2. Telestroke: Improving Stroke Diagnosis, Treatment and Recovery
Like analytics, telestroke seems poised to move from pilot phase to sustainability.
A need certainly exists. More than 40 percent of the nation's hospitals have fewer than 100 beds, says Dr. David Hess, chairman of the Georgia Regents University Department of Neurology, and therefore have little choice but to transfer stroke patients to facilities with more comprehensive stroke centers. But most of those small hospitals are in remote areas, and moving a patient is literally a life-or-death decision.
Technological advances such as cloud-based videoconferencing, though, make it increasingly easier for hospitalists to confer with neurologists, look at a patient's CT scan and quickly answer the "treat, transfer or admit" question. Sure, there are concerns, among them privacy, security, data interoperability and the need for 24/7 tech support - it's OK if your video chat software drops a call with your son at 2 a.m., but not as you await a decision to administer tPA.
But that capability to deliver a tPA decision in the middle of the night is the "Trojan Horse that gets us in" and proves telestroke's worth, Hess says. What's more, adds Yulun Wang, chairman and CEO of telemedicine vendor InTouch Health, hospitals that have laid the infrastructure required to support telestroke technology can then expand the model and apply telemedicine to psychiatric care, pediatrics and other specialties facing pressure to treat more patients with fewer doctors.
3. Healthcare at Home: The Patient-Centered Medical Home
While the so-called patient-centered medical home is largely absent from the Affordable Care Act, the principles of healthcare reform and the accountable care model nonetheless present an opportunity to demonstrate the value of telemedicine and mobile health. The key task is reducing hospital readmissions - which is part of healthcare reform, so much so that hospitals with "excess" readmissions within 30 days face reduced reimbursements.
Simply put, care can't stop just because a patient has been discharged, says Dana Sheer, director of clinical programs for Partners HealthCare at Home. Providers must better monitor, and communicate, a wide range of activities, from medication adherence to falls. Cynthia Campbell, associate director of operational consulting with Fazzi Associates, says she sees telehealth - perhaps in the form of a geographic-agnostic nurse practitioner communicating over a HIPAA-compliant, Skype-like application - as a solution to this problem.
Providers also need to develop "care pathways," Sheer says. It takes years for someone with a chronic disease to actually get chronically ill. Many such patients have multiple co-morbidities to boot. Educating a patient about diet and lifestyle changes can treat the disease or reduce the likelihood of complications. This takes time, though; as Sheer puts it, patients rarely have a "sudden epiphany" when returning home from the hospital. Plus, the same interoperability challenges that stymy analytics and telemedicine initiatives make it difficult for healthcare organization and their partners, let alone their affiliates, to exchange patient data.
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