American Telemedicine Association’s policy duo, Jonathan Linkous, CEO, and Gary Capistrant, Senior Director of Public Policy, return with updates and new information regarding telemedicine.

Congress
In the wake of the Government shutdown, Congress continues to debate several different legislative proposals and provisions. One aspect involves the repeal of the medical device tax which charges a 2.3% tax on all medical devices; including some telemedicine components. The provision to repeal this tax is on the table; however, Capistrant says while this is possible it is not probable.

Bill HR 3077 was introduced by Congressmen Devin Nunez and Frank Pallone to allow providers with one state license to provide care via telemedicine to Medicare beneficiaries wherever. A similar bill, HR 2001, by Charles Rangel would provide the same for VA beneficiaries. These bills will essentially make one license enough for healthcare providers working with federal agencies or federal programs. This will help expand access to telehealth services which can provide numerous cost benefits to both patients and providers.

Greg Harper’s bill, mentioned in the last webcast, to improve Medicare coverage for telehealth has not been introduced because of the shutdown. However, because this is the beginning of a two year congressional session, even if this bill does not get passed this fiscal year there is still next year.

FDA
The FDA has released final guidance on mobile medical applications in an attempt provide clear direction to device makers and application developers as to what constitutes as a medical device and needs to go through the FDA approval process. Their regulatory focus will be on medical apps that present a greater risk to patients if they do not work as intended. Additionally, the FDA will develop a web-based platform for developers to seek advice about devices and situations. This will provide better guidance and make it clear as to when the FDA needs to be engaged and what the provisions will be.

States
Fiscal year 2013 was a very busy year for state telehealth legislation and this year will be more of the same. Much of the legislation that was not enacted last year will be reintroduced in 2014. At the top are the 10 states that had proposals for parity with private insurance companies that were not enacted. These states include Connecticut, Florida, Illinois, Massachusetts, Ohio, New York, South Carolina, Tennessee, Washington, and Pennsylvania.

In other news, it was reported that an Oklahoma doctor was disciplined for using Skype to treat patients. However, the use of Skype was inconsequential to what physician Thomas Trow was doing wrong. The main disciplinary issues were Trow’s over prescription of narcotics and failure to maintain medical records. In fact, Trow had previously received disciplinary action from the Oklahoma Medical Board (OMB) for over prescribing, narcotics violations, and record violations. The OMB filed action September 12 and 16 and put out proposals that, according to Capistrant, may be over-reaching and affect telemedicine. The ATA is working with the OMB to ensure these new provisions do not negatively affect telehealth services.

Guidelines
ATA is currently working on a series of guidelines and telehealth best practices for remote ICU, burns and wounds, and primary and urgent care. They are currently awaiting review and approval from the Board and should be available in the next few months.

The next This Month in Telemedicine webcast is scheduled for October 29, 2:00-3:00PM EST.

The Cohen Children’s Medical Center, a part of North Shore LIJ, strongly believes that art is a crucial aspect of children’s hospitals, as it creates an optimistic and constructive environment. This kind of environment allows children to open up their imagination and begin the healing process. As a result, they implemented an interactive virtual aquarium to entertain the children who are in the pediatric emergency waiting room.

The inspiration of this theme came from Long Island’s very own ocean and shoreline to create a familiar setting for young children, making them feel more at home rather than in a hospital. A hospital environment can be scary for young children and having interactive technology that makes them more comfortable can make their stay much more enjoyable and entertaining. By interacting with the technology and creating their own underwater world within the digital aquarium, children can gain a sense of control, something they may have lost by being in a hospital.

Rather than sitting in an intimidating waiting room, children can now be entertained with the virtual aquarium, and interactive “fish tank” that allows children to create their own fish, and then launch it into the tank to swim among the other fish other children have created. The fish are virtually fed, and swim among other sea creatures, such as turtles, larger fish and live among sea coral. Fish and shells decorate the floors and walls, and the CT scan also has fish painted on it. The renovations have made the hospital more appealing to children, making them less fearful of their environment. “Years of planning went into making the new facility child-friendly. Kids almost want to be here,” said Dr. Charles Schleien, Chairman of Pediatrics, in an interview with Newsday.

IVCi was contracted by North Shore LIJ and The Rockwell Group to install the system which is made up of six LCD panels, each about 55 inches wide, creating a fifteen foot screen. Six iPads are used to control what happens on the panels and allow the children to create the fish they want. The main audio comes from two speakers located on either side of the LCD mounting frame, creating as real of an experience as possible.

See for yourself with the demonstration below!

Digital Aquarium at Cohens Childrens Medical Center – Emergency Waiting Room from labatrockwell on Vimeo.

American Telemedicine Association’s policy duo, Jonathan Linkous, CEO, and Gary Capistrant, Senior Director of Public Policy, return with updates and new information regarding telemedicine.

Medicare
Several weeks ago Medicare created its proposed rulemaking for the physician fee schedule, set to begin on January 1st, 2014. There have also been two major improvements proposed for telehealth. One is the expansion of the definition of a rural health shortage area. The purpose of this is to increase coverage of telehealth by allowing more areas to be considered metropolitan counties. This proposal will help the 104 counties that lost their telehealth coverage due to their lost status as a metropolitan county.

The second proposal would provide telehealth coverage for CPT codes for transitional care management services. With this process however, there are some difficulties. While there will be a website people can visit to find out if they are covered, it does not have direct yes or no answers, making it hard to determine coverage. Another issue is that eligibility for coverage is renewed yearly, meaning one year a person may be eligible and the next they are not.

Congress
In last month’s installment of This Month in Telemedicine, Linkous and Capistrant mentioned legislation that Congressman Greg Harper was working on. His bill is moving forward, and some changes were made in the process of finalizing it. “The effort is to really deal with the Congressional Budget Office and what they will end up saying about telehealth provisions” explained Capistrant. There have also been several proposals to get a savings estimate from the CBO.

  • To have a Medicaid option for high risk pregnancies. Two years ago ATA got an estimate that it would save Medicaid 168 million over 10 years.
  • Giving hospitals an incentive for doing a better job in reducing their number of readmissions. It would allow the hospitals to share in the savings and will pay for home monitoring and video.
  • Have Accountable Care Organizations currently under Medicare (which serve about 4 million beneficiaries) use telehealth the same way Medicare’s managed care plan does. Medicare has started an effort to experiment with bundling with hospital payments with post-acute payments. There has participation in almost 400 hospitals all over the country. The goal is to have those hospitals be able to use telehealth to deal with that post-acute care and not have the restrictions that are in Medicare’s statute continue to apply.
  • Allow home video to people who are doing dialysis at home. This will empower more home dialysis and yield savings.

Other Harper package provisions that have been added include: restoring coverage for 104 counties, provision to go for coverage for telestroke diagnosis country wide, as well as some provisions dealing with critical access hospitals that are in metropolitan areas. These hospitals will not be included in the health shortage area because it is a hospital.

States
There has been a lot of progress among the states with telemedicine. The Governor of Missouri has signed a bill that will allow a parody law for private insurance covering telehealth. Missouri is now the 19th state that has this law. The ATA is finalizing three of the state best practices for Medicaid uses of telehealth, as well as a final report of major gaps in each state about telehealth

The ATA Board just recently approved online, web-based mental health services. It is also interested in developing practice guidelines for teleICU, web based or online primary and urgent care services that are starting to be developed, and remote health date management on wounds and burns, according to Linkous. Telepathology guidelines are also being rewritten.

Fall Forum in Toronto
The focus of the Fall Forum in Toronto is to examine some of the problems that have recently been discussed involving telemedicine. A major focus will be reducing readmission rates in hospitals. “A big topic in every hospital, in not only this country but around the world, is how do you reduce the readmission rate within the hospital and there’s a lot of work that’s been done on this using telemedicine as part of the answer. Not as the answer, but part of it,” explained Linkous. They will also be covering issues such as Telehealth networks, and how you can make those networks sustainable, as well as how to engage customers. They will also be covering topics such as mainstreaming in health applications, or “apps” to be integrated into the healthcare system. Other topics include virtual care and provider services.

American Telemedicine Association’s policy duo, Jonathan Linkous, CEO, and Gary Capistrant, Senior Director of Public Policy, return with updates and new information regarding telemedicine.

Federal Policy Summit
On June 27, Linkous and Capistrant attended the Federal Policy Summit, a conference in which several issues regarding telemedicine were discussed. “It’s a great time to be having this Federal Telehealth Policy Summit, because we’re on the verge of an explosion of opportunities for telehealth, not necessarily things directly or specifically for telehealth but a lot of opportunities for change in the healthcare marketplace,” says Capistrant. Several key political figures attended the summit as well, such as Congressman Mike Thompson, Congressman Gregg Harper, and Congressman Glenn Thompson, all of whom spoke about telehealth and telemedicine. Each Congressman has contributed to the success of telehealth and continues to do so politically. Several pieces of legislation are currently in the works with the idea of positively changing telehealth in mind.

Four leaders of key federal agencies were in attendance as well. These leaders include the Health Resources and Services Administration (HERSA), the Federal Communications Commissioner, the head of the FDA on medical device and the leader in telehealth at the Veterans Affairs Department.

Along with these speakers, there were three different panels dealing with three specific aspects of telehealth. These panels include patient panels, health players and providers, and telecommunication providers. Other issues that are going to be heavily discussed include the FCC’s health care connect program and its opportunities such as the billion dollar funding opportunity that was previously discussed in last month’s installment of This Month in Telemedicine; along with the Nation Institute of Standards and Technology to review standards and guidelines.

Legislation
Congressman Harper is currently working on a bill that was planning to be introduced in time for the summit, however it is not yet ready. “The idea is to create a package that both Democrat and Republican congressmen and senators can line up and support and create the kind of political support through it that the congressional budget office will actually estimate the cost of it,” says Capistrant. The bill borrows most of the provisions from the Mike Thompson legislation to fit into existing payment innovations. There are also improvements regarding Medicare. This bill focuses on dealing with the 104 counties that lost their Medicaid coverage due to the fact that they are no longer considered metropolitan areas. The goal is to get Medicaid back into metropolitan areas and then accomplish the specific goal of getting Telehealth into the home.

The idea of this package is, “to have it ready for much more serious consideration later this fall when Congress has to deal with the physician payment reform issue” says Capistrant.

There has been previous discussion of a bill being put together by Congressman Nunes of California about allowing Medicare beneficiaries to be served by someone across the state line without that provider being licensed in both places. However, an early draft of the bill contained a doctor patient relationship requirement which the ATA opposes. This particular legislation has not yet been formally introduced.

Affordable Care Act
There are certain dates coming up regarding the Affordable Care Act.  On October 1, states will be offered state based health insurance exchanges, although actual coverage begins in January. The ATA estimates that around 14 million people will participate in that new coverage. There are also hopes that telemedicine will be a part of that coverage. January 1 is a very important day for Medicaid enrollment, as the ATA estimates that half of the states that will be opting in to expand Medicaid coverage. Key states such as Ohio and Arizona are still debating it; however if they do there will be an estimated 20 million people on the roll with Medicaid. At the end of the year there will be a “doc fix”, or a bill that is looked at every year called “The Sustainable Growth Rate Bill”. “Congress has pledged to really do something this year, of course they say that every year but this year they really mean it. Several members have told us that if they go through a change that telemedicine is going to be an important part of it,” says Linkous.

ATA Service Provider Forum
The ATA Service Provider Forum is a special meeting that will take place prior to the Federal Policy Summit. “There is a new group coming out of our industry council for industry council members. So many of our companies traditionally have been medical device companies, but now the world has changed,” says Linkous. There are many companies involved in providing direct services as well as specialty consoles to emergency rooms, monitoring services, as well provide web based consultations. This forum serves as a way to discuss this growing field, and will open for the meeting. The ATA Board has also approved exploring the idea of doing accreditation of online web based consultation services.

The thought of implementing a new Electronic Medical Records (EMR) system is enough to make anyone in a healthcare organization wake up in a cold sweat. Switching from paper charts to an entirely new way of providing patient care is a daunting task for most physicians as it requires a brand new set of processes and procedures.

However, the benefits of EMR can no longer be ignored. Not only does storing medical records digitally help prevent filing errors, patient records can be backed up in multiple locations significantly reducing the threat of losing patient health information in an emergency. Plus, the data is accessible almost anywhere allowing physicians to view medical history and treat a patient regardless of where they are.

As a result, five leading health systems have created the Care Connectivity Consortium to pioneer the use of electronic medical records. Together, Intermountain Healthcare (based in Utah), Geisinger Health System (Pennsylvania), Group Health Cooperative (Washington), Kaiser Permanente (California), and Mayo Clinic (Minnesota) are working to develop a secure way of sharing patient information regardless of the vendor used to originally create the record.

The five healthcare systems involved have an enormous geographic reach and access to large volumes of patients. They must work together to develop, test and implement processes and procedures to quickly access and share patient information across multiple different EMR systems. Additionally, the Consortium must address how to obtain a patient’s advance consent and then store it properly to ensure it is readily accessible in the event of an emergency visit, states Todd Allen in a blog article.

Visual collaboration technologies can help connect geographically dispersed members of the Care Connectivity Consortium and enhance the collaboration experience. Audio visual integrated rooms designed to support complex data allow participants to share multiple forms of content from multiple sources. Therefore, members participating in collaboration sessions can view different EMR interfaces side by side along with other data to help advance the EMR process.

These collaboration rooms can also be used within different areas in the health systems. For example, operations staff can meet to discuss best practices around EMR and other hospital operations. Roundtable sessions can also be conducted by connecting medical specialists and allowing them to discuss recent findings, best practices and treatment options.

Once the Care Connectivity Consortium has created an effective process, the organization can utilize collaboration solutions to train physicians, administrators and other staff members through recorded Video on Demand sessions. Embedded video clients can then allow anyone with questions to connect via video to an EMR specialist and receive clarification. Furthermore, embedding video solutions in the EMR system itself would allow doctors or nurses to connect with a patient’s primary physician.

As a mother of three very accident prone children, I have been to the Emergency Room in Intermountain Healthcare’s network. There is a small peace of mind in knowing that when we arrive, my child’s entire medical history will be available with just a click of a mouse. I applaud the Care Connectivity Consortium for their effort in advancing Electronic Medical Records and hope that one day mothers across the country are able to experience these same benefits.