Connecting America
Broadband Policy Issues and Options for State Legislatures
Pre-Conference Invitational Seminar
NCSL Annual Meeting
Boston, Massachusetts
August 4-5, 2007
Session Date: August 4, 2007
Session Summary: Site Visit to the Center for Connected Health
By Michelle Larson-Krieg, Intern, Legislative Information Services, NCSL
This summary is provided for information purposes only. NCSL does not endorse any views it contains.
The Connecting America invitational seminar began with a site visit to the Center for Connected Health. Corporate Manager Douglas J. McClure defines the telemedicine services that the Center provides as “caring for people when they’re not in the hospital.”
Several factors are converging to create a “Perfect Storm” in healthcare delivery. Longer life spans mean that a larger segment of the population is older. Older individuals tend to have a higher incidence of chronic disease. There is also a widening gap between the supply of healthcare providers such as primary care physicians and nurses and the demand for these services. Although schools are training healthcare providers, hospitals such as Massachusetts General cannot hire them fast enough. In addition, most health care providers are unable to keep up with the demand for physical infrastructure.
In order to mitigate the effects of this brewing perfect storm, we Americans need to take better care of ourselves. Douglas McClure maintains that telemedicine is one way to help us do that.
Online consultations, at home patient monitoring, and a glowing orb that reminds patients to take their medication are among the remote services currently provided. These services can address access challenges, improve the quality of care, help manage healthcare costs, and increase efficiency.
CHF Monitoring in a Home Care setting was developed in part as a cost reduction model to save on the number of emergency room visits, re-hospitalizations, and home nurse visits that these patients were utilizing to get the care that their condition required. Instead, the hospital gives CHF patients $2400 in equipment (a blood pressure cuff, monitoring screen, etc.) so that they can be monitored in their own homes. Although the cost of the equipment itself is not eligible for Medicare reimbursement, at-home monitoring gives patients, their families, and health care providers an opportunity to respond to changes that indicate a problem before a visit to the emergency room is required. Emergency room visits are a very expensive way to deliver healthcare services. The equipment uses telephone lines to transmit data. One drawback is that the current equipment limits the patient education that can be provided on-line.
In the 1960s, healthcare providers at Massachusetts General Hospital provided services to patients at Logan Airport via two television studios – one at each location. The current generation of remote services rely on video conferencing capabilities, which in turn rely on the availability of enough bandwidth to ensure a truly synchronous interaction. Video conferencing requires 384 kilobytes. The speed at which the care provider’s image is transmitted to the patient is always constrained. Provided that the image of the patient that the healthcare provider views is good, the speed going the other way isn’t as big a factor.
On-line consultations improve patients’ access to specialists and allow them to obtain second opinions. The service also allows doctors to consult each other or doctors and their patients to communicate with a specialist. The Center has contracts with companies who want to provide their employees who live and work outside of the U.S. with access to American health care providers.
The Center currently has two employees who look at incoming requests for on-line consultations. The speed of the service relies on both the process that is in place and the telecommunications and other infrastructure.
Research has shown that if people who suffer from a stroke receive medical attention within a two-hour window, their chances of recovering neurological functioning are greatly improved. Recent legislation requires hospitals to divert patients if they are unable to provide a neurologist 24 hours a day seven days a week. Because of the Center’s Telestroke program, which allows a neurologist to review the patient’s CT Scan and conduct an examination of the patient from his home or office using teleconferencing, many hospitals in small towns and rural areas are able to provide stroke patients with access to a skilled and experienced neurologist. Insurance reimbursement for the service is handled as a contract between the two hospitals.
Video conferencing also enables health care providers to address further subspecialty challenges. For example, the Center provides a weekly dermatology clinic to patients in Nantucket—located a four-hour ferry-ride from Boston.
Encryption technology similar to that used for financial transactions protects patient confidentiality.
The Center for Connected Health is also actively engaged in research and development. Through the research and development process, the team is able to ask, “What if we could do X?” The viability of potential projects is based on both the economic and clinical outcomes. The first phase is program development, the second is a scale out of the project, and the final phase is for the program to become self sustaining. McClure noted that gaps between what can be envisioned and what can be made real often close as technologies change. One promising project is a Virtual Coach that provides verbal feedback to patients with high blood pressure.
The Center’s diverse funding sources and focus on the economic viability of its programs has helped it avoid a common pitfall: funding for telemedicine services often “fades in” as people get excited about the possibilities remote services offer, and then “fades out” when those providing funding reallocate it to the next big idea. The Center receives some grant dollars, receives additional funding from project partners, and invests in projects that demonstrate an ability to pay for themselves. The Center has found that reimbursement schemes support remote services that improve quality and cost effectiveness.
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