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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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2013 NTT DATA, Inc.


2013_05-WHP-Telehealth

www.nttdata.com/americas
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NTT DATA Americas White Paper:

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outdated reimbursement policy, increased availability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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2013 NTT DATA, Inc.


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NTT DATA Americas White Paper:

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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2013 NTT DATA, Inc.


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NTT DATA Americas White Paper:

Trends in Telehealth

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.

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.

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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.

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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NTT DATA Americas White Paper:

Trends in Telehealth

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.

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.

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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.

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.

2013 NTT DATA, Inc.


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NTT DATA Americas White Paper:

Trends in Telehealth

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.

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

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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.

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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NTT DATA Americas White Paper:

Trends in Telehealth

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.

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.

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.

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

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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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NTT DATA Americas White Paper:

Trends in Telehealth

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.

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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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NTT DATA Americas White Paper:

Trends in Telehealth

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.

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.

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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.

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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NTT DATA Americas White Paper:

Trends in Telehealth

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.

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

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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.

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:

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.

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.

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

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.

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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.

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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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

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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.

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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

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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.

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.

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.

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References
American Telemedicine Association. May 2, 2013. www.americantelemed.org.
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Centers for Disease Control and Prevention. Rising Health Care Costs Are Unsustainable. Centers for Disease Control
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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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