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Taming the wild telehealth frontier


Successful implementation and integration of these technologies will be critical for practices to realize their true benefit

COVID-19 has forever changed the way our healthcare system thinks about and delivers care. It has brought about a paradigm shift, giving rise to digital health technologies such as virtual care and remote patient engagement which are essential – now more than ever.

These innovative technologies, particularly telehealth and asynchronous communications platforms, offer a better and more efficient path for improving outcomes and lowering costs while meeting consumer demand for access and convenience. They’re also shifting the focus of care away from the clinical setting to the patient’s setting—whether at work, on the field or in the home. This truly puts patients at the center of care. Yet despite their great potential, digital health tools also bring significant challenges. Successful implementation and integration of these technologies into legacy health systems will be critical for practices to realize their true benefit.

The future of virtual care is now

Telehealth uses technology to deliver remote or “virtual” care and information to patients and providers in ways that are more efficient, accessible, affordable, convenient and personalized. The ATA outlines four main mechanisms that are used to provide virtual care as:

Live (synchronous) two-way video conferencing, often used in lieu of an in-patient visit

Store-and-forward (asynchronous) communication that’s typically used to share patient medical information such as images and lab reports

Remote patient monitoring, which allows providers to track and monitor patients at a distance

Mobile health (mHealth), a new and evolving modality, leverages mobile devices such as smartphones and software apps to support healthcare, including asynchronous messaging and texting.

There’s been an explosion of new telehealth tools particularly in the field of mHealth, with more than 318,000 apps available—a figure that has doubled since 2015. The lack of regulation and sheer volume of product has created an exciting but noisy and chaotic market environment that’s been likened to the Wild West. While popular consumer health and wellness apps that track everything from activity, calories, sleep and even meditation may generate a lot of marketing buzz and celebrity endorsements, for example, they don’t deliver much clinical value. One study found that most behavioral health apps lacked scientific evidence or peer-reviewed studies to support their claims.

Yet there’s more to mHealth than consumer “self-care” apps. An asynchronous communications platform also includes text messaging (SMS), multimedia (MMS) messages, live video capabilities, Facebook Messenger communications as well as other social media platforms.And despite the noise and need for regulation, these tools moving the needle when it comes to empowering providers to improve outcomes and consumers to make better-informed decisions about their health. Almost daily, we’re seeing startups and big tech companies such as Amazon, Apple and Google entering the space. According to a report published by Allied Market Research, the global mHealth market is expected to reach $58.8 billion by 2024, growing at an annual rate of 33.5 percent. The report also states that mHealth services segment accounts for more than two-thirds of the total market.

Hurry up and wait

Telehealth solutions are not only on the rise but text messaging is riding a wave of high marks, being called the “digital health tool of the century” for its ease, speed, and flexibility in allowing providers to innovate in new ways – from communicating (in real time and asynchronously) with care team members, patients and their families; to sharing videos and educational content; to sending medication, appointment and task reminders. Telehealth options that include secure simple text and multimedia messaging and social media drive organizational efficiencies by reducing call volume and streamlining workflows. Equally important, they offer providers a competitive advantage when it comes to patient outreach and conversion.

Although nine out of 10 health systems are planning to expand their virtual care services in the next year, clinical integration with telehealth services, including mHealth and evolving texting communications platforms, remains a struggle. Most telehealth programs have operated as pilots or separate programs rather than as part of a larger, integrated system. This is because many telehealth solutions don’t integrate with electronic health records. As a result, programs stall, lack adequate funding or are relegated to narrow service lines.

In order to achieve EHR integration with telehealth platforms, hospitals and health systems need interoperability – the ability to exchange patient data between software systems and beyond their own four walls. Yet with the average health system having 18 disparate EHR vendors in use across affiliated providers, it’s no surprise that fewer than 50 percent of health systems report that they are integrating third-party information. The complex challenges surrounding integration earlier this year prompted the Centers for Medicare and Medicaid Services together with the Office of the National Coordinator for Health IT to shift focus from the meaningful use of EHRs to promoting interoperability in an effort to break down information silos and bring about patient-centered care.

The Office for Civil Rights (OCR) at the U.S Department of Health and Human Service has also recognized the importance of interoperability during the pandemic and announced that it would lift penalties around telehealth use during the COVID-19 pandemic. Discretion applies to all HIPAA-covered healthcare providers that use telehealth services during the pandemic.

Taming the telehealth frontier through integration

Nearly all hospitals have an EHR in place today and it is the center of most workflows. EHRs enable easier access to clinical information, powerful data analysis, better continuity of care, improved patient safety and support for clinical decision-making. And while far from perfect, they – like so many other digital tools – are always being updated and upgraded. All this combined with a significant investment of resources and time means they’re not likely to go away any time soon.

Telehealth solutions and other digital health tools are changing the way care is delivered and consumed, making care more patient-centered, convenient and affordable without compromising quality. This explains why hospitals and health systems are eager to invest in these innovative platforms.

Moreover, by integrating systems, organizations will have better oversight and control over the quality, efficiency, usability, reach, data, performance reporting and management of the solutions. In essence, integration is the means for bringing law and order to the digital health frontier.

In addition to payer, provider and regulatory support, third-party vendors are starting to see the value inherent in the free exchange of data and embracing technology standards, which are essential to enabling interoperability. Many EHR vendors are embracing more open connections, but there remain countless antiquated systems that make full integration difficult. Toolsets from Health Level Seven International (HL7) are making those connections easier, offering secure, bi-directional data flow among various EHRs and ancillary systems. API connections also are commonly used. Several top vendors, including Cerner, Epic and athenahealth, have all committed to improving data sharing and are making notable strides, supporting Fast Healthcare Interoperability Resources (FHIR) standards as well as the use of open application-programming interfaces (APIs) to standardize how healthcare systems talk to each other. In a recent white paper, ATA also notes that interoperability must incorporate communication platforms across a range of channels, including secure paging, texting, IM, chats, video and scanning.

Integration wears the white hat

Innovation, consumer behavior, economic pressure all taking place in the setting of a global pandemic are driving unprecedented change in healthcare – not only in terms of how, when and where care is delivered to the patient but also in the way that patient’s data is exchanged and used. The rush to capitalize on mHealth is on, and prospectors from startups to tech giants to top EHR vendors are vying for how previously fragmented, siloed data will be integrated, optimized and managed. The process demands collaboration and the creation of common standards, or a language for communication. Put another way, integration is the new sheriff in town that will bring order and community standards to town, clearing a path forward and driving healthy competition in the marketplace.


Shannon Hastings is chief technology officer for Rhinogram, a HIPAA-compliant virtual care platform.

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