Telehealth reaches critical mass

June 02, 2010 | John Andrews, Contributing writer

From the June 2010 print issue

A significant portion of healthcare activities can be done on a remote basis. By electronically linking patient and provider, chronic disease management, prescription renewals, vital sign monitoring and various other services can be accomplished for a fraction of the cost of a personal office visit.

This may explain why research from New York-based Datamonitor shows the demand for telehealth hardware, software and related services is expected to triple over the next three years to $6.1 billion in North America.

“It is an incredibly exciting time to be involved in telehealth,” said Chris Steel, U.S. head of London-based PA Consulting Group. “There is a convergence of the need to reduce costs, technology that creates different ways of delivering care and a desire on the part of the public to access their information. There is a tremendous opportunity to make significant radical change in delivering healthcare.”

One example is a pilot program from San Jose, Calif.-based Cisco called HealthPresence that is designed to provide health and wellness services to underserved and underinsured communities throughout California. In conjunction with Long Beach, Calif.-based Molina Healthcare, the system works by creating a virtual “face-to-face” visit for patients and clinicians even though they may be hundreds of miles apart. The visit is enhanced by the availability of physical and diagnostic information, such as vital signs, generated from a variety of medical devices integrated with the technology.

Kaveh Safavi, MD, vice president of Cisco’s global healthcare practice in Chicago, believes telehealth has reached a tipping point toward greater utilization because “the technology is now good enough to provide an alternative system of care – a level of face-to-face intimacy where none existed before.”
With a platform that can sustain personal care at a distance, the challenges of supply and demand can be overcome, Safavi said.

“If you look at the history of telehealth – specifically doctor-patient interaction, patient feedback shows a satisfaction level in the 60 percent range, as opposed to 90 percent for actual face-to-face encounters,” he said. “Traditionally, the belief has been ‘something is better than nothing,’ but it has not been a legitimate alternative until now, because the satisfaction rates have finally risen to the level of face-to-face encounters.”

A primary catalyst for telehealth advancement is broadband, specifically the Metro Ethernet high capacity network, observed Eric Bozich, vice president of product management for Denver-based Qwest Business Markets.

“As broadband has become more widely deployed and affordable, it has enabled things to happen,” he said. “It has finally reached that point of critical mass where the experience is high quality enough that people are willing to accept and adopt it. Ease of use is allowing practices, hospitals and clinics to manage and deploy telehealth in a way that is reasonable. All those things are coming together to create an environment that is realistic, affordable and practical.”

Telehealth has become a shaping force in new healthcare business models, especially in urban areas, Bozich said.

“The timing is right with healthcare reform looming and everyone figuring out what it means,” he said. “The pillars are there – greater demands on a finite set of resources and technology will have to be the solution between those opposing forces. And because networks are becoming highly flexible and scalable, geography is becoming less of an issue.”

Connecting Colorado

At more than 103,000 square miles, Colorado is the eighth largest state in area and contains some of the most rugged terrain on the continent. So creating a telehealth network that covers a wide swath of the territory is a very impressive accomplishment; one that Colorado Telehealth Network executive director Steve Ward continues to marvel at.

“We have created what we believe is a usable network for the people of Colorado,” he said. “With 370 participating facilities, it is one of the largest networks in the country.”

The program began with a $4.6 million grant from the Federal Communications Commission to the Colorado Hospital Association and $5.2 million to the Colorado Division of Mental Health. Both groups figured they could make a real impact if they pooled their monies together with the purpose of establishing a rural communications system, Ward said.

“As I drove through rural parts of Colorado, I started wondering what the network would look like if everything was connected together, so we started asking around,” he said. “All the rural hospitals said they wanted it and all the hospitals in Denver did, too. All the major health systems came on board as well as the majority of clinics.”

Qwest won the contract and facilitated linking rural and urban health centers via fiber optic and copper cable that run along major trunk lines. Ward said the scope of this connectivity means no one in the state is more than 40 minutes from having access to healthcare.

“If you have a heart condition, diabetes or asthma and you worry about having an event, Colorado is looking pretty good as a tourist destination,” he said.

Teleradiology

One of the busiest aspects of telehealth is remotely reviewing CT and MRI images. But managing the flow of these heavy digital files can be a challenge, which is why Scottsdale, AZ-based NightHawk offers teleradiology services, CEO David Engert says.

NightHawk has connections to 1,600 sites, performs approximately 10,000 scans per night and 3 million reads a year.

“We’ve developed our infrastructure technology to manage the image, workflow, patient demographic information and match that to the image,” Engert said. “Everything can be digitized and sent over secure lines, enabling radiologists to read from anywhere.”

With the Internet and virtual private networks serving as primary conduits, teleradiology has become “an amazing capability,” Engert said. Going forward, he said wireless functionality should continue to advance in a way that physicians will be able to read images on portable devices “even while they are on the go.”

Wireless expansion

While terrestrial broadband has been the main engine for telehealth, wireless applications are also growing, said Alex Brisbourne, president and COO of Alpharetta, Ga.-based KORE Telematics.
“We have seen a very rapid adoption of wireless monitoring applications and services,” he said. “In 2008, 1 percent of new additions were related to healthcare, while in 2009, new activations for healthcare exceeded 20 percent.”

Three drivers account for the growth of wireless in telehealth, Brisbourne said: The growth of 3G networks, proliferation of inexpensive devices with long battery life and expansion and integration of wireless devices with established systems.

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eisner says: Project Uses Texting to Help South African Diabetes Patients

June 18, 2010 | 12:38PM GMT

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A pilot medical study by the University of California, Los Angeles, or UCLA, uses mobile phones to help diabetes patients in South Africa. Our correspondent spoke with the physician behind the study, Neal Kaufman, about the expanding role of technology in personalized health care.
The UCLA project uses texting on mobile phones to encourage patients with type 2 diabetes to adopt more healthful lifestyles.

Dr. Kaufman, a professor of pediatrics and public health at UCLA, says this form of the disease, called adult-onset diabetes, is becoming common, even among children. He says the problem is in our genes.
"Our genetics have programmed us to want to eat sugar, salt and fat, and to be as inactive as possible," he said. "And that's what allowed us to survive when there was famine and when there was not enough food, when we didn't want to burn any calories."

Today, he says fat, salt and calories are too readily available and that health care practitioners must find ways to urge patients to avoid them. Text-messages provide one way to do that.

The South African study pairs low-income women with type 2 diabetes and links them by cell phone. Each day, a computer program sends an automated message to prompt a conversation between the women. The message might ask whether they ate a healthy breakfast or simply how they are feeling.

"The text message will ask them a question. That question, they answer to their peer as a way to begin a conversation or to encourage a conversation between peers," said Dr. Kaufman. "And what we find is that a lot of these women who would otherwise be isolated and not have someone they could talk with are texting back and forth to each other, which they've never done before, in a way that's really quite supportive."
The text messages are supplemented by group meetings to help educate patients and provide face-to-face support.

Dr. Kaufman developed the program through a company he co-founded called DPS Health - one of many initiatives that uses technology in health care.

The South African project fosters peer-to-peer support and Dr. Kaufman says it has the advantage of being inexpensive. If the program proves successful, it can be expanded to a larger population at low cost. Most important, Dr. Kaufman says, it does not require a computer or Internet connection.

Other technologies connect patients to physicians or offer online chat rooms moderated by a trained medical practitioner. Internet sites provide prenatal advice for mothers or allow patients with specific medical conditions to share advice and comments. Some sites are moderated by trained professionals.
Dr. Kaufman says this type of technology will be an increasingly important link between patients and medical providers.

"We basically believe that most outcomes from chronic conditions can be improved if you help patients to help themselves," said Dr. Kaufman. "Some people call that self-management support - managing their daily lives, helping them take their medicines, helping them to be more active, helping them to adopt health behaviors."
Dr. Kaufman says the South Africa study will yield important information on how a population of middle-aged diabetes patients responds to text prompts from mobile phones. He says results so far show that patients are interacting and encouraging each other.

The UCLA researcher says the project is part of a trend to connect patients.

"We know that social support is the wonder drug of the 21st century, that connecting people to other people - whether it's in person, whether it's online, whether it's through a cell phone - is really a very, very powerful medicine," he said.

The World Health Organization says six people die every minute from complications from diabetes and that the prevalence of the disease is rising rapidly. It says the largest number of diabetes patients is in India, followed by China.

Dr. Kaufman says that if the UCLA project is successful, it can be applied to low-income diabetes patients around the world, including in the United States, where the disease is also a major problem.