Although the telehealth concept has been around for decades, the changing healthcare business model combined with the proliferation of wireless communications may finally give it the spark it needs to really catch fire, market observers say. By giving telehealth a solid platform, accessible tools and the right environment, many believe it can finally fulfill the potential it always promised.

It certainly appears that the burgeoning shift from acute to post-acute care and the public's penchant for wireless personal devices have created the right conditions for telehealth to thrive, says David Dimond, chief strategist of healthcare industry solutions for Hopkinton, Mass.-based EMC.

"Where it used to be about the technology side of it, telehealth now is about presence management," he said. "It has grown from viewing images to working collaboratively on patient care and getting patients engaged."

"It has grown from viewing images to working collaboratively on patient care and getting patients engaged."  David Dimond

As a collaborator with Johns Hopkins Professor of Medicine Jay Sanders - widely considered "the father of telemedicine" - Dimond has a deep understanding of how the concept has evolved.

"When it was telemedicine, the focus was on delivery of care from point to point," he said. "We don't use that term much anymore. It became telehealth as the healthcare business shifted to electronic medical records and took a longitudinal view of the patient."

In Dimond's view, four trends are shaping the growth of telehealth: the shift from fee-for-service to pay-for-performance; higher patient involvement in the care process; an emphasis on treating chronic conditions and preventing hospital re-admissions; and the increased utilization of wireless technologies such as smart phones and tablets.

Overall, the opportunity for telehealth rests with the virtual delivery of care based on geography and patient location, Dimond said.
"Clinicians, technology and business models are all organizing around community care delivery," he said.

New vernacular?

Kevin Quinn (pictured at right), senior vice president of sales and account management for New York-based AMC says the telehealth term may soon give way to "remote location monitoring" because that is a more accurate description.
"Communications devices, video streaming, chatting and virtual office visits have been a part of telehealth for a long time and we realize their value," he said. "But now it is more about how technology can enhance the view a clinician has of the patient and how it can be used to enhance efficiencies and workflows to drive outcomes and ROIs."

Based on AMC's experience setting up telehealth systems for providers, Quinn says each one looks a little different based on a number of variables, such as geography, organizational makeup, technology and demographics.
"We don't try to pound square pegs in round holes," he said. "We try to understand our customers' needs and workflows. It is not just about providing data, but providing resources to do something with the data."

Meeting clinicians' needs is an especially vital part of assembling an effective telehealth program, Quinn said. The goal, he said, is to make it simple and accessible for users.
"We don't want clinicians to perceive this as additional work," he said. "So we are working with them to make sure it is incorporated into their daily workflows so that it provides value. We want them to realize the nature of their involvement with patients further upstream."

Network setup

Vernon Hills, Ill.-based CDW Healthcare has been actively working with providers on designing telehealth systems and the number of these networks is growing, says Jonathan Karl, sales director.

"As affordable and accessible options become more available, concerns over cost and infrastructure readiness are overshadowed by clear benefits, such as increased communications between providers, greater access to care and simplified system integration during mergers and acquisitions," Karl said.
For those interested in setting up a telehealth program, Karl offers the following suggestions:

• Find a supporter in top management. "The backing of your CEO or medical director will drive the project forward and promote interest throughout your organization," he said.
• Enable remote access to your electronic health record system. Without it there cannot be a "true telehealth solution," he said.
• Evaluate infrastructure. "Telehealth is great, but only if your infrastructure can support it," Karl said. "Be sure your network is reliable and secure, and confirm that you have enough bandwidth for video conferencing elements."
• Train staff. "Preparation and staff support are critical to any telemedicine initiative. Video conferencing systems and other applications are only useful if your practice knows how to use them."

Karl also recommends working with an experienced partner for design and implementation.

"The insight of a healthcare technology expert is priceless, not only in evaluating your program options, but in ensuring the organization is prepared and capable for supporting a telehealth initiative that supports your specific goals," he said.
Portable telehealth

One of the staid perceptions of telehealth patients is that they are homebound and never get out, says Bill Reid, vice president of product management and chief security officer for Seattle-based Numera. In reality, he said, a growing number of active seniors are looking for connectivity with clinical professionals in case of a sudden health episode or accident.

"There is a demand for personal emergency response," he said. "Most of the solutions for fall monitoring are restricted to the home. But people are at risk wherever they are - at the store, at church or a friend's house."

The Numera portable device goes beyond similar call systems, Reid says, because it doesn't require the patient to be conscious to push a button. That is an important feature, he said, because the reason why many people fall is that they lose consciousness.

About the size of a key fob, the device can be worn around the neck or on clothing. It is connected to a cloud-based system that processes data from the wearer and contacts a call center if it detects an emergency situation.