NTT DATA Americas White Paper

Trends in Telehealth
Making healthcare more collaborative, affordable, and effective.
Telehealth is changing the way healthcare is delivered and consumed. It gives patients the tools to manage their health, extends services to rural areas, and enables specialists to intervene in real time. But can it overcome the barriers to adoption?

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Trends in Telehealth

EXECUTIVE SUMMARY
Telehealth is a game changer for the healthcare industry. The current healthcare system focuses on the diagnosis and treatment of acute disease and on emergency care. Telehealth is patient centric and concentrates on health rather than illness. It will play an important role as the industry moves away from a fee-for-service model toward more outcome-focused care and reimbursement. More importantly, it brings healthcare directly into patient homes and to patients wherever they may be. The market for telehealth is being driven by significant trends in healthcare, population, technology, government, and consumerism. At the same time, outdated reimbursement policy, increased availability of healthcare, and a shortage of providers are eroding the barriers to adoption. Telehealth acts as a bridge for enhancing the relationship between patient and provider and for improving patient satisfaction and behavioral changes by weaving healthcare guidance and treatment into daily life. Patient behavior and lifestyle choices have a profound impact on health and wellness since most healthcare is self-care. In fact, one of the major uses of telehealth is for the self-management of chronic disease. In addition, telehealth increases access to care in remote rural areas which do not have specialty treatment facilities. As a result, many industry experts believe that telehealth holds the key to optimizing population health. One of the most important benefits of telehealth is in the lowering of costs as measured by reductions in hospitalizations, readmissions, and length of stays. The potential for financial saving can best be seen in the ongoing management of chronic disease. The approximately 100 million Americans with chronic disease account for 75% of healthcare expenditures. Examples of the positive impact telehealth can have can be in the results from the US Department of Veterans Affairs (VA) and the United Kingdoms Department of Healths Whole System Demonstrator program. Telehealth systems most frequently enable real-time communication between patients and care providers, such as via videoconferencing; the storing and forwarding of clinical data to offsite locations for evaluation by specialist teams; and remote monitoring of patients chronic conditions via sensors and monitoring equipment. Telehealth technology is evolving into wearable and even implantable devices that detect information such as EKG readings. Healthcare companies seeking to integrate telehealth systems into their technology platforms should seek an experienced IT services partner fully versed in legacy and latest technologies and an understanding of the changing healthcare marketplace and regulatory environment. Selecting a partner with international capabilities and a global view of the marketplace is essential for healthcare companies seeking to expand their telehealth solutions into foreign markets.

Confidential
2013 NTT DATA, Inc. The concepts and methodologies contained herein are proprietary to NTT DATA. Duplication, reproduction or disclosure of information in this document without the express written permission of NTT DATA is prohibited.

About NTT DATA

NTT DATA is your Innovation Partner anywhere around the world, with operations in more than 35 countries. NTT DATA Americas emphasizes long-term commitment and combines global reach and local intimacy to provide premier professional services from consulting, application services, business process and IT outsourcing to cloud-based solutions. Visit www.nttdata.com/americas to learn how our consultants, projects, managed services, and outsourcing engagements deliver value for a range of businesses and government agencies.

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Trends in Telehealth

TABLE OF CONTENTS
Why Telehealth?4 Telemedicine Versus Telehealth4 Primary Usages of Telehealth5 Benefits of Telehealth5 Telehealth Industry Drivers and Opportunities7 Case Study7 Telehealth Industry Barriers and Threats9 How Telehealth Works10 Telehealth Solutions11 Case Study14 Conclusions and Recommendations15 References16

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Why Telehealth?
The cost of healthcare represents approximately 18% of the US Gross Domestic Product (GDP), according to the Council of Economic Advisors and this percentage is growing. Such a financial trend is unsustainable. Industry experts and studies continue to point toward the promise of telehealth as a means to reduce costs and change patient behavior to optimize population health. Significant trends in healthcare, population, technology, government, and consumerism are driving healthcare providers and government agencies to adopt telehealth technology in order to improve patient care, lower costs, and reduce readmissions. More importantly, major health plans, the federal government, national pharmacy chains, large behavioral health systems, and very large employer groups are beginning to leverage telehealth to advance their strategic goals.

Telehealth has many parallels to distance learning in the higher education world. The solution is less about technology and more about changing the value perception of the people associated with telehealth. These include: patient advocacy groups, medical societies, and payer organizations that hold the purse strings to reimburse for more telehealth-related activities. Many proponents hope the proposed federal Telehealth Promotion Act, introduced in the House at the end of 2012, will be reintroduced and pass this year. Among other things, the proposed legislation would create incentives to use telemedicine to prevent hospital readmissions and would make telemedicine a covered benefit under all federal insurance programs, including Medicare and Medicaid. Once the US government jumps on the bandwagon, we will see a wave of telehealth acceptance much like the online degree programs at major universities throughout the world. Bill Boucher Vice President, Healthcare and Life Sciences, NTT DATA, Inc.

Telemedicine Versus Telehealth

Telemedicine and telehealthare terms that describe the exchange of medical information from one site to another using electronic communications. The use of both terms has proliferated as the healthcare industry and governmental agencies seek to leverage telecommunication technology as a means to transform the delivery of healthcare services. According to the American Telemedicine Association, telehealth is the use of medical information exchanged from one site to another via electronic communications to improve patients health status. In short, telemedicine acts as an electronic bridge to connect the patient and physician at a distance to provide ubiquitous access to critical care.

The cost of healthcare represents approximately 18% of the US Gross Domestic Product (GDP). Industry experts continue to point toward the promise of telehealth as a means to reduce costs.

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Telehealth is an expansion of telemedicine which encompasses preventative, promotive, and curative characteristics. Telehealth includes not only actual physician-patient interactions, but education and information services designed to increase awareness of diagnoses and medical conditions, treatments, and good health practices. Telehealth supports the entire healthcare continuum with the goal of increasing the overall wellness of the patient. Telehealth uses video conferencing, transmission of still images, remote monitoring of vital signs, specialist consultations, preventive care, continuing physician and nursing medical education, and the integration of administrative services.

Medical education and mentoring: comprises a wide range of continuing education services for healthcare professionals and seminars for targeted groups on special topics or procedures. Consumer medical and health information: involves the use of the Internet to provide consumers with specialized health information and/or peer-to-peer support groups. Remote patient monitoring: uses devices to remotely collect and transmit data to a monitoring station of some type. For example, sensors are used to capture vital signs such as blood pressure, glucose levels, electrocardiogram data, or weight, which are then transmitted.

Primary Usages of Telehealth

By bringing healthcare services to patients, whether at home or in a healthcare facility, telehealth is becoming a transformational tool for the delivery of services. As a result, the healthcare industry is beginning to embrace the use of telehealth as part of its standard toolkit. Current telehealth industry usage can be categorized into four major classifications of healthcare services: Patient care, medical education and mentoring, consumer and medical/health information, and remote patient monitoring. Patient care: includes the sharing of audio, video, and medical data between the patient and healthcare professional to develop a diagnosis, treatment plan, prescription, or advice. It also incorporates specialist referral services in which a patient sees a specialist via a live, remote consult or by the transmission of diagnostic images to a specialist for later viewing.

Benefits of Telehealth
The current healthcare system focuses on the diagnosis and treatment of acute disease and on emergency care. Telehealth is patient centric. It focuses on health rather than illness. Telehealth will play an important role as the industry seeks to improve quality by moving away from a fee-for-service model toward more outcome-focused care and reimbursement. Moreover, telehealth affords a means for the industry to cope with forecasted increases in healthcare demand and for offering care to remote and rural areas. Most importantly, telehealth may hold the key to the optimization of population health as a result of its potential to change human behavior. Telehealth will play an important role as the industry seeks to improve quality by moving away from a fee-for-service model toward more outcome-focused care and reimbursement.

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Changing Patient Behavior

Patient behavior and lifestyle choices have a profound impact on health and wellness since most healthcare is self-care. In fact, many experts believe that the patient is the biggest untapped resource in healthcare. Patients need to change their behavior and not simply receive vital information. Telehealth transports treatment directly into a patients home and into daily living. The technology also allows providers and care managers to understand more fully the challenges patients face by being able to observe a 24-hour cycle of time. For example, by leveraging telehealth, physicians will not just be able to tell their patients to lose weight during infrequent visits, but instead monitor their progress and provide ongoing feedback and encouragement. Such real or near-time observation and more frequent interactions with patients without bringing them into a hospital or specialty center will also enable elderly patients to better manage their health situations while remaining at home.

the geographic reach and frequency of interactions between both parties. Telehealth improves access to care and supports timely treatment of emergency situations in remote rural areas which do not have specialty treatment facilities. Telehealth makes real time second opinion or consultation with a medical specialist a reality. Of great significance is the fact that studies substantiate that patients with access to telehealth have a higher opinion of the quality of care in their community.

Lowering the Cost of Chronic Disease

One of the most essential advantages of telehealth is in lowering costs as measured by reducing hospitalizations, readmissions, and length of stays. The potential for financial savings can best be seen in the ongoing management of chronic disease. The largest cost-driver in healthcare today is chronic disease such as hypertension, congestive heart failure, diabetes, and end stage renal dialysis, all of which are frequently associated with the aging population in the United States. Remote monitoring enhances patient engagement and improves the self-management of chronic disease. It also leads to better adherence to medication and treatment protocols. Research and the findings of major long-term studies substantiate the cost benefit of telehealth and remote patient monitoring.

Improving Patient Satisfaction

Telehealth represents an efficient and cost-effective means for the industry to improve rates of patient satisfaction and for making healthcare more collaborative. Satisfaction is directly correlated to the time and attention that a healthcare professional can spend with a patient and to the strength of the patient and provider relationship. Both of these elements of satisfaction have been significantly eroded given the realities of current reimbursement rates and the resulting need to see a different patient every 15 minutes. Technology can act as a bridge for enhancing the relationship between patient and provider by extending

The largest cost-driver in healthcare today is chronic disease. Remote monitoring enhances patient engagement and improves the self-management of chronic disease.

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One example is the US Department of Veterans Affairs (VA), a recognized pioneer in telehealth, which served over 485,000 patients and completed approximately 1.4 million telehealth consultations in 2012. The VA reported outcomes that included 53% fewer bed days, 30% fewer hospital admissions, and savings of about $2,000 per patient on an annual basis in its home telehealth program. At the same time, the agency reported a mean score of 86% in patient satisfaction.

Telehealth Industry Drivers and Opportunities

Major factors driving the healthcare industry toward the adoption of telehealth include the need to expand access to healthcare services, positively impact the behavior and self-care of an aging population, better manage costly chronic illnesses, and improve quality and lower costs. The proliferation of smartphones and broadband services combined with the availability of wireless monitoring devices is further accelerating its implementation.

The VA reported outcomes that included 53% fewer bed days, 30% fewer hospital admissions, and savings of about $2,000 per patient on an annual basis in its home telehealth program.

An Increasing and Aging Population

The US population is increasing and is estimated to grow at a rate of 20% to 363 million people between the years 2008 and 2030. Significantly, the population

Case Study
Wireless Health Monitoring System Provides a Competitive Advantage to Leading Provider of Healthcare Services
A US provider of healthcare services and leader in the homecare market wanted to provide caregivers with a mechanism that would enable them to more effectively plan for the care of a loved one by alerting caregivers when their loved one had a medical event. The phase 2 release will provide customers with the ability to coordinate the scheduling and calendaring of caregiver tasks. The initial challenge was to develop a state-of-the-art mobile application that would provide user registration, user authentication, and automated subscriber event notifications. As a company focused on providing innovative peoplecentric healthcare solutions, it was essential that the application deliver a holistic, easy-to-use solution so that caregivers could get the information needed and subscribers could easily self-register using a mobile phone and without the need for a PC. To accomplish this objective, the company retained NTT DATA, which has significant experience in both healthcare and technology, to develop the new application. NTT DATA provided guidance and options around native code, a multi-platform solution and browser based alternatives. A native coding1 approach for functionality and cost reasons was selected and the Apple IOS platform and the iPhone device were chosen as the platform for the first release.

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The decision also delivered additional value to the client in providing guidance as to how to efficiently move a new application to the Apple Store. NTT DATA engaged a multi-disciplinary team including a User Experience Designer, a Mobile Solutions Architect, IOS Developers, and Java Developers to deliver this application according to the pre-determined business requirements. NTT DATA employed a global onsite/offshore delivery model to keep delivery of the application as cost-effective as possible. As a result, NTT DATA created a holistic, easy-to-use solution that provided this healthcare client with a competitive advantage in their homecare market by leveraging leading-edge mobile and remote monitoring technology.

NTT DATA helped this healthcare company to continue to progress its mission of finding innovative solutions to improve patient outcomes while lowering healthcare system costs, by: Introducing a leading-edge remote monitoring technology that leverages mobile technologies and communications protocols Enhancing customer satisfaction through a userfriendly navigation and industry-leading concepts Meeting the needs of the clients user base with an easy-to-install, easy-to-use telehealth application Creating an interface with an existing user application that validates users and provides application security Providing customers with wide-spread and easy access to the mobile application via the Apple Store

Native Coding, also referred to as native language is programming code that is written to run on a specific processor using that processors instruction set.

is aging. People 65 and over represented 12.4% of the population in the year 2000, but are expected to grow to be 19% of the population by 2030. This aging population has increasing incidence of chronic diseases including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes and hypertension, and end stage renal dialysis. Treating these chronic diseases is accelerating the cost of care for chronic conditions. In fact, approximately 100 million Americans with chronic disease account for a whopping 75% of healthcare expenditures (Centers for Disease Control and Prevention). As life expectancy increases, so do the number of Americans with chronic disease, thus further escalating expenditures.

Fewer Physicians
The question is who will treat this growing pool of elderly patients? According to the Association of American Medical Colleges, a physician shortage in the US was anticipated even prior to the Affordable Care Act being passed in 2010. Now this same group estimates that there will be a shortfall of 63,000 doctors by 2015 and 130,600 physicians by 2025. The scarcity is a result of several factors. First, a large number of medical professionals are reaching retirement age. Second, there are fewer healthcare professionals being educated, trained, and licensed. This in turn will intensify the continuing issue of a lack of specialists and healthcare facilities in rural areas.

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Outcome-based Reimbursement
Millions of additional Americans will qualify for Medicaid or federal subsidies to buy healthcare under the Affordable Care Act (ACA). Under the ACA the agency will begin docking Medicare payments to centers with high incidence of 30-day readmission and patients who contact pneumonia in that same 30-day period. The act will also result in an increasing focus on quality and outcome-based reimbursement as opposed to the traditional fee-for-service system. In fact, by the year 2014, hospitals with high rates of readmissions could forfeit up to 3% of their regular reimbursement as a penalty.

Telehealth Industry Barriers and Threats

The healthcare industry is historically a late adopter of technology and this has proven to be a barrier to all new solutions that rely on technology. A recent illustration of this is the acceptance of cloud technology, which the industry has been slow to embrace. Technology that represents the foundational underpinnings of teleheatlh such as mobility, social media, and gamification (turning information into a game or contest to motivate and help change behavior) represent leading-edge and rapidly evolving domains, and few healthcare organizations have hands-on experience leveraging them. Additionally, a lack of telehealth standards hinders the interoperability of medical devices, such as videoconferencing and other systems.

Ubiquity of Mobile Technology

Smartphones and mobile wireless devices are now a ubiquitous element of everyday life in the United States. eMarketer, a service which closely follows the digital marketing, media, and commerce industries, estimates the number of US consumers with smartphones will more than double from 93.1 million at the end of 2011 to 192.4 million by 2016. In addition to this, the availability of wearable monitoring devices is increasing rapidly. According to Juniper Research, the market for wearable devices is expected to grow to $1.5B in 2014 and $6B in 2016, up from just $800 million in 2012. Consumers also indicate that they want telehealth. According to an Anthem market study, 74% of US consumers indicated that they would use telehealth services. This number is expected to increase as boomers continue to retire and more millennials become healthcare consumers.

Legality, Privacy, and Security Concerns

The healthcare industrys reluctance to embrace technology is not only due to a lack of organizational agility, but also as a result of regulatory apprehensions and the potential for legal liabilities. Hospitals and health centers are fearful that they will be held legally responsible for the treatment of patients at remote sites. Add to this industry privacy and security concerns, which have only multiplied given the recent changes in Health Insurance Portability and Accountability Act (HIPAA). These modifications enlarged the scope of HIPAA coverage to include telehealth companies, increased the maximum penalty for negligence, strengthened data breach notification requirements, and provided new requirements on how patient information can be used for fundraising and marketing.

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Limited Reimbursement
Reimbursement is another major barrier to the implementation of telehealth. Approximately 90 million people in US are currently enrolled in managed care systems which have not yet incorporated telehealth as a significant means to control costs. Under the current fee-for-service system, Medicare does not offer much reimbursement for telehealth. In fact, the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 put constraints on the reimbursement of telehealth in Medicare. The Center for Telehealth and e-health Law estimates that the Centers for Medicare & Medicaid Services (CMS) reimbursed approximately $5.2 million in 2011 for telehealth out of an estimated $558 billion in Medicare expenditures for the year 2011.

Remote Patient Monitoring, where a patients physiological data is fed through sensors to an external system for monitoring

From a process perspective, telehealth services begin with a physicians prescription. The patient is referred to a home health agency, which then installs the necessary equipment and trains the patients in its use. Following the process, the patient takes their own vital signs and answers personalized questions on a survey. Results are automatically transferred to a website or third party. The agency monitors the patients daily metrics and alerts the patient and the care team when results fall outside of pre-defined boundaries. From the technical standpoint, the basic telehealth process is also fairly straight forward. Sensors capture desired physiological data and transmit it on either a wired or wireless network. This data is then stored and analyzed so it can become information meaningful to healthcare professionals. A user interface then provides the healthcare team with this information, which in turn supports faster and more accurate patient diagnosis and decision making.

How Telehealth Works

Telehealth improves clinical outcomes and reduces acute care hospitalizations because its process and core technologies enable careful, 24-hour monitoring of patients by healthcare professionals from a remote point. Telehealth can be delivered through a variety of mediums including telephone, video conferencing, fax, emails, and computers for data/imaging, virtual reality, and tele-robotics. However, telehealth systems can be classified into three major types: Store and Forward, where clinical information is captured and forwarded to another site for assessment Real-time, such as when a patient and provider communicate live via videoconferencing

Pulse oximeter data can be captured and stored and then transmitted to specialists for evaluation.

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Telehealth Solutions
The primary uses of telehealth encompass critical care, education, and administration. In other words, patient assessments, diagnosis, consultation, and supervision; ongoing healthcare related education of healthcare professionals, communities, and individuals, and for purposes such as conferences, preparations, utilization and quality studies, etc. Examples of major telehealth applications include the following:

Store and Forward Applications

In this type of system, digital images, video, audio, observations of daily living and clinical data are captured and stored on the clients computer or mobile device and then transmitted securely in a batch to another location where they are studied by relevant specialists. Dermatology and pathology are two specialties that do not require the use of real-time technology and where an immediate response is not required. Monitoring and trending of basic vital signs for long-term chronic care, such as monitoring blood pressure, cardiac events, hemoglobin saturation, weight, and sleep patterns, is typical for this type of application.

Observation of Daily Living (ODL) Applications

Much can be learned about a patients health and well-being by observing daily routines. Such information if tracked through an application and stored, can become a Personal Health Record (PHR) that is far different from traditional clinical or other kinds of health records. ODL data can take the form of measures of sleep, medication adherence, levels of physical activity, and weight. Many groundbreaking applications in this area have been developed by teams at Project Health Design, part of the Robert Wood Johnson Foundations Pioneer Portfolio. One such example is the BreathEasy team, which has designed a mobile application for treatment and self-monitoring for patients with asthma. Patients use the system on their smartphones to capture and report observations of daily living such as use of control and rescue medications, symptom levels, quality of life, and smoking. Using a dashboard with analysis and visualization tools on the Internet, healthcare professionals then view the patients data and health status and can recommend treatment changes as required.

One UK study looked at the remote monitoring of 3,030 patients with chronic conditions. Results included: 45% reduction in mortality rates 20% reduction in emergency admissions

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One example of such an application is the Latitude Patient Management System by Boston Scientific, which can monitor implanted Boston Scientific ICD or CRT-D devices from a patients home. The system uses a communicator that can sit bedside to monitor the cardiac device and then transmits information through a regular landline phone at a time previously arranged by the patients physician. This information is collected on a secure website that only a patients healthcare support team can view. If needed the system can also monitor heart failure and includes: a blood pressure monitor, weight scale, device diagnostics, and a symptom self-report survey.

critical. Several trials of such systems have proven effective at saving lives and preventing long-term disability from stroke. One such study, funded by the Arizona Department of Health Services, is currently being conducted by Mayo Clinic neurologists in Phoenix who can remotely consult with emergency departments at 12 rural hospitals, mostly in Arizona, that have fixed telemedicine platforms or robots (U.S. National Institutes of Health 2012).

Remote Patient Monitoring Application

In a Remote Monitoring system, the patient has a central system that feeds information from sensors and monitoring equipment to an external monitoring center so that doctors or healthcare professionals can check a patient remotely. This type of application is primarily used to monitor chronic conditions such heart disease, diabetes, or asthma. These services can deliver comparable results to in-person appointments and have proven to provide major levels of patient satisfaction. One use for a remote monitoring application solution is for home dialysis patients. Such a system enables patients to receive dialysis on their own schedule at home rather than in a center, leaving more time for family, work, or other activities. The treatment can even be done while a patient sleeps, all while vital signs are being safely monitored by their healthcare team. In addition, more recent home dialysis machines are smaller and more portable, making travel a more convenient possibility. Another example of remote patient monitoring at work is the United Kingdoms Department of Healths Whole System Demonstrator program, which was launched in 2008. This study represents the largest randomized control trial of telehealth involving 6,191 patients and

Real-time Applications
This category of system allows for instantaneous interactions between both the onsite and remote party. Consequently, a telecommunications link to enable direct two-way audio and video communications is required. This usually takes the form of video conferencing or video and audio streaming over the Internet. Typical uses for real-time telehealth systems include: telehomecare, telenursing, telemental health, telecardiology, and teleneurology. Real-time applications are often used for specialist consultations or telemental health. For example, for a patient experiencing a stroke with the nearest hospital or neurologist hours away, access to specialty care and treatment such as intravenous tissue plasminogen activator, a clot dissolving medication, is

Telehealth applications of the future may include a Bluetooth-enabled application to monitor vital signs of drivers and passengers.

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238 general practices and included 3,030 patients with one of three conditions: diabetes, chronic health failure, and COPD (British Medical Journal 2012). The conclusive results of this study to date are persuasive: 45% reduction in mortality rates 20% reduction in emergency admissions 15% reduction in A&E visits 14% reduction in elective admissions 14% reduction in bed days

Wearable Devices and the Future

Even though it may at first sound like science fiction, future wearable devices will move telehealth from the home to onto and even in a patients body. These devices were first developed on the consumer side of the market and used for fitness monitoring and feedback among sports enthusiasts. This market is continuing to gain momentum with products such as Body Bugg, FitBit, Lose it, RunKeeper, and Nike Fuel. However, some soon-to-be-released products currently at the bleeding-edge of telehealth technology are already moving from the laboratory to the market. Some of this development is being encouraged by the Federal Communication Commission (FCC), which recently allowed for more intensive use of a spectrum for the use of Medical Body Area Network (MBAN) devices. These are miniaturized body-worn sensors that collect patient-specific information including EKG readings and respiratory function.

One example of such technology is a wearable device, called First Warning System, which is designed to be worn for 12-24 hours to detect breast cancer. The device will enable doctors to see changes in cellular structure over a period of time instead of within a static mammogram. Another instance of this type of wearable hardware can be found at the University of California in Los Angeles (UCLA). Researchers at UCLA have developed a Smart Insole that contains a sensor which can analyze the gait of patients. Other researchers at Oregon State University have invented a bandage-sized system-on-a-chip that is powered by ambient radio frequency waves from cell phones and other RF devices. In addition, Ford is now collaborating with Microsoft, Healthrageous, and BlueMetal Architects to develop a Bluetooth-enabled In-Car Health and Wellness application to monitor vital signs of drivers and passengers. Scientists at Stanford University have already demonstrated a device that is small enough to literally swim through veins, and the US Food and Drug Administration recently approved a tiny digestible microchip that can be added to pills to allow providers to monitor if patients are following their medication protocols. On March 14, 2013 Samsung introduced the latest model of their smartphone, the Galaxy S4. This smartphone includes health sensors that are integrated with a built-in app called S-Health, which can track steps, food intake, and even sleep with an added accessory. Other options which will be available include a wristband, scale and heart rate monitor. This is the first smartphone to incorporate both health sensors and applications and is a harbinger of things to come.

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Case Study
The US Department of Veteran Affairs (VA) Improves Patient Care and Reduces Costs by Leveraging Telehealth Services
The US Department of Veterans Affairs (VA) was an early adopter of telehealth services and is one of its largest and most successful user organizations. In 2012 the VA provided care from 150 Medical Centers and 750 Community Based Outpatient Clinics to 485,163 patients via 1,380,431 telehealth consultations. Approximately one-third of these patients reside in rural areas and have limited access to healthcare without telehealth services. The VAs telehealth services are growing at an annual rate of 70%. Telehealth services at the VA support both patients and caregivers and enables patients to receive care at home or within their local community. It is accessible on a variety of platform and devices and supports greater patient self-management. In fact, the VA permitted 41,483 patients to live independently in their own homes rather than within an institutional care environment. The VAs telehealth services can be divided into three major categories: Clinical Video, Store and Forward, and Home. Clinical video supported 145,192 patients in 2012 using 44 specialties by leveraging real-time video technology to link hospitals and clinics. This is done using 6,600 video conferencing units connecting via direct dial Internet protocol. The Store and Forward telehealth services from the VA services 255,729 patients in 2012 by enabling the viewing and analysis of clinical images at sites located close to patients. This area is focused primarily on tele-retinal imaging, teledermatology, and telepathology. The Home segment optimized care for 116,729 patients in 2012 while remaining in their own homes. Its focus is chronic care and acute care management and health promotion and wellness. The VA has documented substantial and impressive benefits to both patients and the agency by using telehealth services. The VA reported outcomes that included 53% fewer bed days, 30% fewer hospital admissions, and savings of about $2,000 per patient on an annual basis in its home telehealth program. At the same time, the agency reported a mean score of 86% in patient satisfaction. Telehealth is a significantly different means than what the VA previously used to provide patient care to its constituents and it has been transformational for the agency. In 2012 8.9% of Veterans received portions of their care from telehealth services. In short, telehealth has helped the VA to provide the right care, in the right place, and at the right time.

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Conclusions and Recommendations

Telehealth technologies are beginning to mature and pieces of the telehealth puzzle are coming together. However, companies must build a telehealth system that can fit within their existing technology platform today, as well as support their technology roadmap and that of their customers tomorrow. To minimize the risks of leveraging emerging telehealth technology, it is recommended that companies look for an experienced partner with an understanding of the changing healthcare environment from the provider, payer, and life science perspectives. An effective partner should also be fully versed in the both legacy and the latest technologies such as mobility applications, user experience design concepts, using HL7.

Moreover, it is essential for healthcare companies seeking to introduce their telehealth solutions into foreign markets to choose an IT services partner with international capabilities and a global view of the marketplace. Telehealth is a transformational tool for the delivery of services and the industry is beginning to embrace the use of telehealth. Now is the time for leading players in the healthcare industry to move down the learning curve and begin to leverage telehealth to advance their strategic goals and stake out a position in this important new market.

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References
American Telemedicine Association. May 2, 2013. www.americantelemed.org. Boston Scientific. Cardiac Rhythm Center. January 2, 2013. www.bostonscientific.com. Centers for Disease Control and Prevention. Rising Health Care Costs Are Unsustainable. Centers for Disease Control and Prevention, Division of Population Health. Washington, DC, 2011. Center for Telehealth and e-Health Law. 2013. www.ctel.org. Council of Economic Advisors. The Economic Case for Healthcare Reform. Presidential Report, Executive Office of the President. Washington, DC, 2009. Darkins, Adam. Chief Consultant for Telehealth Services. Telehealth Services in the Department of Veterans Affairs. Center for Connected Healths Connected Health Symposium. Boston, 2013. eMarketer. January 2, 2013. www.emarketer.com. Juniper Research. Smart Wearable Devices. Research Report, Hampshire, United Kingdom, 2012. Project Health Design. January 2, 2012. www.projecthealthdesign.org. Oza, Dr. Manish N., Wellpoint Comprehensive Services. Presentation: Private Payment, The Role of Telehealth in an Evolving Health Care Environment, Workshop Summary, The National Academies Press, Washington, DC, 2012. U.S. National Institutes of Health. May 31, 2012. www.ClinicalTrials.gov. British Medical Journal. Effect of Telehealth on Use of Secondary Care and Mortality: Findings from the Whole System Demonstrator Cluster Randomised Trial. Whole System Demonstrator Evaluation Team Research. London, United Kingdom: British Medical Journal, 2012.

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