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Combining Telehealth And Mobile Technology To Improve The Quality Of Health Care

Bill Crounse, MD, Senior Director, Worldwide Health, Worldwide Public Sector Microsoft Corporation shares his insights and describes four leading trends and technologies that will transform health and health care in 2012 and beyond.

These leading technologies include:  cloud computing, health gaming, telehealth services and remote monitoring/mobile health.

Telehealth, Remote Monitoring, Mobile Health

I’d like to focus on telehealth and remote monitoring/mobile health since I feel telehealth is the nucleus of patient care, and telehealth can help reduce health care costs, and improve quality health care for patients. Telehealth technology combined mobile technology such as smartphones will make monitoring patients conditions easier and more efficient, and “cheaper and more scalable.

Patient Quality Health Care

Through the Accountable Care Organizational Model (ACO), the core concept is to improve the quality of care for individuals with the notion to reduce health care spending.

According to the CDC, chronic diseases cause 7 in 10 deaths each year in the United States, about 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness, and more than 75% of health care costs are due to chronic conditions. In 2009, the five leading causes of death were heart disease, cancer, chronic lower respiratory diseases, stroke, and accidents.

By moving points of care into the community, individuals can maintain their independence with continuous support supplied by remote patient monitoring.  By transmitting personal biometics via advanced data services, patients have the opportunity to have their chronic condition managed continuously by health professionals.

With constant monitoring it is possible to identify high risk patients quickly and provide them with evidenced –based information they need to quickly resolve their condition.  Instead of identifying health care risk at the critical point, telehealth can identify a situation before it progresses to the critical stage requiring potential hospitalization.

To help decrease health care costs, by identifying a potential risk early on, intervention can occur before a critical situation arises.  Not only does this assist with decreasing costs, more importantly it allows individuals to be managed at home.

I recently had a casual conversation with a physician about this topic on remote patient monitoring and mobile devices, health care costs and hospital re-admissions, etc., and he said that he would love to be able to implement remote monitoring for his patients so he can readily monitor them, but he willingly admitted that he really does not know anything about it.

I agree with Bill Crounse, MD:

Remote monitoring with advanced sensor technologies coupled with mobile devices and services as outlined above, will make it possible to care for more patients in less acute settings, including the home, and to do so at scale with fewer staff.  I am particularly impressed by companies that are working with regulators (such as the FDA) to develop approved medical devices and secure gateways that facilitate clinical information exchanges.”

Stakeholders

As I wrote in my article published in HIMSS, this technology already exists, and it does not need to be developed.  The problem is that this technology has been slow to adopt, but more than that, the forward thinking stakeholders involved in the deployment of this technology need the push and pull of not only industry insiders but the biggest stakeholders of all, the patient.

Individuals may have a huge role and may be able to help move the “product to market.”

The health care industry needs to not only understand the value of telehealth, but it needs to implement it.

Your turn

We would love for you to share your insightful thoughts and comments.  Are you aware of the type of telehealth platforms which are available to help transform health care?  What suggestions do you have to help take telehealth products to market?

[image:  Ambro / FreeDigitalPhotos.net]

*This blog post was originally published at Health in 30*


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One Response to “Combining Telehealth And Mobile Technology To Improve The Quality Of Health Care”

  1. Dr. Khare says:

    I cannot agree with this article more. My idea is that readmissions can be curbed with tele health. From the hospitalists who discharge their patients (with a 20% chance of readmission) as well as us ER physicians who see the patient when they are about to be re-admitted and don’t have any other options other than admit and discharge. Telemedicine is the answer, but as the author points out, it’s the implementation that is the problem. Let’s pilot this and get it done! If anyone wants to do this in Chicago, please contact me!

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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