Telemedicine: Use of remote monitoring to reduce readmissions to hospital -

Telemedicine: Use of remote monitoring to reduce readmissions to hospital

October 30 , 2015 by Debra Gordon, MS

Sally was 74 years old and lived alone. She also had congestive heart failure. Last year, she was hospitalized five times when his condition worsened. After the last admission, however, his doctors tried something new. They sent Sally home not only with a handful of prescriptions and instructions to train, but with an iPad, a digital scale, a blood pressure monitor, a pulse oximeter to determine the oxygen levels in his blood, and a device pocket ECG to measure his heart rate.

its IT ringing every morning, a reminder to check your vital signs. Sally also uses touch screen computer to answer a few questions about how she feels. The results are transmitted wirelessly to the hospital, where an algorithm determines if it is showing signs of danger, such as weight gain, indicating his condition deteriorates. If it is, the computer transmits the information to a nurse following via teleconference.

Sally loves equipment, especially because it means she does not have to go into the doctor's office as often. It also gives him a greater sense of control over their condition.

But the best part? She was not at the hospital in 11 months.

Such is the power and potential of telemedicine, sometimes called e-health, to keep people out of hospital. Telemedicine, described as "the use of technology to provide health care services and information remotely to improve access, quality and cost," includes everything from video conferencing and surveillance remote for phone calls, emails and text messages. But what it really does is to remove the walls between the healthcare provider and the patient, allowing care to be available everywhere, at any time. It is therefore not surprising that 52 percent of hospitals now use telehealth, with another 10 per cent the rise.

One of the biggest goals of telemedicine in hospitals today is to reduce readmission rates. Hospitals have a major incentive. If they do not reduce preventable readmissions 30 per day, they risk losing a significant amount of revenue

Indeed, the Hospital Reduction Program readmissions, which the Centers for Medicare & Medicaid Services (CMS) established in 2012 . the program is designed to reduce readmission rates 30 days of Medicare patients, who have peaked this year by almost 20 percent.

sanctions are difficult. This year, hospitals may lose 3 percent of their total Medicare reimbursement for excess readmissions of patients who have had heart attacks, pneumonia, heart failure, chronic obstructive pulmonary disease (COPD), and hip and knee.

In 2014, 2,610 hospitals were fined by the program, with 39 penalized the entire 3 percent. This is enough to hurt the hospital bottom line. Overall, CMS estimates that hospitals paid $ 428 million in penalties this year.

But financial reimbursement is not the only reason for reducing readmissions. These efforts also prevent exacerbations of the disease that can land patients return to the hospital. For example, monitoring the weight of a person suffering from congestive heart failure can provide an early warning signal that the patient's heart has difficulty pumping enough blood. Ensure that COPD patients using their maintenance drugs every day can prevent problems that lead to hospital readmission

Better still, of course, would be to prevent the initial response providing better preventive care.

Therefore, hospitals have a powerful incentive to find ways to keep their patients discharged home. Increasingly, they are turning to telemedicine.

The main type of telemedicine used to reduce readmissions is remote monitoring. The hospitals provide patients with computers, video conferencing equipment and portable monitors that track vital signs such as oxygen levels in the blood and blood pressure. Patients hold video calls in real time with nurses, complete online questionnaires designed to assess their condition, receive education through interactive programs and send their vital signs monitoring information wirelessly directly to their supplier Health care. The evidence shows that such programs can work quite well.

• Partners HealthCare in Boston implemented a monitoring program and education for patients with heart failure and other chronic diseases in 06. More than 1,0 patients have been through the program so far. The results are surprising: readmission rates for heart failure patients fell and one half non-heart failure readmissions decreased by 44 percent. Partners estimates the program saved more than $ 10 million in its first six years.
• A similar program by the administration of former combatants health for patients who have had heart attacks reported similar results.
• The University of Virginia Medical Center in Charlottesville up a telehealth program that combines real-time data with remote monitoring for patients discharged with heart failure, pneumonia, COPD, recent heart attack, or replacement of the hip or knee. A technician sets up the equipment in the patient's home within two days off. Simple to use equipment consists of a small box that wirelessly transmits data from a blood pressure cuff and pulse oximeter to a registered nurse. If nurses are noticing problems, they contact the patient by phone or, if appropriate, make a home visit. Just one year after the implementation of the program, the medical center has seen its 30 days readmission rates drop to about 10 percent, compared to a national average of 17.5 percent.
• St. Vincent Health System in Indianapolis followed 300 patients with congestive heart failure, COPD, or both within 30 days after discharge from the hospital. Half of the patients received videoconferencing equipment; half (the control group) did not. A nurse has completed at least 10 videoconferencing sessions with patients of the intervention more often if patients needed their vital signs taken. Meanwhile, the control group received a typical post-discharge treatment, especially just a phone call. The results have been impressive. Videoconferencing group of patients had a readmission rate of 5 percent compared to 20 percent in the control group.

The success of telemedicine must be tempered by its challenges however. These include:

• Legal and regulatory issues. medical commissions of states regulate the practice of medicine in every state, often with different requirements. What happens when a doctor or nurse licensed in one state provides telemedicine services to patients living in another?
• Refund. Insurers pay for telemedicine services? In most programs readmission, the hospital takes cost.
• Malpractice insurance. How does provide care for virtual patients influence the malpractice rates?
• Privacy and confidentiality. Does the program meet all HIPAA requirements concerning information on patients' health care? For example, the patient data is encrypted and stored safely? Are the technicians who help set up equipment include HIPAA policies?

The Center for Telehealth and e-Health Law has more on these topics.

George Washington University is at the forefront of telemedicine and mHealth initiatives. These include:

• Telemedicine Institute of George Washington University is an online institute hybrid that introduces the subject of telemedicine to qualified students, graduate students and professionals interested in a multidisciplinary size while stimulating innovation and entrepreneurship in the fields of medicine, engineering, public health, business and law.
• School of Medicine & Health Sciences University George Washington leads the mHealth (mobile health) collaborative, interdisciplinary team with representation from the GW faculty committed to advancing academic part of mHealth on campus GW. Several courses related to mHealth, telehealth, application design, politics, technology health information, communications and wireless networks are available in both the second and third cycles.
• In addition, the mHealth Collaborative is currently working on the design of graduate- level certificate programs in space.
• George Washington University Hospital is also deeply involved in telemedicine and mobile health. The hospital grants to study the use of text messaging to communicate with patients who have diabetes and use of telemedicine to enable patients to receive dialysis at home. Its clinicians also provide medical services via telemedicine to ships at sea, remote clinics and teams and correctional facilities. It also provides emergency medicine fellowship telemedicine to develop future leaders of telemedicine.

The ultimate promise of telemedicine is to break down the walls that traditionally surround patients and providers and enable the provision of health care everywhere, at any time. We are closer than many think. Today, there are services that allow patients to talk to a specialist via Skype-like programs 24 hours a day, seven days a week; "Cybersurgeons" that use remote robotics to operate on patients in remote locations; and virtual ICU, in which specialists and nurses in intensive care in hospital high acuity monitor patients in community hospitals, avoiding the transfer. No wonder, then, that 89 percent of health care managers in a poll believed that telemedicine will transform the US health care system - if it has not already

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