According to the study’s authors, who are based at Stanford University, the University of California, San Francisco, and the Santa Clara Valley Medical Center, patients who suffer but survive one stroke are often at risk for a second one—which could be deadly. This makes identification of risk factors in patients crucial. As a press release accompanying the study from the Stanford School of Medicine explains, “one important risk factor for that perilous second stroke is an irregular heart beat called atrial fibrillation.” In most cases, providers monitor post-stroke patients for atrial fibrillation while they’re hospitalized; the American Heart Association recommends, too, that patients undergo 30 days of monitoring within six months of the stroke occurring. But as study co-author Calvin Kwong explained in the Stanford press release, this rarely actually happens: “Once they go home — after about a week — clinicians aren’t usually too vigilant about monitoring them for atrial fibrillation,” he said of stroke patients, citing cost as one explanation for this. What’s more, not all patients require such monitoring.

With that in mind, and with access to a database of more than 9,500 stroke patients’ health information, the researchers sought to develop a way to more easily spot atrial fibrillation in post-stroke patients, eventually arriving at an algorithm that examined EHRs for certain key words associated with atrial fibrillation. As outlined in the press release, “By ranking the clinical attributes of patients whose medical records indicated they went on to be diagnosed with atrial fibrillation, the team was able to assemble a set of seven risk factors that, when combined, predicted which stroke patients were the most likely to develop the condition and should be monitored after hospitalization.” While the study’s authors note that further research is needed to validate their findings, they are optimistic about the system they created. As Fierce Healthcare and Stanford both note, the study’s results are part of an ongoing effort at the university to prioritize precision medicine. Earlier this year, we highlighted research from another Stanford faculty member focusing on wearable devices. Euan Ashley and his team examined how well wearable devices track such measures as heart rate, believing that the devices could be potentially useful for improving cardiac health outcomes.

Click here to read the article from Fierce Healthcare on the EHR algorithm study.

Click here for the article abstract from Cardiology (full article requires payment). 

Click here for the press release from Stanford University on the EHR/stroke study.

The legislation, Sen. Schatz’s office explains in the press release, would allow for the provision of broadband service at a discounted rate to practitioners who are members of telehealth consortia and are mostly treating patients located in rural areas, even when the providers themselves are in non-rural areas. (Currently, rural consortia members receive a 65 percent discount on broadband service.) Essentially, as Sen. Schatz notes, the bill, which was first introduced in the 114th Congress, “will give telehealth service providers better incentives to serve more rural areas.” For his part, Sen. Wicker highlighted the legislation’s potential economic benefits. “Telehealth services are critical to increasing rural Americans’ access to quality care,” he said in the release, pointing to the work being done in his own state. “Mississippi is leading the nation in developing telehealth technology. Our health-care providers have demonstrated that targeted investments in telehealth can increase access to life-saving services and drive down costs.”

The importance of broadband coverage for the provision of telehealth services—and for health outcomes generally—has been a recent key area of focus for many rural health care advocates. Earlier this year, the American Medical Informatics Association (AMIA), the American Telemedicine Association (ATA), and other organizations urged the Federal Communications Commission (FCC) to prioritize the expansion of broadband access as a way of addressing health care disparities. As we noted at the time, AMIA encouraged the agency in a letter to consider broadband access “a social determinant of health,” given its importance to telehealth and other mobile health technologies, as they craft broadband policy. And last month, a report from the FCC’s Connect2Health initiative found an increase in the number of Americans residing in so-called “double burden” counties, where people experience both limited access to high-quality broadband Internet and significant prevalence of chronic disease. Testifying before a Senate committee last month, CTeL Board member Dr. Karen Rheuban, who heads up the University of Virginia’s telehealth program, cited the report in urging lawmakers to step up their investment in rural broadband. “Affordable broadband connectivity is without question, the requisite underpinning of our telemedicine program, and as such, these efforts have changed the standard of care in rural Virginia,” she told committee members.

Click here to read the mHealth Intelligence article on the RURAL Act.

Click here to read the press release from Sen. Brian Schatz on the RURAL Act.

The ACA allotted $200 million for school-based health centers, allowing for the construction of new centers and the refurbishment of existing ones. Medicaid is another key source of funding, given that, among the 70 million Americans currently enrolled in the program, most are children. But the Senate ACA “repeal and replace” bill, the Better Care Reconciliation Act (BCRA), would drastically cut back on Medicaid funding, with approximately $772 billion slated to be stripped from the program during the next decade if the bill were to become law. The House legislation, known as the American Health Care Act (AHCA), would also turn Medicaid into a block grant to states; President Trump’s FY 2018 budget blueprint proposes doing the same thing, which would leave states with far less flexibility when it comes to investing in new, innovative programs. Steve North, medical director and founder of the Center for Rural Health Innovation, put the importance of Medicaid in stark terms: “If the Medicaid reimbursement isn’t there, you’re not going to make it.”

Studies, Pittman explains, have demonstrated the positive impact that school-based health programs can have. A 2014 Brigham Young University study, for example, identified cost savings to families as well as lower rates of absence from school. Similarly, a May Slate article on potential casualties of the AHCA also highlighted the safety net that the programs often provide for working families in rural areas—and the bipartisan support that they tend to have among lawmakers who recognize their value. “They’ve all been here to our ribbon-cuttings, they’ve written letters to help us get grants—they’ve all been very supportive,” an Ohio woman who helped to set up one local school-based health center told Slate of area legislators. Indeed, as Pittman notes, telemedicine in general has traditionally enjoyed broad support from lawmakers on both sides of the aisle. (The current Congress, for example, has seen the introduction of a number of bipartisan telemedicine-related bills, along with the formation of the bipartisan Telehealth Caucus, even amid talks of ACA repeal.) Health and Human Services (HHS) Secretary Tom Price, too, has voiced support for telemedicine in the past, even mentioning its potential during his confirmation hearings. For their part, the people Pittman interviewed emphasized the crucial role that school-based health centers play for students with limited access to medical care. “In many of our situations … the school nurse is the only health care provider a child ever sees,” Kelli Marie Garber, the operator of a school-based telemedicine program out of Charleston, South Carolina, told Politico. Stay tuned as the “repeal and replace” talks continue.

Click here to read the Politico article on school-based telemedicine programs and Trumpcare.

Click here to read the Slate article on school-based health centers. 

PDMPs, the CDC explains, are “state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients.” For prescribers and pharmacists, they can provide valuable information on the drugs that a patient has already been prescribed, as well as on the potential for drug abuse; having access to this information can also allow for early intervention with at-risk patients. Integrating Michigan’s PDMP with hospitals’ EHR systems will save health care providers from having to manually log into the program—a step that many, as it stands, aren’t taking. Per Crain’s, only about 28 percent of providers are currently utilizing MAPS; however, officials believe that that number could rise as high as 80 percent with EHR integration.

Doctors have previously advocated for the integration of EHRs and PDMPs, noting that it would make the monitoring program more effective by facilitating its usage. Last year, for example, as Fierce Healthcare reported at the time, two Yale School of Medicine faculty members cited study results that showed providers changed prescribing habits once they had access to patient data from a PDMP. And in Michigan, some are cheering the state’s new MAPS EHR integration initiative. “If the data is accessible, easily accessible, and doesn’t take time, every provider I know is happy to use it,” said Dr. Rami Khoury, M.D., an emergency medicine physician at Henry Ford Allegiance in Jackson, Michigan, in an interview with WWMT.com. Providers oppose, however, mandating the use of MAPS for all providers. As Michigan State Medical Society President-Elect Betty Chu told Crain’s, “Making [the system] easier to use by integrating into EMRs, we are happy about that.” At the same time, she worries that requiring MAPS usage would be overly burdensome and potentially “contribute to physician burnout.” According to Chu, the Medical Society is currently working with legislators to address that issue and others related to MAPS.

Click here to read the Fierce Healthcare article on the Michigan PDMP/EHR initiative.

Click here to read the article on the PDMP/EHR initiative from Crain’s Detroit Business.

These days, the survey’s authors noted, the overwhelming patient preference is for their health care providers to be as tech-savvy as they are. “Across industries, consumers have become accustomed to using virtual technology for both real-time and asynchronous interactions,” Tom Cassels, a national strategy partner at the Advisory Board, said in the company’s press release. “Health care providers can no longer wait to catch up.” The respondents’ high comfort level with technology could also be seen in their answers to survey questions about the types of telehealth visits they would prefer to have with providers, with respondents indicating that they’d be comfortable having a wide range of virtual consultations. Among the options: psychology visits, pre- and post-surgery check-ins, and prescription-related consults. “Many interested over 70 percent of respondents,” the researchers noted.

Respondents did have some concerns about using these new technologies to connect with their health care providers. Indeed, all but nine percent of respondents said that they were worried about certain aspects of telehealth visits, with the potential for reduced quality of care and the possibility of incorrect diagnosis topping the list of commonly cited concerns. Still, the Advisory Board team is optimistic about the continuing trend toward virtual care, and, as other researchers have expressed, they believe it presents new opportunities to empower patients to play a more active role in their own health care. The survey’s findings echo those of a recent study demonstrating health care organizations’ desire to invest in telehealth and remote monitoring. As we reported back in April, an American Telemedicine Association (ATA) survey of 171 health care executives found that an overwhelming 83 percent of health care organizations have plans to invest in telehealth and mHealth in the next year. Only one percent of respondents had no plans to do so at any point in the future.

Click here to read the article from PatientEngagementHIT on the Advisory Board study.

Click here to read the Advisory Board press release on the study results.

The 115th Congress, which began in January of this year, has been a particularly busy one for the introduction of telehealth-related legislation. Notably, at a time of intense partisanship on the Hill, the vast majority of these bills have been bipartisan ones. Telehealth, though, has long been an area that has seen support from both sides of the aisle, and the legislation introduced over the past few months appears to be continuing that tradition. Similarly, this spring also saw a bipartisan group of lawmakers debut the Telehealth Caucus; led by longtime telehealth advocates Rep. Mike Thompson (D-CA), Rep. Gregg Harper (R-MS), Rep. Diane Black (R-TN), and Rep. Peter Welch (D-VT), it will be dedicated to improving access to and quality of telehealth and remote monitoring.

This spring also saw the release of a Government Accountability Office (GAO) study asserting that outdated Medicare reimbursement policies and other coverage limitations are standing in the way of wider utilization. Such restrictions, the agency’s researchers argued, “limit the geographic and practice settings in which beneficiaries may receive services, as well as the types of services that may be provided via telehealth and the types of technology that may be used.” Many of the bills introduced have specifically targeted existing Medicare restrictions, and the GAO report could help bolster the case for their passage.

While, of course, most bills that are introduced fail to become law, the introduction of legislation can serve to raise awareness and to start conversations—and to build momentum for future legislative action. So even if the 115th Congress ends without any of the below bills becoming law (a likely scenario), their introduction serves to show that a growing number of lawmakers see the value in telehealth.

We’ve been following the progress of a number of these bills here on the Telehealth Buzz blog (and will continue to do so). But be sure to download our in-depth report, available in the Research Library, for further analysis.

See below for more detailed information about the Coalition, and join our first conference call this Thursday, June 29, at 10 AM. You can register  here!

Background

In 2001, when telehealth was still in its comparatively early stages, advocates for reimbursement presented findings to the Congressional Budget Office (CBO), the nonpartisan entity that assesses the potential fiscal impact of proposed legislation, in support of Medicare reimbursement for telehealth services (this was shortly after the passage of telehealth-related legislation in Congress). However, the CBO had concerns about the degree to which telehealth would reduce costs for Medicare; these misgivings led them to put in place the restrictions, including originating site and geographic limitations, that frustrate patients and providers today. Even with these restrictions, CBO significantly misjudged the cost of federal telehealth spending. Today, the members of the Telehealth Reimbursement Coalition and their Hill allies are seeking to present the CBO with a base of research that clearly demonstrates telehealth’s ability to reduce health care costs—or at least that it is cost-neutral. The Coalition’s three core teams are aiming to complete their work by October.

What have coalition members been doing?

• Identifying relevant research. Drawing on existing research is the foundation of any academic study, and is a crucial part of what the Coalition is doing. Some members are using specialized search tools to identify studies that could bolster the case for expanded reimbursement with the CBO. Not all studies, of course, are created equal, and the goal is to only include studies with clear data on costs, or that examine the utilization of telehealth as either a complement or a substitute for traditional health care delivery. But there have been some promising initial findings, including one study that showed decreased costs from the use of tele-mental health services; meanwhile, the research is continuing.
• Sharing the patient/provider perspective with utilization data. Other members are focusing on the provider and health-system experience of utilizing telehealth—including its impact on access to care. As more and more organizations build telehealth into their standard of care, Coalition members told meeting participants, the better the position we will be in to influence the CBO.
• Identifying successes, including with federal payers, and using that data. One example of the successful use of telehealth has been at the Veterans Administration (VA), where about 700,000 veterans received care through virtual visits last year. The visits have generated some good outcome measures—for example, a reduction in bed days of care and in spending on travel. Telepsychiatry has been particularly useful for this population; now, as the agency looks to grow the number of patients utilizing telehealth services, they are also looking to expand home care and remote monitoring programs.

What are some of the challenges that have arisen?

• Not all studies are created equal. Some of the current studies of the utilization of telehealth are not well designed, or are outdated, or don’t include data on cost savings. At the same time, existing research is crucial to our efforts.
• There is a limited window of time between now and October—the Coalition’s deadline. Ideally, the Coalition would have time to build a complete “data warehouse,” but the time frame will likely not allow for that. To that end, members suggested reaching out to other groups and organizations as potential collaborators, whether to provide existing data or to conduct additional research.
• Data from different studies is presented in different ways. How should data, especially coming from different studies using different metrics, be presented in a consistent way to the CBO? This is an ongoing challenge that the Coalition will need to address.

What still needs to be done, and how should we work toward it?

What does the Coalition need as it moves forward? Members shared their goals and their potential ideas.

• Help in building a body of research, complete with real data from clinical work, that clearly demonstrates the efficacy of telehealth. Simply put, there is a need for more research, and for more data. For example:
  • Medicare and Medicaid data on utilization and costs.
  • Private payer data on utilization and costs.
  • Evidence from new practice models.
  • In the long term, new data from studies authorized by Congress.
• Clear examples of “low-hanging fruit” across studies and from clinical data. There are common threads throughout studies when it comes to successful telehealth programs. One example that came up during the Coalition meeting was that of telestroke, which several members noted has been effectively implemented in a number of settings. Members suggested potentially setting up a patient registry to gather data on telestroke care’s successful use.
• Help in defining “cost savings” in a consistent way. One member pointed out that there is a gray area between “cost prevention” and “cost savings” when it comes to data. Another pointed to the importance of setting clear benchmarks for measuring cost savings, particularly in the long term, and of accounting for the initial costs of setting up telehealth programs, which could lead some to wrongly conclude that it doesn’t lead to money being saved. What’s more, different providers across different specialties see savings in different ways, and not all studies focused on cost savings are focused on the same specific costs. Still others examine quality and don’t really consider costs. All of this makes it important to arrive at a more consistent definition of “cost savings.”

In conclusion

All in all, the first meeting was a productive one, highlighting both the work that had been done thus far and what remains to be done. Ultimately, as one member pointed out, the group wants the CBO and everyone to understand that telehealth is simply another form of care delivery. What’s more, the goal is to arrive at a place where there’s no longer the need to prove to a wider audience that telehealth works—and that’s what the Coalition is working toward.

We know that, with telehealth, we have the potential to create lasting, positive change in the American health care system. Please send along your thoughts and suggestions—we encourage you to get involved in our efforts to make the case for telehealth with the CBO. And join our first meeting this Thursday at 10 AM!

The goal of the researchers, who are based at the Arctic University of Norway and who received support from the Northern Norway Regional Health Authority in conducting their study, was to demonstrate that, in cases when an in-office neurology consult might prove challenging for patients, telemedicine is a viable option. “New technology is available to diagnose and treat people through telemedicine, but few studies have looked at whether it is effective for people with headache,” explained study author Kai Müller, noting that many people struggling with headaches do not end up getting the treatment that they need. Participants included 402 patients suffering from “nonacute headaches,” or those that “came on gradually,” per AAN. While all of the patients visited a hospital for their treatment, half had in-person visits with a neurologist, while the other half had the consultation via telehealth. Before their visits, and again three months and one year after the visit’s conclusion, participants were asked to fill out questionnaires about the level of pain they were experiencing, as well as “the impact their headaches had on their daily life.”

Ultimately, the researchers “found no differences between telemedicine and traditional consultations” when it came to patients’ outcomes. In other words, “Telemedicine consultation for nonacute headache is as efficient and safe as a traditional consultation.” They also recommend further study, perhaps with a placebo group for comparison; Müller, too, notes that the fact that the entirety of the study was based in a hospital made it “less realistic.” Still, AAN, for its part, is optimistic about the findings, particularly given the potential to help headache patients in rural areas, as the hospital where the Norwegian study’s participants received treatment is located in a very remote part of the country. Said Müller, “Telemedicine may be valuable for people all over the world who are suffering with headaches and want to see a specialist without any extra hassle or inconvenience.”

Click here to read the press release from AAN on the Norwegian telemedicine study.

Click here to read the article from Neurology on the study of telemedicine for headache patients. 

Obesity in American adults, the researchers note, continues to be a cause for concern from a public health perspective. Indeed, approximately 71 percent of adults are overweight, and more than a third are classified as obese, meaning they face significantly higher risks of chronic health conditions like diabetes, stroke, and heart disease. To explore how digital interventions might help improve these metrics, the researchers examined data from a registry of patients, all of whom were either overweight or obese, who participated in a four-month study from Vida Health and a health insurance provider. Participants in the intervention group both downloaded and used the Vida Health app and received “intensive health coaching via live video, phone, and text message through the app.” Coaches, the researchers explained, helped participants set health-related goals and held them accountable for them. The data gathered throughout included participants’ body weight and blood pressure.

The results? Relative to a control group, those who both received digital coaching and utilized the Vida Health app showed steps in the right direction. Specifically, they lost an average 3.32 percent of their body weight, with 28.6 percent of the group even losing five percent or more of it. While data on blood pressure was not available for all participants, nearly half of those who provided it experienced an improvement in blood pressure following coaching and use of the app. Notably, participants who rated the app also gave it very high marks. While satisfied with what they found, the researchers encourage future study of interventions like this one. These results come shortly after the publication of a study that highlighted the role that mHealth can play in tackling childhood obesity. As we noted last week, researchers at Massachusetts General Hospital, working in collaboration with Harvard Vanguard, developed an intervention that had positive results for children and families alike by using technology to connect people to community resources—a crucial component of weight-loss programs, as the Vida Health results also demonstrate.

Click here to read the article on the digital health coaching study from mHealth Intelligence.

Click here to read the results of the digital health coaching study from JMIR. 

The ability to coordinate clinical health data in a centralized location would take the iPhone beyond the capacity of its current health-related features. While its “Health Kit” enables patients to track everything from physical activity to sleep, and even allows them to input and track vital signs like blood pressure and blood glucose (usually measured through recommended compatible apps), the new features would take steps toward interoperability—long an elusive goal for many in the health care industry—by helping patients to share their health information among their various doctors and clinics, as is most people’s preference. “As health care goes digital, the promise has always been to give patients and the doctors they trust full access to their health information,” former United States Chief Technology Officer Aneesh Chopra told CNBC. Facilitating the easy sharing of information among health care providers, he noted, can cut down on medical errors and incorrect diagnoses.

Apple, per CNBC, has been seeking feedback from health IT industry experts as they undertake their new project. Some of the company’s new hires also have a background in the development of electronic health records. (The company is being secretive about the project’s specifics, however, refusing to comment on the CNBC story.) At the same time, the task ahead of Apple isn’t necessarily going to be an easy one. CNBC notes that Google and Microsoft have both failed in their own efforts to promote interoperability. But experts who spoke to Farr are optimistic about Apple’s prospects, given the company’s track record. “If any company can figure out engagement, it’s Apple,” Micky Tripathi, who serves as president and CEO of the Massachusetts eHealth Collaborative, told CNBC. What’s more, Apple is already popular among health care providers (most, CNBC notes, already use iOS) and around the globe (there are currently more than one billion Apple devices in use), adding to the company’s advantages. Stay tuned for more details…

Click here to read the article from CNBC on Apple’s work toward interoperability.