electronic health screening stations in retail pharmacies are already having an effect, and that someone will find a more attractive alternative to the "big, ugly kiosks" that have popped up.

"As access becomes more prevalent, we're more engaged in [patient care via telehealth], and the level of quality will go up," Coressel said.

"Data is the foundation of quality systems," added Chow, who largely agreed with the Telsano CEO. "Personally, I think the biggest impact will be on quality because telehealth gives us the ability to collect data that we didn't have before."

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