Telehealth reaches critical mass

By John Andrews
09:25 AM
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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.