Last week, the Better Health Care Together coalition held a briefing at the National Press Club to unveil a new study written by economist Dr. Robert Litan.

The study, entitled Vital Signs Via Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives, found that the United States could cut $197 billion from its health care bill over the next 25 years by the widespread use of remote monitoring to track the vital signs of patients with chronic diseases such as congestive heart failure and diabetes.

But, and here’s the catch: Dr. Litan warned that adoption of remote monitoring and other telemedicine opportunities will be slowed and benefits reduced unless the United States does a better job of reimbursing health care organizations for remote care and encouraging continued investment in broadband infrastructure that can be tailored to meet the privacy, security, and reliability requirements for telemedicine applications.

Failure to make the right policy adjustments will cut estimated health care savings by almost $44 billion over the 25-year period.

In order to avoid that, Dr. Litan offers several suggestions—listed below are a sampling of some of his policy recommendations for encouraging the technical environment necessary to enable telemonitoring and remote monitoring applications:

- Remote monitoring products must be interoperable, safe, effective, and easy for patients or caregivers to use. Many individual companies offer products that are safe, effective, and easy to use, but interoperability is still far from a reality. Continua Health Alliance is an example of an industry effort toward several common standards for hardware and information sharing. Commitments from Medicare to provide preferential reimbursement for interoperable products (as part of the broader changes to Medicare reimbursement discussed below) would accelerate interoperability.

- Widespread broadband connections allow for rich patient data exchange, video visits, and patient education via the internet and video-on-demand. However, seniors tend to be late adopters of technology and at the same time benefit disproportionately from more effective chronic disease care. For telemedicine to achieve its promise in both service improvements and cost reductions, policymakers should encourage adoption (especially among seniors) by several means: investments in internet education; incentives for rural broadband infrastructure investment; and telecommunications policies that allow broadband providers to experiment with different offerings that attract marginal users without sacrificing profits on other users.

- While broader broadband penetration is clearly desirable, the right kind of broadband is just as important. Effective remote monitoring requires “smart networks,” those which ensure that patients’ critical data and communications are not disrupted. As with ambulances on the road, communications essential to patients’ survival should take priority over other traffic on the network. The resulting reliability and quality of service is crucial to the ability of providers to supplement virtual care for in-person care. Policy must therefore ensure that network providers retain maximum flexibility to assure the quality of service necessary for effective and reliable telemedicine services.

- The critical and personal nature of the health data involved in remote monitoring calls for network infrastructure that allows for extremely reliable and secure transmission of patient communications and data. Although some stop-gap technologies have been employed in trial applications, wider adoption will require investment and support of innovation in network capabilities.

- Given the sensitivity of personal health information, privacy rules are essential. At the same time, privacy rules for telemedicine should be no more burdensome than those that apply to non-electronic environments. Furthermore, providers of telemedicine services must not be subject to unreasonable liability rules that could chill their provision of such services.

- To take full advantage of the available data and communications capabilities, providers need hardware and software (managed either by the health organization or by a third party) that allow health professionals to quickly access relevant patient data, communicate with patients, and track patients’ health conditions. In particular, integrated systems that feature interoperability between and among hardware and with health IT infrastructures, and between and among multiple providers are necessary to accomplish these objectives. As with hardware for patients, Medicare clearly should provide preferential reimbursement for products that allow care to be coordinated across providers.

Dr. Litan also recommends investments and policy changes that need to be made in the health arena:

- Health boards and associations should adjust their accreditation procedures to include professionals specialized in various aspects of telemedicine and remote monitoring. In particular, telecare coordination specialists and monitoring specialists are two important new professions necessary for taking full advantage of the data from home monitoring.

- Hospitals and health organizations need to invest in IT infrastructure. HIMSS Analytics projects health IT spending to account for about half of hospitals’ total capital spending for 2008, but this investment is building on a low base: for example, computerized physician order entry systems (CPOEs) and clinical decision support systems (CDSSs) were used in less than five percent of hospitals as of the end of 2007. Many investments, including CDSS and CPOE systems as well as electronic health records, are complementary with telehomecare and telemonitoring.

- Increased grant funding for telemedicine-specific health IT investments such as video-conferencing equipment, remote exam rooms, and remotely monitored ICUs is vital at this early-adoption stage, when the external benefits of “joining the network” are at their smallest. Similarly, funding for technology training makes adoption easier for providers, and the increased awareness encourages providers to embrace telemedicine programs. Special attention may be required to meet the needs of small (less than $1 million billed per year) health agencies and organizations, based on their current low adoption rates.

- Preventive medicine also has synergies with telemonitoring. Policymakers should consider creating incentives at the national level for physicians to enter preventive medicine, which is one of the 24 specialties recognized by the American Board of Medical Specialties (ABMS).

It seems to me that if you could save the system money, improve quality of care for patients, and enhance the productivity of caregivers – all at the same time, it makes no sense not to implement these recommendations.

I would be interested in hearing from others about their experience with remote monitoring.

This entry was posted on Friday, October 31st, 2008 at 9:37 am and is filed under Cost, Technology, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.