Electronic Health Records

Policy & Regulation News

MU for mHealth? Why telemedicine should get better faster

By Jennifer Bresnick

- You’re not done once you’ve implemented your EHR.  Whether you’re interested in joining a health information exchange or you’re shifting into accountable care, the EHR is simply the first piece in a complex web of information technology systems that will help your patients take charge of their own wellness, keeping your quality measures high and your dollars in your pockets.  The continuum of care doesn’t start and end with the information typed into your EHR during an office visit.  Telemedicine, mobile tools, and online interactions are going to be playing an increasingly important role in patient care, yet there are few standardized approaches to dealing with patient-provided data, remote consults, and mHealth applications.

While communication with patients plays an important role in the latter stages of the EHR Incentive Program, there is no explicit link between meaningful use and telemedicine.  But patients want it, and physicians find it useful and cost-saving. After less than three years of incentives paid for meaningful use, nearly half of the nation’s providers and three quarters of hospitals have adopted electronic records.  Why isn’t telemedicine receiving the same treatment so it can see the same astonishing results?

Meaningful use is ultimately designed to engage patients in their own healthcare, which can be made safer and better coordinated through EHR use in the physician’s office.  Coupled with this, accountable care initiatives are transforming payment models to focus on value-driven services, shorter hospital stays, and better outcomes.  Telemedicine is the clear link between these vectors, making it easier for patients to connect with their providers, and easier for providers to help with chronic disease management, send reminders and tips, provide, motivation for smoking cessation or weight loss, and run a direct line to a personal health record or EHR data through a standard internet connection.  There is no accountable care without those things, and no better way to make them happen than through smartphones, laptops, and video calls.

“We are at the threshold of a new environment in which telemedicine must be an essential part of mainstream healthcare if patients are to receive the appropriate care (based on clinical need and evidence-based medicine), at the appropriate site (closest to where they live and work aided by electronic links), by the appropriate provider (based on explicit and rational triage criteria), while avoiding duplication and waste (using uniform protocols for diagnostics and procedures),” states Rashid Bashshur, director of telemedicine at the University of Michigan Health System.  “This prodigious task can only be achieved through a deliberative process of developing telemedicine systems that incorporate and integrate the core elements of healthcare reform, namely, EHR, meaningful use, HIE, and ACO.”

The HITECH Act and the Affordable Care Act give us an opportunity to think carefully about the role of telemedicine and mHealth in the transformation of healthcare, Bashshur asserts.  A telemedicine-enabled ACO is the embodiment of the full-service healthcare system, he argues.  Without telemedicine, there is no way to optimize the health IT systems the industry been working so hard to implement.  And a structured approach towards system integration is the only way to make sure that healthcare delivery is as streamlined and efficient as everyone would like it to be.

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“We’ve had four national coordinators for meaningful use, but we don’t have one for telehealth,” said Ryan Spaulding, director of telemedicine and telehealth at the University of Kansas Medical Center during a recent talk. “We’ve got some people in the shadows, I think, that could do this kind of work and drive this kind of program, but we just haven’t really taken that idea to the next step to get somebody in place.  How can we take a little more of a structured approach to not just adding current telehealth into meaningful use, but how can we create almost our own meaningful use for telehealth?”

His plan to address the issue includes establishing a national coordinator for telehealth, working hand-in-hand with the ONC on health IT issues.  Mirroring the EHR Incentive Program would give telehealth the boost it needs to take off and supplement the work being done on EHR adoption and health information exchange.  “We don’t really have at the national level a strategic plan that was designed in a way that [meaningful use] was designed,” he said. “It would be nice if we could pursue something like that.”

It’s true that providers already facing hundreds of thousands of dollars in new health IT investments might not be thrilled to have more work heaped on their shoulders at such a critical point in the industry’s transition.  Money is scarce, IT staff members are overworked, and many frustrated practices are shopping around for new EHR systems after failing to adapt to their first implementation.  Why add telemedicine to the mix?  Because if they’re properly constructed, “a full-service telemedicine network would provide the foundation for a successful ACO,” writes Bashshur. “It would introduce the necessary organizational change in the delivery process rather than simply making the old system operate electronically.”

“It is time to think boldly about the current health reform legislative environment and the unprecedented opportunities for not simply promoting the diffusion of telemedicine but, much more importantly, to establish telemedicine as an integral component of a more rational healthcare organization in this country,” he adds.  “Only marginal improvements in efficiency and effectiveness can be achieved unless telemedicine moves to the forefront, in concert with other health information technologies, in planning the health system of the future.”

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