1. the use of the Electronic Health Record4 (EHR)
Telemedicine Benefits Study: and of integrated telephonic and Internet
Integrating Enhanced Service Offerings access to health services.
and Providing Measurable Cost Savings
The Medical Home model is an approach to
within the New Medical Home Model
providing comprehensive primary care,
facilitating partnerships between patients and
their physicians, and, when appropriate, the
September 21, 2010 patient’s family. It has been shown that a
patient care team, centered on a primary
physician, is best suited to take a whole person
Patient-Centered Medical Home orientation of care to enable coordinated or
integrated care. Because the care is
During this time of healthcare assessment and
integrated, patients have less difficulty
realignment of healthcare services, the
accessing care after-hours, there is improved
essential factors of providing patient-centered
information flow among providers and there
as well as cost effective care are being are fewer duplicate tests with less medical
reviewed by all employers, health plans and errors.
providers. The concepts of Medical Home1 (or
Patient-Centered Medical Home) and
Meaningful Use2,3 are providing a new
Meaningful Use and EHR
vocabulary to describe our health decision-
making process. The EHR enables much of this integrated
health service model. The secure EHR allows
By providing more healthcare options to the both patient and their physicians to access and
patient with a more patient proactive focus on monitor a patient’s medical records. Patients
service provision, patients will be empowered can then more easily track their own wellness
to use healthcare wisely at reduced cost and, or disease management directly to encourage
at the same time, develop more responsible, them to take the proper steps towards
preventive health habits. Healthcare benefits prevention or proper chronic illness
providers can benefit in this revisionist management. Physicians are freed from
environment by adding cost effective health paper-based record-keeping and can access
services to their health plans and by providing patient records from a web-based portal for
integrated, cost and time saving health face-to-face or for remote consultations, more
administration services. One of the key easily tracking previous consultation outcomes
aspects to providing this new set of services is and prescriptions and testing and lab status.
1
When care is to be provided by a non-primary
For an overview of the (Patient –Centered)
care physician, this same patient EHR can be
Medical Home, see Medical Home, WIKIPEDIA,
http://en.wikipedia.org/wiki/Medical_home securely accessed by the patient or another
2
HHS’s HIT Policy Committee Releases Draft PCP designated physician to ensure all of the
Recommendations on Meaningful Use for Public pertinent patient health data is available to the
Comment, Ed Jones, HIPPA LLC, 2009 specialist or alternate health provider. Certainly
,
3 4
Modern Healthcare, “The search for meaning – For an overview of the Electronic Health Record
and money – in “meaningful use” regulations”, (EHR), WIKIPEDIA,
Webcast, January 27, 2010. http://en.wikipedia.org/wiki/Electronic_health_record
14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292
O 310-339-9042, F: 310-305-1619, Email: imdonaldino@aol.com
2. the principle of Meaningful Use hinges on the either develop their own EHR system, select a
strategic usage of a patient EHR and the vendor's EHR solution, or integrate with a
integration of health services through selected health provider EHR system that is central to
access to these health records. many telemedicine solutions.
Health providers must decipher the numerous
regulations coming out of Washington and Medical practices are being led towards and
determine how best to take advantage of the rewarded for early adoption of EHR and
healthcare revolution. Washington is providing integration of those records across providers to
stimulus in a variety of packages to encourage build the Medical Home. Vendors in the
adoption of Meaningful Use features at the healthcare market have responded to this need
earliest date. Although the focus for health by developing proprietary EHR models for use
reform is patient-centered, it is up to the in health services. Unfortunately, it is up to
healthcare providers to decide on the best those independent health practices to convert
strategy and implementation path for these their records to electronic media and then
new integrated services. decide how and when to share that EHR with
other healthcare providers.
Medical Home and the Integrated EHR By adopting a certified EHR standard at the
core of their data service model, healthcare
When considering the integration of
providers, health plans, and employers can
information, heathcare providers, health plans,
more readily embrace the Medical Home
and employers, must assess all of their
standards. Adopting a certified EHR will ensure
ancillary service providers and the types of
that one’s digital records meet national
data that will need to be communicated among
standards for data exchange between doctor
them. The international non-profit organization,
and patient and between practice and ancillary
Health Level 7 (HL7)5 has grown out of this
health service providers.
need for clarification and definition of
interoperability and is dedicated to providing a
framework for the exchange, integration,
Medical Care Access
sharing, and retrieval of electronic health
information. Just as in the early days of the Another feature of Medical Home is the
information superhighway construction (the patient-centered aspect of enhanced access to
Web), the health information highway is now healthcare. The demand for PCP care has only
being built. increased while the number of qualified PCPs
has not kept up with demand, and will only
The emergence and convergence of the EHR become more severe as additional uninsured
is one of the nascent applications that have are brought into the system with healthcare
coalesced to become a healthcare framework reform. This has put increasing pressure on
building-block. It is up to the healthcare the PCP to provide care to increasing numbers
providers, health plans and employers to of patients per day, with the typical PCP visit
strategically plan how they will adapt to these lasting 3-5 minutes. A common provision of
emerging standards. Healthcare providers can this medical model is based on the PCP’s
agreement to cover groups of patients in a
5
For overviews of the Health Level 7 (HL7) Working plan. In these cases, it is entirely up to chance
Group, see Medical Home, WIKIPEDIA, whether a PCP’s schedule will be manageable
http://en.wikipedia.org/wiki/Health_Level_7 and the or not, and more than likely not. PCP's are
Electronic Health Record Working Group.
14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292
O 310-339-9042, F: 310-305-1619, Email: imdonaldino@aol.com
2
3. often caught in an untenable situation where the phone or the Internet can provide another
they are unable to provide the time and alternative for patients and doctors to conduct
attention that patients need due to time acute care consultations. It can provide access
constraints on their overbooked schedule. to board-certified physicians 24 hours a day, 7
days a week accessible either by phone,
So often, the patient has come to their PCP secure messaging or webcam video. Patient
because they are suffering from a common members have the ability to call, email, or
illness. They just want to be able to ask a few “see” a physician to describe their common,
more questions, but the doctor is already on to non-urgent condition and receive advice, a
the next patient. Neither doctor nor patient is diagnosis, or even be prescribed medication.
satisfied with this, but we make do. Patients When PCP patients are given the alternative of
waiting to see their PCP may have to wait a waiting days to see their PCP, go to an urgent
few days for an appointment. Now, what was a care facility or the emergency room, or access
minor illness a few days ago has them in great a certified physician from their own home, they
pain or they are home in bed and can’t work. chose the telemedicine option.
Many patients cannot wait a few days to see a
doctor even though their illness is not serious.
They decide to go to an urgent care facility or Telemedicine and Medical Home
even an emergency room to get seen today.
When used within the context of Medical
Actually, only 42% of doctor visits for acute
Home, telemedicine services are a valuable
care (treatment for newly arising health
and necessary service to include in full-
problems) are with the patient's PCP6. As we
coverage health plans both for their employers
all know, health care costs start soaring with
and their employees. PCPs can be assured of
this and similar options.
informed, cross-coverage service for their
patients during after-hours. Healthcare
providers require access to a secure-
Telemedicine and Telehealth
networked EHR system interoperable the
The American Telemedicine Association (ATA) patient's PCP EHR format. Heathcare
defines telemedicine7 as the use of electronic providers must also track the progress of
communications and information technologies government regulations with respect to EHR
to provide clinical services when participants Certification to ensure their own EHR
are at different locations. Telehealth compliance. Telemedicine consultations
encompasses a broader application of require sufficient patient information to be
technologies to distance education, consumer available in order to provide informed advice or
outreach, and other applications wherein a diagnosis. A patient EHR must be completed
electronic communications and information before using telemedicine services as one
technologies are used to support healthcare would do during any initial visit to a new doctor.
services. Telemedicine services accessed via Access to complete prescription records
ensures that care is coordinated and integrated
6
Where Americans Get Acute Care: Increasingly It's within the patient’s current health regime.
Not At Their Doctor's Office, Health Affairs,
September 2010, pgs 1620-1629. Most telemedicine physicians are specially
trained in cross-coverage, telemedicine care
7
Telemedicine, Telehealth, and Health Information provision so patients are assured of getting
Technology, American Telemedicine Association, informed, caring advice. The Medical Home is
May 2006.
14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292
O 310-339-9042, F: 310-305-1619, Email: imdonaldino@aol.com
3
4. not only maintained by this cross-coverage wellness and disease management tracking
service, but enhanced as each telemedicine assists patient members in being more
consult is logged and tracked, something that proactive in maintaining their health; a key
is unavailable should that patient have needed feature of the Meaningful Use initiative. Also
to go to either urgent care, retail clinic, or the high on the Meaningful Use must-have list are:
emergency room. In the event that a patient is increasing access to physicians when they are
advised to get immediate face-to-face needed (two-thirds of acute care visits to
treatment through one of these urgent or emergency rooms were on weekends and after
emergency facilities, there is still a record of business hours on weekdays6), maintaining
the patient’s condition logged in their EHR and integrating an electronic record (EHR) of
enabling the PCP to exercise Continuity of all patient interactions, relieving PCPs of
Care. burdensome routine care, increasing wellness
awareness, and saving cost for patients and
The ease of use and expertise of the health providers. Telemedicine, although not
telemedicine physician consultation experience resolving all of these issues, provides many
increases a patient’s satisfaction of care benefits to aid employers, health plans,
considerably. The patient's PCP also benefits providers, and the members they serve survive
from this augmented service. For those PCPs and thrive in the new heathcare environment.
who do not want to be on-call after-hours, as is
true of 60% of PCPs in the US6, they can rest
assured that their patients are still able to Communicating Telemedicine Services and
receive quality care and that they will be able Lowering Costs
to maintain awareness of their patient’s
From a benefit plan or employer perspective,
ailments and treatment. From a quality of care
the behavior change of its patient members
perspective, PCPs can encourage their
away from using urgent care or emergency
patients to feel comfortable in using the
room facilities toward using telemedicine
telemedicine services for routine treatment or
services provides considerable cost savings for
when they are seeking advice of a general
the plan provider or the employer.
nature. This allows the PCP to be more freed-
up and be able to spend quality time with those
Typically priced lower per consultation than
patients experiencing acute need or those that
any other physician health service, the more
have more complicated conditions, reducing
patients use telemedicine services as an
the scheduling pressure that is so common for
alternative to urgent care centers and the
many PCPs these days. If the PCP is covering
emergency room, the more savings will be
patients under a plan that has capitated fees,
returned to the provider. Of course patients
then being relieved of patient treatment for
can be rewarded for this cost savings behavior
routine illnesses by more cost and time-
by passing on this provision savings to them by
effective means is a real boon.
making telemedicine choices be a less
expensive health treatment choice. An ROI
(return on investment) assessment clearly
Additional Meaningful Use Benefits
shows how utilization drives savings. The
Many telemedicine services provide the means National Center for Policy Analysis reported
to fulfill additional Meaningful Use criteria that over 90% of respondents said they would
through the implementation of a patient health recommend telemedicine services to a friend
and wellness management portal. Enhanced
14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292
O 310-339-9042, F: 310-305-1619, Email: imdonaldino@aol.com
4
5. or family member8. Once patients become Vendors today have addressed various pieces
familiar with telemedicine services, their usage of this puzzle to varying degrees. In order to
rate remains high with nearly 93% of those comply with all aspects of the new regulations,
who used the service report they would use it it may be prudent to consider an integrated
again8. In a recent Mercer study, satisfaction approach to meeting all of the aspects
ratings for interactive telemedicine were required.
reported at 98% whereas face-to-face primary
care physician visits were in the 70-78% The combination of a secure information
range9. To drive utilization and reap additional integration platform that enables data rich
savings, an outreach education program EHRs along with a telemedicine (electronically
tailored to the healthcare provider or data compliant) patient-centric supplemental
employer's needs makes it easy to get the care provider can take away much of the onus
word out to members. Additionally, it is helpful of addressing these new regulations and
to track ongoing service usage and gather reduce them to a manageable plan.
satisfaction surveys to gain insightful data
enabling providers, employers, and plans to
understand member feedback and usage
patterns and enable further incentives drive
utilization and savings.
Louise Falevsky
The Picture of Health Executive Vice President
The Grant Group
Two important factors of compliance within the
falevsky@azander.com
Medical Home and Meaningful Use world of
today are the ability to gather, maintain, and
Donald G. Lightfoot, MBA, CLU, CEBS
integrate medical data records (EHRs) and to
President and CEO
provide patient-centric care including increased
The Grant Group
access and dissemination of proactive health
www.thegrantgroup.org
information. This is a tall order for many PCPs
and health plans to address.
8
Convenient Care and Telemedicine, National
Center for Policy Analysis, November 2007, pg 12.
9
Telemedicine MD consultations: satisfaction rates
and use patterns among working-age adults,
Mercer Health and Benefits, LLC, 2008.
14040 Tahiti Way, Suite 512, Marina Del Rey, CA 90292
O 310-339-9042, F: 310-305-1619, Email: imdonaldino@aol.com
5
