When it comes to telemedicine and telehealth, the future is most definitely now. Advances in technology have spurred advances in telemedicine and carry with it the potential to increase access to care, improve quality and reduce costs.
“Telehealth solutions have the capacity to improve the quality of care, improve access to care and reduce the cost of delivering care,” says Dr. Stephen Perkins, vice president of Medical Affairs for UPMC Health Plan. “It has the potential to reduce costs for both physicians and patients.”   

Smart Business spoke with Perkins about telemedicine and telehealth and their potential to improve care and reduce costs.

What is the difference between telehealth and telemedicine?

Telehealth is a general term describing the delivery of health-related services and information by the use of telecommunication technology. It can include phone calls between physicians, videoconferencing or even robotic technology.

Telemedicine has a narrower definition: The specific use of medical information that is exchanged from one site to another via electronic communications for the health and education of a patient or a health care provider for the purpose of improving patient care. It includes consultative, diagnostic and treatment services.

Historically, hospitals and health systems in rural areas have been most closely connected with telemedicine, as travel times and a lack of specialty physicians has made telemedicine more attractive. However, the entire health care industry, urban and rural, national and even international, could benefit from its widespread use.

What are the most significant benefits from telehealth and telemedicine?

Certainly, the top benefit would be increased access both for patients and physicians.

Persons who live in remote areas have not always had access to the latest medical advances. With telemedicine, there is the capacity for specialists to evaluate a patient’s condition from afar. Homebound patients could have their conditions monitored and reduce the number of trips they need to make to a physician’s office.

With telemonitoring technology, a physician can oversee the progress of a patient and help the patient avoid problems. Telehealth technology breaks down many barriers to access to care.

What technologies are used in telehealth?

Many different technologies can be used. Among them are: videoconferencing, the Internet, store-and-forward imaging, streaming media, terrestrial communications and wireless communications.

What are some examples of telehealth?

Telehealth can mean e-visits, whereby patients do not have to come into their physician’s office for a routine problem, but correspond via Internet and may even get a prescription for their condition, if needed. This way, routine matters do not tie up a physician’s time, and patients do not need to miss work or arrange for day care in order to get medical advice for minor matters.

In some instances when someone has a chronic condition requiring consistent monitoring, or they are homebound with a stroke, a telestroke program allows them to be seen by a specialist.   

Are there barriers to telehealth becoming more widespread?

Telemedicine implementation can be expensive and time consuming, which may make it difficult for health system executives to see the value, especially since not all patients will use the services.

In addition, with telehealth’s ability to transcend state boundaries, there may be issues regarding licensing and certification. Policies regarding telehealth licensing vary greatly between states.

How will this impact health care costs?

While the initial cost of the technology may be high, the overall impact should be to reduce costs. If monitoring a condition becomes easier because of telehealth access to patients, that should improve preventive care and reduce the number of emergencies, which will help to hold down costs. If telehealth advances can bring specialist care to places where it has never been before, that, too, should mean more effective treatments and, ultimately, lower costs.

Dr. Stephen Perkins is a vice president of Medical Affairs at UPMC Health Plan. Reach him at (412) 454-7682 or perkinss@upmc.edu.

Insights Health Care is brought to you by UPMC Health Plan

Published in Pittsburgh

The advantages of an electronic health record (EHR) for individuals are readily apparent to many physicians. According to the most recent survey by the Centers for Disease Control, 75 percent of physicians who have adopted EHR say the technology has led to better care.

But, for any number of reasons, that message has not quite gotten through to the general population. Privacy and security concerns are the major reasons cited by the public for its unease, and the main factors keeping many people from embracing the concept, even as the nation becomes more “digitized” in other areas.

“The general public doesn’t know much about electronic health records, and so there is some unease about the concept,” says Dr. Stephen Perkins, vice president of Medical Affairs for UPMC Health Plan. “It will take an educational effort to get more people to see what the positive impact of EHRs can be.”

Smart Business spoke with Perkins about the advantages of EHRs and the impact it can have on health care.

What are electronic health records?

EHRs are an electronic record of information that reflects all of the health care that was delivered to a specific patient in various locales over the years. The information can include patient demographics, progress notes, medications, vital signs, medical history, immunizations, laboratory data and radiology reports. Ideally, an EHR gives a physician a streamlined look at a patient’s complete health record and should make the delivery of health care more efficient and effective.

Why is there resistance to EHRs?

In a Harris Interactive survey taken in 2012, only about one quarter of the respondents said they wanted their records to be transferred from paper to an electronic version, and 85 percent of respondents expressed some kind of concern about EHRs. The survey also revealed that only 40 percent of people think that EHRs would help doctors deliver better, more efficient care, which is actually a slight decrease from previous years.

The reasons for the resistance include a fear of records being stolen by computer hackers, the potential for misuse of the personal information stored, and even the fact that physicians might not be able to access a patient’s record during a power or computer outage.

Even some physicians see a downside to EHRs. In a recent study by the American Medical Association, some physicians complained that EHRs increase their data entry responsibilities and requires them to perform added, time-consuming tasks.

What are the advantages of EHRs?

With EHRs, the chance of medical errors should be reduced because the accuracy and clarity of medical records is improved. When a vast amount of patient information is available in one place, it also should reduce test duplication, in turn reducing treatment delays and helping patients be better informed to make better decisions.

Other advantages of EHRs range from conservation of storage space to the fact that EHRs make patient information accessible from remote sites to many people at the same time. EHRs can make communication between health care providers easier and better, and the information is less likely to be lost or destroyed.

Are there any disadvantages to EHRs?

Disadvantages would include the initial expense, the unwillingness of employees to adapt to the new technology and the need for additional maintenance. The cost of starting an EHR system can be excessive, especially during a time when health care organizations are extremely concerned about higher prices. But it also can be argued that EHRs will ultimately reduce costs and improve quality by helping providers and patients be better informed, by eliminating costly and unnecessary duplicate tests and by helping to better coordinate care.

How can resistance be overcome?

Basically, patients need to be educated to the fact that EHRs will not replace their personal physician. EHRs just help their physician do a better job. Nothing can replace the critical thinking ability of a physician. What a well-designed EHR system can do is collect and disseminate information and assist in decision-making.

Dr. Stephen Perkins is a vice president of Medical Affairs at UPMC Health Plan. Reach him at (412) 454-7682 or perkinss@upmc.edu.

Insights Health Care is brought to you by UPMC Health Plan

Published in Pittsburgh

Preventable hospital readmissions cost the U.S. health care system an estimated $25 billion every year, according to a study by PricewaterhouseCooper’s Health Research Institute. A logical first step toward containing health care costs would be in controlling the expenses related to these readmissions.

“The patient-centered medical home is becoming a very effective tool for reducing preventable hospital readmissions,” says Dr. Stephen Perkins, vice president for Medical Affairs at UPMC Health Plan. “The care and attention that patients are provided in the medical home model is compatible with improved quality of care, well-coordinated care and readmission prevention. Coordinating care for patients with complex conditions is essential.”

Smart Business spoke with Perkins about how the patient-centered medical home (PCMH) can be effective in reducing preventable hospital readmissions.

Why is the PCMH concept effective in reducing preventable hospital readmissions?

The PCMH stresses that a personal physician and a personal physician’s staff should proactively and holistically coordinate their patients’ care. Because the model encourages patients to become more engaged in their own care, patients are more prepared before, during and after their hospitalization to understand their condition. This leads to less confusion about their care plan and a better understanding of their self-care once they are sent home from the hospital.

What elements of PCMH make it especially suited to reduce preventable hospital readmissions?

One potential component of a PCMH is the use of practice-based care managers. These care managers — who are often nurses or social workers — can coordinate health services with other providers, manage a patient’s health conditions, connect the patient with community resources, assist patients with managing prescriptions, and help members focus on lifestyle changes including lowering or maintaining weight, decreasing stress, smoking cessation, and identifying safety and fall risks in the home.

Practice-based care managers help serve as the bridge between members and their physicians — before, during and after office visits — as they function as part of the physician’s team, coordinating and assisting in the development of a care plan for members. They support their physician practices and meet with members face-to-face to address knowledge gaps and provide self-management tools.

These care managers also assist physicians in the delivery of continuous, accessible and high-quality patient-oriented population management by identifying stresses placed on patients and caregivers upon discharge from the hospital. They coordinate health services with other providers, and work with patients before and after hospital stays to make sure each patient understands his or her condition and care regimen. Practice-based care managers make direct contact with patients, identify barriers to care and educate patients.

Essentially, the use of practice-based care managers is a way of changing the workflow in the medical community. Historically, the medical community has approached health care in a reactive way; that is, they react to a patient presenting for care, rather than anticipating care needs. Likewise, patients react by seeking episodic care. In order to control costs and improve quality, this paradigm must change to allow the practice team to understand management of their patient population, and yet focus on the specific to identify the needs of individual patients.

What are the benefits to patients in a medical home situation?

Patients receive more coordinated services in a medical home system, which results in less confusion about their care plan. This usually leads to better compliance with the recommended treatment. In addition, they share in the decision-making with the physician and care team. The physician and patient are on a much more parallel track, understanding the patient’s goals, which causes greater patient satisfaction.

Dr. Stephen Perkins is a vice president, Medical Affairs, at UPMC Health Plan. Reach him at (412) 454-7682 or perkinss@upmc.edu.

Save the date: Tuesday, Oct. 22, webinar “The Physician’s Role in a Changing Health Care System,” from 11 a.m. to noon. To register, visit the “Webinars” page, or email Lauren Formato at formatol@upmc.edu.

Insights Health Care is brought to you by UPMC Health Plan

Published in Pittsburgh