Telemedicine: Paving Way for Cost Effective Medical Services for Primary Care


According to an article published in the Herald Journal, the history of telemedicine can be traced back to the 1920s, when patients on ships at sea would connect with physicians on shore through radios. With innovation in technology, telemedicine services were provided through interactive television in the 1970s and via video conferencing in the age of digital technology.

Telemedicine: Paving Way for Cost Effective Medical Services for Primary Care

However, the evolution of telemedicine has been curtailed in every period of time – lack of technology in the early 20th century to government regulations in the 21st century – which has added to the skepticism of physicians.

Barriers to adopt Telemedicine healthcare

Under the government’s Affordable Care Act, focus has shifted to cost-effective, quality patient care that has given rise to different approaches of healthcare delivery such as Accountable Care Organizations and telemedicine. However, there are certain barriers to adopting telemedicine at a practice:

1.      Barrier to establish patient-physician relationship

This is the major concern for primary care and specialist physicians, who haven’t introduced telemedicine at their practices. Initially, they hesitate that the use of telemedicine will hinder them from developing effective patient-physician relationship, which will affect outcomes.

2.      Barrier to prevalent practice workflow

Another barrier that most physicians face is disruption to prevailing workflows. Physicians have adapted to changes in the health IT industry by implementing EHRs technology at their practices and designing new workflows accordingly.

However, they are hesitant to adopt telehealth, fearing that it will not be possible to incorporate this approach with the current workflow that is suitable for the new technology they have spent heavily on.

3.      Barrier to medical practice beyond state borders

State and federal laws regarding physicians’ license and reimbursement procedures create a barrier to telemedicine adoption. According to the law, physicians should be licensed to provide medical services in the state they have physical presence in and where they provide telehealth services.

Moreover, changes to reimbursements – shift from value to volume – make it harder for practices to collect from patients via telemedicine.

Benefits of Telehealth services

Despite an air of skepticism among providers, telemedicine is growing by leaps and bounds. Medical Economics, quoting statistics from an IMS research, said over 300,000 patients were monitored via telehealth services for various health problems including cardiac, mental health and diabetes in 2012. The report further said that the number is expected to increase to 1.8 million by 2017.

Assisting home care patients

Telemedicine has made a difference in lives of home care patients by providing telehealth services. Its effectiveness can be measured from the success of a healthcare program introduced by the Veterans Health Administration (VHA) Department that aimed to provide telehealth services to home care patients with chronic diseases.

The services were provided via vital sign monitors, videophones, digital cameras – specifically for wounded patients and those having skin-related issues. Within four years of starting the program, 30,000 patients enrolled to receive telehealth services bringing down hospital visits by 19% which helped in saving costs.

Assisting patients in rural areas

Telemedicine has been particularly helpful in providing efficient and quality health service to patients living in rural and remote areas. Rural primary care physicians have used telehealth approach to facilitate their practice and patients by:

  • Providing quality healthcare within the community
  • Saving cost and time on travelling to city
  • Making medical care available round the clock
  • Providing emergency care to patient prior to transporting them to hospital
  • Making initial diagnosis prior to specialist consultation
  • Consulting with specialist

Assisting primary care physicians

Primary care practices have faced setback because of increase in specialist practices and changes in the health IT sector. According to a study, Primary Care: Current Problems and Proposed Solutions, a shortage of over 40,000 primary care physicians is expected by 2025.

Telemedicine has played a role in primary care health as it has proven to be a successful approach to provide cost and time effective healthcare to patients, resulting in patient retention.

  • Primary physicians can team up with specialists to provide healthcare
  • Facilitate hospitals in providing post-surgery general medical care according to specialist instructions
  • Providing cost effective care in nursing homes
  • Giving privacy to patients suffering from diseases that are still stigmatized in closed communities, like HIV and mental health issues

 Solutions to Barriers for Telehealth

Dr. Adam Darkins, chief consultant for telehealth services at the U.S. Department of Veteran Affairs (VA) has emphasized on the importance of relationship between patients and their physicians for telemedicine system to function effectively.

Dr. Jason Mitchell, director of AAFP’s Center for Health IT clarified that telemedicine is not different from regular medicine practice. He explained that only difference is the mode of interaction between the doctor and the patient.

However, the government needs to make certain provisions in order to remove barriers that hinder success of telemedicine.

  • Flexibility in practice license for telehealth physicians: Telemedicine providers should be given relaxation to practice medicine in states other than their own. This way government can cover the shortage of primary care physicians and facilitate them to recruit patients to meet their costs.
  • Modify reimbursement policies: With changes in insurance policies, patient payments have become a major part of collections. This will create further problems for practices to collect payments from patients who have received consultation via telemedicine.

Changes under the Affordable Care Act are all about providing cost effective, quality healthcare services to patients that can be achieved through telemedicine system. This system is particularly beneficial for small to medium practices that can provide services to more patients, while saving time and money.

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Why EHR customer satisfaction is the highest among big groups?


The health IT market is flooded with government certified EHRs to meet the Meaningful Use program. The task is to find out the right medical vendor that fulfills practice requirements. This is particularly difficult for small to medium practices, as it appears vendors pay more attention to providing flawless services to large practices. According to Black Book Rankings 2014 Survey, practices having 25 or more physicians are more satisfied with vendor customer support than practices catering to small/medium groups.(2-5, 6-25). Among the respondents, 90.2% of physicians from large practices reported satisfaction with their vendors as compared to 72.5% of physicians from small or medium sized practices.

One of the major reasons is the vendor resources that do not allow them to give proper attention to small practices. Health IT is a competitive market where large practices and hospitals are major buyers of technology. They drive the health IT market by creating technology demand for huge infrastructures. With sufficient financial backup to implement an EHR system, they partner with vendors for a long period. Similarly, vendors prefer to utilize their limited resources on big projects that promise maximum revenue. By doing so, they usually miss the opportunity to create loyal customers among small practices and provide most of their customer support to physicians in large practices, as highlighted by the Black Book Rankings 2014

Another reason for dissatisfaction among small practices is related to their efforts in vendor search and implementation of EHR. It’s fair to suggest that part of the blame is on the physicians with small practices. Instead of conducting a thorough research of the market, they rush into buying the first EHR they come across [EHR buyer tips]. On the contrary, large practices take their time in understanding the market, the products they offer, strengths and reputation of vendors and demands of their practice before selecting the right vendor. For them, it’s a business partnership that can only work when the vendor fulfills its side of bargain with impeccable technology and customer support.

However, one cannot blame small practices entirely for lack of customer support on the vendor’s part. Ideally, it’s the vendor’s responsibility to provide customer support during the implementation and post implementation phase of EHR. Before signing a contract with a new practice, vendors should make analysis of their available resources and capabilities, so that the customer does not have to suffer in the long run.

 

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Narrowing down your EHR options


Adopting an Electronic Health Record (EHR) system is no longer an option, but an obligation. If your practice does not do so, you’ll be subject to penalties that will increase as time progresses.

Additionally, you will be deprived of the incentive payments that many of your competitors are benefiting from. However, with several hundred EHR vendors to select from, you require an EHR pricing and vendor comparison to make the right decision.

While the most important component of most decisions is price and costing, you still must develop an initial plan to determine which EHR vendor is appropriate including the how-much-will-it-cost-me component.

First you need to limit the number of vendors on your option base. For doing so, you will first need to identify several vendors based on your personal knowledge, market research and on recommendations of other physicians.

Look at the software and hardware their systems require. For example, a server-based system will require more hardware. Additionally, many of the leading vendors have EHR solutions that do not require installable software and can be accessed via internet. So first, you need to be sure of the solution you require.

Once this comparison is done, you should narrow down your options by a more specific EHR software assessment. In this, you’ll analyze specific features that you require in your EHR. Which vendor is ready for ICD-10 and Meaningful Use Stage 2 certified, for example. Also do some research on other services offered by these vendors; common techniques for this are via rating and review websites, asking other healthcare professionals and by visiting the vendors’ websites. For example how efficient their customer service is and if they have integrated systems (if you require practice management solutions as well).

Now with your options even more limited, conduct an EHR pricing comparison to determine which vendor has solutions that meet your budget. During this stage, include all costs such as those needed for the implementation, average staff training costs and any potential cost that you can think of.

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6 Steps for Choosing the Right EHR Vendor


EHR Vendor Selections TipsSelecting the right Electronic Health Record (EHR) software for your practice is not an easy decision to make since it will have a major impact on your future workflows. Carefully research the health IT market and make EHR vendor comparison to make an informed and intelligent decision. Following are some useful steps to help you with the right vendor selection:

  1. First of all, assess your practice that will help you to identify the right EHR to meet your needs. Don’t forget to select an EHR that is government certified for 2014, so that you can achieve Meaningful Use Stage 1 and 2.
  2. After identifying your practice needs, set realistic and measurable goals that you would like to achieve with the help of EHR.
  3. Analyze the infrastructure of your practice and decide if you want a server-based or Cloud-based EHR. Small to medium sized practices should implement Cloud-based EHR to save cost of hardware and space.
  4. Carry out EHR vendor comparison based on earlier analysis of your practice and requirements from EHR. During this phase, carry out EHR price comparison, analyze features of the software and the support services of the vendor.
  5. Once you have completed the research at your end, contact the vendors that you have narrowed down. Ask them to provide you with complete information about their profile, product and services. Share your practice needs and demands from EHR and services with them and request a demo, so that you know what you are buying.
  6. Verify the references they provide you. Once you are satisfied with everything then get into a binding contract with them.
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Meaningful Use criteria for Eligible Professionals (EPs)


In order to avail government incentives for Meaningful Use program, eligible professionals (EPs) would have to demonstrate that they have been using their electronic health records (EHRs) according to the criteria of meaningful use program. Physicians would have to successfully attest to the program in order to qualify for government incentives program, administered by Centers for Medicare & Medicaid Services (CMS).

EPs who have just adopted EHRs would not have to attest for meaningful use program in their first year of implementation, but without later attestation they won’t be eligible for government incentives.

Meaningful Use criteria

The first criterion to fulfill in order to achieve meaningful use is to adopt a government certified EHR system. The certified software should be interoperable and have ICD-10 coding system. The software should have a patient portal to engage patients for informed and improved healthcare. This is required under the Medicare EHR Incentive Programs, which is run under by the CMS.

The objectives and criteria for the meaningful use program have been divided into three different stages that will span over five years period. The objectives are further divided into core and menu, of which core objectives should be fulfilled. However, there is option for EPs to meet any criteria in the menu set.

In meaningful use stage 1, EPs should have certified EHRs, use it to record clinical and non-clinical data of patients, share information with necessary stakeholders and patients. The meaningful use stage 2  [whitepaper] requires EPs to be more rigorous about health information data, while the third stage focuses on the efficiency and quality of data shared and improved patient care.

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