Taking off with telemedicine
Joe Tracy, vice president of telehealth services at Lehigh Valley Hospital and Health Network in Allentown, Penn., delivered his talk, “Telemedicine: Make it Work,” at HIMSS07 in New Orleans on Wednesday.

Tracy said the organization implemented telehealth to improve access to quality care, reduce costs, improve access to medical information, improve patient safety and allow patients to play a prominent role in their healthcare process.

Acceptance of telemedicine is crucial to reaping the benefits. Unlike in some other situations, “build it and they will come” will not work. To get providers to accept telemedicine, you have to answer their question of “What’s in it for me?” The answer, Tracy said, is additional reimbursement, the ability to build a better referral base and build up their practice. Referring providers believe that telemedicine will lead to them losing patients. “Time and trust will fix that,” said Tracy. Meanwhile, good training and careful selection of equipment can go a long way to helping clinicians become more comfortable with telemedicine.

A thorough cost-benefit analysis must be done before implementing telemedicine, Tracy said. Lehigh Valley developed the Advanced Intensive Care Unit (AICU) to improve patient safety, improve compliance with the Leapfrog ICU requirements for intensivist staffing and enhance the ICU infrastructure. The $3 million project was approved with a net present value of negative $750,000. However, through telemedicine, the organization has avoided more than 3,500 patient days but monitored more than 5,500 patients in 2006. ICU telemedicine reduced the mortality rate from 16.2 percent to 10.3 percent. Nurses have been able to add more than 95 minutes per 12-hour shift to direct patient care.

Tracy successfully implemented telemedicine at University of Missouri Health Care before joining Lehigh Valley by making sure that it was very convenient for the physicians. He said one doctor told him he wouldn’t walk more than four doors down the hall out of his way. So, using the same scheduling, billing and medical record systems as those used for physically-present patients is vital. “The only difference is that the physician is seeing the patient on television,” he said.

Broadband is not yet available everywhere so you must assess your equipment and access. Tracy said you should plan for a minimum of 60 days for a typical installation. He also suggested looking beyond the common carriers for better deals.

On a broader level, there are federal issues regarding telemedicine. Past laws and regulations are no longer completely applicable given current technology. However, as of November 7, 2006, 87 bills contained the words “health information technology” and 76 contained the word “telemedicine.” Telemedicine has been approved only for reimbursement for services provided in rural areas, however, rural areas continue to shrink due to reclassification. The American Medical Association eliminated several CPT codes that were approved by Congress for telemedicine reimbursement and if the replacement codes are not on the list of CMS-approved telehealth services then they are not reimbursable.

Tracy encouraged his audience to get involved with policy efforts pushing for telemedicine. Given the capabilities of today’s technology and the vast amount of underserved patients, telemedicine is an opportunity that shouldn’t be squandered.