Telehealth

The new deal is part of a larger initiative to transform Penn State Health into a hub of telehealth services that cater to patients in Central Pennsylvania. 

(SPONSORED) There is an unprecedented convergence occurring between healthcare and technology – and telemedicine is an increasingly important initiative in the connected health market.

Getting pharmacists involved in patient-centric activities, including being part of clinical care teams, is a little easier thanks to telepharmacy technology. When Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, needed to optimize its pharmacy workflow with the goal of improving patient care, it turned to PowergridRx, a cloud-based HIPAA–compliant telepharmacy platform from San Francisco-based PipelineRx. Starting in February, Dartmouth-Hitchcock began deploying PowerGridRx in its hospitals across New England. PowerGridRx is a software as a service platform that aggregates, manages and optimizes virtual pharmacy management for health systems. In addition, it differentiates Dartmouth-Hitchcock's telepharmacy network and manages the order verification process for current and future facilities. The interoperable technology platform is designed to improve medication administration visibility between facilities and addresses logistical and budgetary challenges that arise from managing and staffing multiple care settings. [Also: Dartmouth-Hitchcock, Harvard Pilgrim join forces on population health] Sarah Pletcher, MD, medical director and founder, Center for Telehealth at Dartmouth-Hitchcock Medical Center, said the health system uses PowerGrid Rx as a tool in the delivery of telepharmacy services across wider landscape. "Our customers are the ultimate end user in that regard," Pletcher said. After going live in six hospitals Dartmouth-Hitchcock has processed thousands of patient orders: "We have data that suggests the benefit to the hospitals in that we are allowing them to load-level staffing and optimize their in hospital team sometimes deploying them to more patient care or clinical activities," she said. Pletcher pointed out that for many smaller rural and critical access hospitals, the volumes that they see on weekends for example, aren't enough to rationalize them having an in-house pharmacist. "But we are also finding hospitals recognizing the value of having telepharmacy support for scenarios where they want to allow their pharmacists to be out on the floors helping with patient care," she said. In a cancer infusion suite for instance, Pletcher explained that oftentimes pharmacists are part of clinical team working on projects where they might be involved in an electronic medical record implementation, or working on quality or formulary projects for the hospital. "Any time we can help extend their team to allow them to optimize their in-hospital team, we're happy to be there for them," she said. From a technology perspective, Pletcher noted that there are obstacles associated with integration and with host IT systems and EMRs. She said that with anything involving multiple hospital IT departments and multiple hospital EMRs, there's always a challenge – not just the technology integration, but cultural barriers where hospitals have different levels of comfort for how much bi-directional integration they want with outside software platforms. "Because we offer so many other telemedicine services this is something we are familiar with managing – the telepharmacy is the latest service – we have six or seven other 24/7 telemedicine services to hospitals where we've had to contend with IT or EMR integration. We kind of know to expect and support those conversations." Pletcher said Dartmouth-Hitchcock is expanding its telepharmacy program to more sites and more regions. "We're excited about the opportunity to further integrate our telepharmacy solutions with other clinical services." Industry insiders contend that the demand for PowerGrid Rx-type technology is on the rise for multi-site multi-facility organizations that are growing and want to tie their pharmacy network closer and closer together. "We want to create a platform that enables them to share pharmacy labor and pharmacy resources across their whole organization, opposed to having to staff individually each hospital within their network, this enables them to tie them to together," said Brian Roberts, CEO of PipelineRx. Roberts noted that among the challenges is to work with different and multiple types of IT systems. "Some of our customers have eight to ten different types of IT systems that they work with - we integrate back with their host IT systems and bring it into one platform." The other side, according to Roberts, is that they want a system that can capture policies and procedures for each one of their individual hospitals. So for example, if they were creating a central telepharmacy center they would want that telepharmacist to have information at their fingertips. "Our tool helps consolidate and bring policies and procedures into one software offering," said Roberts who added that because PowerGrid Rx is a cloud-based piece of software – there is no hardware on each individual site. "So we use the power of the Internet to build a private cloud that can manage all that information – manage the information and store the information for the hospitals." Roberts said CIOs like that because it’s a cloud-based piece of software that doesn't require them to have to go and do updates and update hardware; that's all taken care of from the PipelineRx side.

Project ECHO, a health IT pilot that launched in 2003 in rural New Mexico to connect rural doctors to specialists, is now front and center in Congress as lawmakers consider employing the model across the country. Senators Orrin Hatch, R-Utah, and Brian Schatz, D-Hawaii, introduced the Expanding Capacity for Health Outcomes Act this past week. The bill calls for studies on how best to expand the model. In New Mexico, Project ECHO has recorded unprecedented success in treating patients with hepatitis C. "Project ECHO has proven that technology can help overcome traditional barriers to adequate healthcare treatment, such as distance, income and lack of specialized medical professionals for underserved communities with no access to treatment," Sanjeev Arora, MD, project director, told Healthcare IT News back in 2008. [Also: IT employed in hepatitis-C fight in rural New Mexico] The initiative is underpinned by a Web-based application developed by Infosys Technologies. Project ECHO – it stands for Extension for Community Healthcare Outcomes – was funded by Agency for Healthcare Research and Quality, so the federal government already has a hand in the effort. "In states with large rural populations like Utah, it's vital that we do everything we can to ensure that patients have access to quality health care – no matter where they live," Hatch said in an April 29 statement posted on his website. "Our bill would help connect primary care providers in underserved areas with specialists at academic hubs, making it easier for medical professionals to access the continuing education they need and provide health care to more people," added Schatz. The bill requires the Department of Health and Human Services to work with the Health Resources & Services Administration to prioritize analysis of the model, its impacts on provider capacity and workforce issues, and evidence of its effects on quality of patient care. It calls on GAO to report on how increased adoption of a Project ECHO model might boost efficiencies and potential cost savings and improve healthcare. It also requires HHS Secretary Sylvia Burwell to submit a report to Congress on the findings of the GAO report and the HHS report, including ways such models have been funded by HHS and how to integrate the models into existing funding streams and grant proposals.

In the first major overhaul of Medicaid managed care requirements in more than a decade, the Centers for Medicare and Medicaid Services published new rules on April 25 that affect how Medicaid works for the nearly two-thirds of beneficiaries who get their coverage through private managed care plans. It aligns key rules and practices with those of marketplace and Medicare Advantage, including the addition of reporting medical loss ratio to Medicaid to ensure managed care plans focus on delivering care, not profits, CMS said. The rule finalizes a medical loss ratio at 85 percent. Insurers must spend at least 85 percent of their Medicaid revenue on medical care to improve quality. The remaining 15 percent may be spent for administrative reasons such as salaries and marketing, CMS said. Health plans that don't meet the goal will face future penalties in having their state rates lowered. On the health information technology front, the rules encourage – but don't require – commitment to the principles of health information exchange "Health information technology and the electronic exchange of health information are important tools for achieving the care coordination objectives proposed," according to the final rule. HHS "supports the principle that all individuals, their families, their healthcare and social service providers, and payers should have consistent and timely access to health information in a standardized format that can be securely exchanged among the patient, providers, and others involved in the individual’s care," it states.   "Further, the Department is committed to accelerating health information exchange through the use of health IT across the broader care continuum and across payers. Health IT that facilitates the secure, efficient and effective sharing and use of health-related information when and where it is needed is an important contributor to improving health outcomes, improving health care quality and lowering health care costs." Specifically, the rule points to ONC's Nationwide Interoperability Roadmap and 2016 Interoperability Standards Advisory as containing the "best available standards and implementation specifications to enable priority HIE functions." Providers, payers, and vendors are encouraged to take them into account "as they implement interoperable HIE across the continuum of care, including care settings such as behavioral health, long-term and post-acute care, and community service providers." CMS also sets the conditions for broader applications of telehealth, specifically as a way to bolster network adequacy standards. "Several commenters recommended that CMS add elements (to the rule) to include triage lines or screening systems, as well as the use of telemedicine, e-visits, and/or other evolving and innovative technological solutions," officials write. "We agree with commenters that such services and technological solutions could impact the needs of enrollees in a particular area and could change the manner and extent to which other network providers are needed and utilized. We encourage states to consider how current and future technological solutions could impact their network adequacy standards." An estimated 72 million Americans currently rely on Medicaid as their source of health insurance coverage, 14 million more than in 2013, CMS said. This is largely due to the Affordable Care Act's coverage expansion. The improvements modernize the way managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers, according to Monday's announcement by Andy Slavitt, CMS acting administrator and Vikki Wachino, CMS deputy administrator and director for the Center for Medicaid and CHIP Services. The rule strengthens states' efforts to support delivery system reform and authorizes the first-ever Medicaid and CHIP quality rating system so that states can publicly report plan quality information, and people can use that information to select plans, CMS said. The rule also addresses quality of care standards, as well as focusing on improved communications, such as electronic notices to beneficiaries and creating online provider directories. "States are making gains in using population based payments, episodes of care and quality-based payments," write Slavitt and Wachino in a blog post. "In addition, states operate 30 health home programs that focus on coordinating care for people with chronic conditions like obesity, diabetes and mental health conditions. Over the last several years, sates have undertaken significant efforts through State Innovation Models, integrated care models, and delivery system reform incentive programs to create alignment with physicians and hospitals to provide the highest quality of care. And we have proven that when we and states dedicate ourselves to changing the delivery of care, we get results." Read the final rule here.

Here’s the rub: $50 billion might be hyperbole, but $5 billion is still a sizable enough market to drive innovations that health systems can harness to engage patients, better manage populations and ultimately improve care and the bottom line.    

(SPONSORED) The year ahead offers some promising trends—and optimizing the full potential of digital health will be the key to real progress.

Cleveland Clinic clinicians will be available for on-demand visits at CVS Health MinuteClinics in Ohio via technology from American Well.

The Konica Minolta Business Innovation Center is working to involve 30 U.S. health systems in the wide-ranging test program.

The popularity of health and wellness apps and devices is being fueled more by fitness or activity trackers than clinically-focused tools to help manage chronic conditions.