Moving Beyond EMRs to Sustainable Business Models for Telecare

"Three years ago, telecare was about EMRs. Today, the world has embraced EMRs as proven technology to improve quality and efficiency and healthcare providers are willing to pay for it," says Dr. Blatt. He is convinced however that, looking to the future, EMRs can form the basis for care beyond the hospital and in this way intersect with telemedicine and telehealth. By this reasoning, sustainable business models where telehealth technologies can be useful to patients can be thought of in four fundamental ways:

• Chronic Disease Management at Home - decreasing more costly contact with healthcare systems in institutional settings (EDs, Surgeries, Hospitals)
• ED Diversion: Safe and effective treatment by Home Telecare system, instead of admitting patient to hospital
• Early Discharge (free up BDOC). Via use of a monitoring system. Stops the need for more hospitals as more conditions can be managed at home
• Readmissions Prevention: If you have an acute exacerbation following discharge, how can Telehealth help avoid readmission?

In each of these cases the issue is not the technology, but how to coordinate care across the continuum and how to pay providers for the most effective care possible. 'Care coordination' is the answer.

Care coordination is more than just getting data. You need to have the ability to ask questions to patients. If their answers are not consistent with the pure data then you might not use the data to change therapies. Providers treat patients, and not data. Systems for collecting data are a good start, but what's really needed is a connection/trust with patients. Better video conferencing is a key element in gaining that trust. We know that people like video and it works.

For telehealth to scale, patients need to trust the systems, and social connections established by video is key to that trust. "We need to change patient behaviour to make telehealth successful and scalable," argues Dr. Blatt. "To support video conferencing, we need to drive national broadband initiatives (e.g. National Broadband Network initiative in Australia). Also needed are improved decision support, algorithms and knowledge based systems. Simply relying on the doctor to do what he or she did face-to-face, gets you the same inefficient and unscalable care you used to get but just via video."

Hospitals are currently reimbursed based on treatment given at the hospital. Sending patients home is better for everyone except the hospital. Hospitals need to be reimbursed for doing the right thing, not for volume.

Dr. Blatt will talk about payment reform models that include Accountable Care Organizations (ACOs) and Patient Centred Medical Home (PCMH) as well as 30 day rebundling payment for post discharge care. Payment reform goes hand in hand with business models that take advantage of the ubiquity of telehealth care delivery.

He will provide some examples and present case studies of efficiencies in care delivery in all four business models listed above and give examples of ongoing pilots and emerging business models world wide that take advantage of payment reforms and the new care delivery models noted above.

"Care coordination is imperative going forward if telemedicine business models are to succeed. Simple remote patient monitoring, etc. was a good start for telemedicine, but over two decades it has not scaled. By changing business models, healthcare policy and reimbursement, Telemedicine can and will scale as the preferred delivery model for the 21st century," according to Dr. Blatt.

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About Med-e-Tel
Med-e-Tel focuses on ehealth and telemedicine applications and a wide range of other medical ICT applications and on the convergence of information and communication technology with medical applications, which lead to higher quality of care, cost reductions, workflow efficiency, and widespread availability of healthcare services.

The "Med" in Med-e-Tel stands for healthcare services (institutional and home based care, prevention and education) and for medical products and equipment (medical imaging equipment, monitoring devices, electronic health records, etc.).
The "e" stands for the electronic and IT industry and services (hard- & software, internet, e-mail, etc.).
The "Tel" stands for telecommunications (whether it is POTS, ISDN, wireless, satellite, videoconferencing, VoIP, or other).

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