Telehealth

Wen Dombrowski, MD, has been in the field of clinical informatics since the 1990’s. Back then, her work involved building diabetes databases for community health centers. Today, she’s a geriatrics physician executive at Resonate Health, a role that sees her combining technology, social media, and business solutions to help patients with complex conditions. Dombrowski is also one of only a fistful of social media influencers to sit in the top slot of the #HIT100 list. [Also: Steve Sisko: 'Healthcare literacy' surge coming soon] We reached out to Dombrowski ahead of HIMSS16 to discuss what she’s hoping to find at this year’s conference, what trends she expects to see taking hold in 2016, and what she sees as the untold benefit of social media for healthcare. Q: What’s something about you that even your devout followers likely don’t know?  A: My early days in Clinical Informatics were in the 1990's building diabetes registry Access databases for community health centers in inner-city of Chicago. As part of an IHI (Institute for Healthcare Improvement) Diabetes Learning Collaborative, I learned to track key clinical measures and use the data to identify and reach out to patients with gaps in care. Q: One health IT prediction for 2016? A: In 2016 we will see more direct-to-consumer telemedicine and other digital health services. Mainly because consumers are increasingly demanding easy-access user experience of healthcare, and also because technologies are maturing while state and federal payment policies are starting to cover telehealth. I really like this recent quote: "The digital strategy of a healthcare organization must be aligned with everyday consumer experiences in other industries," from @dchou1107. Q: What is the untold benefit of social media in healthcare today? A: Social media is not only an information-sharing tool — it catalyzes online and local conversations about what are the problems and potential solutions in healthcare. While social media is rich in content for anyone to learn about a diverse array of topics, the online interactions between individuals can be encouraging, thought provoking, and motivating people to action. See all of our HIMSS16 previews Q: What are you most looking forward to learning about at HIMSS16? A: I am looking forward to reconnecting with my Health IT colleagues from around the country and brainstorm how to accelerate healthcare innovation so that patients can truly get the best care. At the HIMSS16 conference I am planning to participate in the sessions related to Physician Informaticists, Long Term & Post Acute Care Providers, Women in Health IT, and HX360 Innovation Leaders.  Q: What inspired you to apply for the Social Media Ambassador program? A: I am already active in using social media to promote awareness of the benefits and challenges of using technology to improve health and care. I helped plan the #HIMSS16 Physician IT Symposium, so I was already planning to be at HIMSS sharing about the latest ideas and discussions happening there. Twitter: @SullyHIT This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

A bipartisan group of Senators this week unveiled legislation to remove Medicare barriers to telemedicine use in a bill that proponents say can generate $1.8 billion in savings over 10 years. Led by Sen. Brian Schatz, D-Hawaii, and Sen. Roger Wicker, R-Miss., the CONNECT for Health Act seeks to create an opening for more providers to incorporate telemedicine into their practices. The Senate group hopes to use the platform to further study its effects on healthcare. [Also: Doctor on Demand expands telehealth services to include psychiatry] Currently, many providers are restricted in telemedicine use by geography, strict rules around originating sites, restrictions on store-and-forward technologies, limitations on reimbursable codes and more. Under the CONNECT act, the Senators propose a bridge program to assist providers in the transition to the new Medicare Access and CHIP Reauthorization Act, with its the Merit-Based Incentive Payment System, by removing many restrictions to telehealth and remote patient monitoring under Medicare. Qualifying providers participating in MACRA's alternative payment models, for example, will be allowed to use patient monitoring for patients with chronic conditions. In addition, it would allow new originating sites – dialysis facilities, telestroke evaluation and management sites and Native American health service facilities – and permit further telehealth and remote patient monitoring in community health centers  and rural health clinics. The bill would also allow telehealth and RPM to be basic benefits in Medicare Advantage. That optimism will be scrutinized by the Congressional Budget Office, which has been skeptical of telehealth's ability to reduce government spending. The act is endorsed by a long list of organizations including American Medical Association, Kaiser Permanente, Cerner, AARP, Anthem, Telecommunications Industry Association, American Academy of Physicians and National Association of ACOs, amongst others. Twitter: @JessiefDavis

(SPONSORED) Telehealth technologies are on the rise. For hospitals and providers, telehealth enables more frequent connections with existing patients, and the ability to reach new patients in new markets. Here are the top ten questions providers ask when considering telehealth.

Doctor on Demand has expanded its telemedicine platform to include board-certified psychiatrists, the company announced on Tuesday. In December 2014, Doctor on Demand began offering mental health services with the addition of psychologists to its provider network. Extending the network to include psychiatrists will complete the mental health cycle, from therapy to medicine, officials said. "Mental health is a vital area, where there may be the most need for telemedicine," said Donovan Wong, MD, medical director of behavioral health at Doctor on Demand. [Also: Telehealth's biggest roadblock: physician reimbursement] "There's really a lack of access to care," he said. "Rural areas have the worst access, but even in big cities, like Los Angeles, the wait time is up to five weeks or more for 80 percent of the population. That's really our mission: increasing high quality care. With mental health, that's really what we'd like to do." Doctor on Demand's telemedicine platform connects patients with care providers. It started in 2012, with board-certified physicians, later expanding to offer consults with lactation consultants and psychologists. More than 300 mental health professionals can be found on the network in 27 states, including licensed psychologists and board-certified psychiatrists. The company plans to expand the services nationwide by mid-year. Currently, many patients pay out-of-pocket, but Wong said Doctor on Demand hopes to change that in the near future. The platform has partnered with dozens of employers and health plans, such as United Healthcare, providing 45 million Americans access. Last month, the company announced it signed its 400th corporate customer. “Many Americans don’t have access to mental health treatment, and for those that do, long wait times, distance, cost and stigma are still barriers to getting care.” Wong said in a statement. "These are all challenges telemedicine can address." [Like Healthcare IT News on Facebook] A 2013 National Survey on Drug Use and Health estimated one in five adults aged 18 or older had a mental illness, but only 45 percent of these affected parties received treatment. Furthermore, 55 percent of the nation's 3,100 counties have no practicing mental health workers and the average wait time to see a psychiatrist is two months in some cities and eight months in rural counties. "Too many people don’t know where to turn for mental health care, so they get overpriced care, the wrong care, or no care at all," said Adam Jackson, co-founder and CEO of Doctor on Demand, in a statement. "By adding psychiatrists, we're striving to meet our mission of increasing access to high-quality care.” Twitter: @JessiefDavis

Group sends letter to lawmakers urging fixes such as strengthening telehealth reimbursement policies under Medicare.

Marin General Hospital has entered a 15-year, $90 million agreement with Philips to roll out an array of technologies including clinical informatics, patient monitoring, telehealth and imaging.

The Arkansas Antenatal and Neonatal Guidelines, Education and Learning System, otherwise known as ANGELS, has seen big gains in improving the state’s access to care and reducing infant mortality rates.

Microsoft has been building health-centric features into its stable of products and heading into HIMSS16 is also hoping to tap into the show’s overarching trends: patient engagement, telehealth and wearables. Acknowledging that Microsoft has historically been known as the Windows and Office company, Microsoft communications manager Greg Ormsby said the company is looking to build on those platforms in healthcare. "What’s changing are the emerging care scenarios," Ormsby said. "We’re looking to augment that shift." See all of our HIMSS16 previews At the upcoming HIMSS16, for instance, Ormsby said Team Redmond will be showcasing demonstrations of a partnership that will see MDLive using Skype for Business to conduct telehealth consults between doctors and patients as well as physicians and specialists. That’s one example. Ormsby said that Microsoft is set to release the Surface Hub this quarter and that collaboration tool will be a key piece of the company’s aim to "transform the hospital room." "Patient engagement really rests on helping doctors do their jobs more efficiently so they can help patients during the visit," Ormsby said. On the back end, Microsoft is girding to make the doctor’s experience with any EHR fluid so they can take notes, change apps naturally within a tablet, PC or phone, and access information they need in what Ormsby said should be an unburdensome way. [What healthcare organizations need to know about Windows 10 and Office 16.]  And while much work remains, by Microsoft and other wearable providers, to determine how endpoint devices can be integrated with healthcare organizations other data sources, Ormsby said Microsoft is seeing partners and customers looking into use cases, such as chronic care — and the devices evolving as well.  "Microsoft Band is a fitness and wellness wearable, we target that stay-fit crowd," Ormsby said.  "But one would argue it has the ability to do a lot, like a mobile health app — but that’s to be determined still." Microsoft will be in booth 3832. Twitter: @SullyHIT

Daniel Barchi has taken the reins as chief information officer at NewYork-Presbyterian, where he will oversee a new telehealth program set to launch this year as well as the development and implementation of technology across the health system.

Healthcare practices used on the International Space Station are serving as model for caring for people in some of the most deprived and isolated parts of the world, according to an article published last month in the World Health Organization. Several of the systems used to ensure healthcare for astronauts working in cramped and isolated space station have been studied and implemented in undeveloped areas, Alfred Papali, MD, wrote in “Providing healthcare in rural and remote areas: lessons from the International Space Station.” Papali, with the Division of Pulmonary and Critical Care Medicine at the University of Maryland School of Medicine, shows how the space station astronauts ensure their health while circumnavigating the globe in space by employing three essential services — task-shifting, point-of-care ultrasound and telemedicine services. NASA has mitigated the risk of medical emergencies aboard the space station by training the crew medical officer and by using on-board ultrasound and an Earth-based telemedicine consultation. Space flight, though, presents several challenges, such as engineering and space constraints, limited bandwidth for data transmission, a lack of advanced diagnostic equipment and the absence of a physician. How space station crewmembers overcome these challenges may present a model to Earth-bound programs. For space flight task-shifting, a crew medical officer receives about 60 hours of preflight training, similar to the level of a paramedic in the United States. The WHO cited task-shifting as a key element in cost-effective access to antiretroviral medications, and  nurse practitioners and physician assistants are providing a wide variety of medical services where doctors are scarce, Papali wrote. Additionally, NASA-funded studies in remote locations around the world have had a direct impact on the development of the space station’s ultrasound program. Likewise, the space station’s extensive use of telemedicine is leading to advances of the technology on Earth. Medical data and ultrasound images are routinely transmitted to ground-based flight surgeons for diagnostic and training purposes. Data transmission is not continuous, however, and as in the developing world the connection can be very slow or completely absent. Judicious use of limited technological resources is necessary in any location, Papali wrote. To address this issue, just-in-time educational modules have enabled crewmembers to perform complex ultrasound examinations despite the time lag in communications between the space station and the ground. “These modules could be adapted to terrestrial environments with limited connectivity,” Papali explained. “In addition, NASA has tested virtual remote guidance (i.e. recorded instructional videos for use by crew members using wearable technology) as a means of overcoming connectivity barriers; this technique will soon be used in Haiti to study remote guidance of endotracheal intubation.” It is worth noting also that health services developed and used in space differ in important ways from those used on Earth. “The great challenge for emergency care on Earth will be whether such services can be developed across diverse and fragmented health systems in a coordinated fashion to optimize outcomes, reduce costs and minimize duplication,” Papali wrote. Nonetheless, the services developed for the spaced station can show the way from continued innovation in health services. Twitter: @HealthITNews