Telehealth

The program uses a mix of home visits and telehealth technologies to bring more services to the home.

Samitivej Hospital Group, a private hospital brand in Thailand with a network of eight hospitals and owned by Bangkok Dusit Medical Services (BDMS), recently announced the launch of its one-stop Virtual Hospital app, offering three key services: Teleconsultation – a remote telemedicine consultation service that provides round-the-clock medical advice via a video call with Samitivej’s doctors and nurses. Test@Home – patients can have their blood samples taken in the comfort of their home and blood samples will be sent to the laboratory immediately. Medicine Delivery – medication will be delivered to patients with absolute data security as Samitivej adheres to the data protection standards mandated by the Health Insurance Portability and Accountability Act (HIPAA). Samitivej Virtual Hospital will be available on April 1, 2019, with services 24 hours a day, seven days a week. The consultation fee is 500 baht (approx. US$15.78) per 15 minutes, and patients using the service will receive a 20% discount on medications. In addition, the services of the Samitivej Virtual Hospital do not require appointments to be made in advance. Samitivej Hospital Group teamed up with six leading companies to launch the virtual hospital services: Advanced Info Service, Line Thailand, Muang Thai Life Assurance, Siam Commercial Bank, Sansiri and SCG Cement-Building. There is also a Samitivej Virtual Hospital control room (see featured image) located at Samitivej Srinakarin Hospital that has been designed with the specific purpose of enhancing the Samitivej Virtual Hospital experience. “A significant challenge in today’s healthcare industry is to move beyond digital disruption and service providers need to keep up with trends, innovate and develop new service models to continuously meet the needs of consumers in all sectors,” said Chairat Panthuraamphorn, Managing Director and Chief Executive of Samitivej Hospitals and BNH Hospital, in a statement. There are also plans to expand the Virtual Hospital service to BNH Hospital in the future, he added. Last month, BC Platforms announced that it will be providing its genomics platform to Bumrungrad International Hospital, a private multiple-specialty medical centre founded 1980 in Bangkok. In January this year, the Thai government added medicine, medical supplies and medical services to its price control lists. While there has been outcry from the private hospital industry that the price controls would adversely affect Thailand’s reputation as a medical tourism hub, the effects of the price controls remain to be seen.

Despite its clear potential to improve access to high-quality care in underserved communities, telehealth is underutilized by safety-net providers due to a range of barriers, according to a new report from the RAND Corporation. The analysis, based on interviews with Medicaid officials from seven states and representatives from 19 Federally Qualified Health Centers in those states, points to insufficient reimbursement as a leading culprit for this lag, in addition to other logistical, policy and operational barriers. WHY IT MATTERS Telehealth can help rural, low-income and vulnerable populations better access health care -- and analyses have shown use of this technology, particularly live video telehealth, is growing among FQHCs. In some cases, telehealth is the only way to bring specialists into remote places. But uptake, maintenance and expansion of telehealth services have been spotty at best. The RAND report, sponsored by the Department of Health and Human Services, seeks to find out why. Interviews with Medicaid and FQHC stakeholders revealed a lack of clarity around state telehealth policies and insufficient reimbursement as top barriers to adoption. Other limiting factors included: infrastructure issues (e.g., insufficient broadband), technology costs, telehealth as a cost center, billing challenges, lack of buy-in among FQHC providers, challenges specific to the patient population (e.g., elderly patients, homeless patients), complexities in adjusting clinic workflow, inadequate supply of specialists to provide telehealth services to FQHC patients, complex and time-consuming logistics around credentialing and licensing, and challenges in working with remote providers. The report suggests several possible solutions that address stakeholder concerns directly as well as areas for further research -- including surveying "the policy environment faced by FQHCs nationwide and explore whether certain policies seem to be associated with greater utilization of telehealth." THE LARGER TREND Given the advantages of using telehealth in underserved communities or to treat vulnerable patients, it is important that state officials and safety-net providers come to a mutual understanding of what's standing in the way of telehealth expansion for these populations -- and modify or clarify policies accordingly. Exciting developments in telemedicine technology must be evaluated in the context of whether they will provide benefits to all users, particularly those with the most need. ON THE RECORD "Telehealth is widely recognized as a tool that can increase access to care and improve quality, and, given that FQHCs are experimenting with telehealth across the United States, it is highly likely that many have confronted challenges and implemented strategies that can benefit others at different stages of implementation," the report authors write. "Studies such as this can support Medicaid programs and FQHCs in the important process of peer learning. Furthermore, our findings highlight the important role of policy, in combination with cultural, organizational, and infrastructure factors, in strengthening the delivery of telehealth services." Deirdre Fulton is communications professional and freelancer based in Maine. On Twitter: @deirdrefulton Healthcare IT News is a HIMSS Media publication. 

At the hospital's inflammatory bowel disease center, providers can now deliver better care to patients with delicate conditions.

Royal Darwin Hospital (RDH) and Siemens Healthineers have partnered in a venture to expand oncology services available in the Northern Territory, providing the hospital with an advanced PET CT scanner that offers patients the capability to scan faster using lower doses of radiation and personalises scans to a patient’s specific medical condition. RDH is the largest hospital in the Northern Territory region of Australia. Siemens Healthineers A/NZ Molecular Imaging Business Manager Tim Lagana said that the Biograph mCT Flow Edge scanner features advanced capabilities such as improved lesion detectability and reduces unnecessary exposure to radiation with two features.  The first is FlowMotion, which eliminates the need for bed-based imaging used by traditional PET scanning forms.  “As a result, examination parameters such as speed, image resolution and motion management can be easily adjusted to the precise dimensions of organs and routinely incorporated into a single scan for every patient,” Lagana said. The second feature he identified is the Definition Edge CT scanner. “Due to the full electronic integration of Siemens’ Stellar detector, electronic components like microchips, conductors, etc. are integrated directly at the photodiode. This reduces electronic noise coming from the detector elements and thus, improves the signal-to-noise ratio (SNR) for optimised image quality.” According to the RDH, the new service will be the “first of its kind” available in the territory and is one of only four in Australia. NT Health Senior PET Technologist Jack Anderson said that following installation, patients who had to previously travel up to 3400km interstate for access to diagnosis and treatment monitoring equipment can access these services much closer to home. “Previously, Northern Territory patients would have to travel interstate to have a PET scan in order to diagnose or help manage their medical condition,” he added. “The new RDH PET service can make a huge impact for these patients by reducing delays to diagnosis and treatment due to the need for interstate travel; better access to specialist diagnostic services for patients with geographic, physical mobility, language or income barriers; and reducing the costs to patients, carers, families and friends incurred during interstate travel for diagnostic services and treatment.” Anderson said this installation also puts the Northern Territory on the map with one of Australia’s most advanced medical imaging systems on the market, providing treatment options and pathways for the region’s most complex diagnostic and disease requirements. “RDH now has equivalent medical imaging services to the major hospitals in other capital cities, with enhancement to its provided services,” he said. “The new equipment has the potential to position the territory as a hub for PET research in Northern Australia and the Asia Pacific region, and furthers medical specialty in the territory, increasing the capability and integration of the local cancer services.” Although currently geared towards oncologic applications, Anderson said the system also has the capability to image neurological disorders such as alzheimer's, dementia and epilepsy, and assist in the diagnosis and provision of care for patients with other medical conditions like infections and inflammatory disorders. This article first appeared on Healthcare IT News Australia.

Patients across some of Australia’s rural and regional areas now have access to advanced medical imaging technology that aims to help with the early detection and treatment of cancer. Royal Darwin Hospital (RDH) and Siemens Healthineers have partnered in a venture to expand oncology services available in the Northern Territory, providing the hospital with an advanced PET CT scanner that offers patients the capability to scan faster using lower doses of radiation and personalises scans to a patient’s specific medical condition. Siemens Healthineers A/NZ Molecular Imaging Business Manager Tim Lagana told HITNA that the Biograph mCT Flow Edge scanner features advanced capabilities such as improved lesion detectability and reduces unnecessary exposure to radiation with two features. The first is FlowMotion, which eliminates the need for bed-based imaging used by traditional PET scanning forms. “As a result, examination parameters such as speed, image resolution and motion management can be easily adjusted to the precise dimensions of organs and routinely incorporated into a single scan for every patient,” Lagana said. The second feature he identified is the Definition Edge CT scanner. “Due to the full electronic integration of Siemens’ Stellar detector, electronic components like microchips, conductors, etc. are integrated directly at the photodiode. This reduces electronic noise coming from the detector elements and thus, improves the signal-to-noise ratio (SNR) for optimised image quality.” According to the RDH, the new service will be the “first of its kind” available in the territory and is one of only four in Australia. NT Health Senior PET Technologist Jack Anderson told HITNA that following installation, patients who had to previously travel up to 3400km interstate for access to diagnosis and treatment monitoring equipment can access these services much closer to home. “Previously, Northern Territory patients would have to travel interstate to have a PET scan in order to diagnose or help manage their medical condition,” he said. “The new RDH PET service can make a huge impact for these patients by reducing delays to diagnosis and treatment due to the need for interstate travel; better access to specialist diagnostic services for patients with geographic, physical mobility, language or income barriers; and reducing the costs to patients, carers, families and friends incurred during interstate travel for diagnostic services and treatment.” [Read more: New AI tech reshapes skin cancer detection | New bid to map AI’s impact on radiology] Anderson said this installation also puts the Northern Territory on the map with one of Australia’s most advanced medical imaging systems on the market, providing treatment options and pathways for the region’s most complex diagnostic and disease requirements. “RDH now has equivalent medical imaging services to the major hospitals in other capital cities, with enhancement to its provided services,” he said. “The new equipment has the potential to position the territory as a hub for PET research in Northern Australia and the Asia Pacific region, and furthers medical specialty in the territory, increasing the capability and integration of the local cancer services.” Although currently geared towards oncologic applications, Anderson said the system also has the capability to image neurological disorders such as alzheimer's, dementia and epilepsy, and assist in the diagnosis and provision of care for patients with other medical conditions like infections and inflammatory disorders.

At the federally qualified health center and patient-centered medical home, telehealth technology has changed the way primary care physicians deliver care.

A new study shows that effective pre-triage for telehealth could reduce patient pressure on GPs by up to 73 percent.

Advancements in healthcare technology are necessary, but they can’t take away the human element, says Tammy Kwiatkoski, director of clinical informatics for the HIMSS Office of the CTIO.

Speaking during a panel session at the recent AFR Healthcare Summit, Royal Australian College of General Practitioners (RACGP) President Dr Harry Nespolon said the way remote healthcare and telehealth is offered has changed little since the 1960s.   “Doctors still need to see patients in front of them to dispense care. It hasn’t changed much over the last 50 years. I used to work for the AMA [Australian Medical Association] and my boss once said, ‘fish and chips shops today have more technology than most GPs’. There is still some truth in that,” he said. NSW Health Secretary Elizabeth Koff addressed the need for industry, governments and patients to grasp the concept of new-age telehealth and remote care as virtual care delivery models see traditional provider-patient interactions evolve. “Not everyone universally understands what we’re trying to achieve with telehealth. It’s not just about providing face-to-face communication in an effectively and timely manner in rural and remote Australia,” she said. “It’s also about data and information exchange that we can do in a systematic way to enhance patient care.” According to Silver Chain CEO Dale Fisher, consumers are ready and asking for changes to how remote care is offered, but there are some setbacks. “Consumers are directing the future of care and are asking for changes to how remote care is offered. The policies exist, but there needs to be funding flow from governments to support those policies,” she said. “The funding needs to flow into innovative programs that consumers are asking for. Digital disruption and innovation has already happened. What we haven’t done as a health system is adapt and take advantage of the digital revolution.”    Nespolon agreed, adding that general practice needs to be freed from its current regulatory and financial constraints and that’s something that needs to be worked towards. “Medicare and Medibank were set up as face-to-face systems and they still are face-to-face systems. Over the years, successive governments have credibly tried to resist the idea of breaking that nexus. That is about to change and both the potential governments are interested in delivering on what consumers want, which is the ability to access their healthcare in a variety of ways depending on their needs.” Royal Flying Doctor Service of Australia (RFDS) CEO Dr Martin Laverty said telehealth is part of the organisation’s DNA, but part of the challenge it faces is that the latest technologies don’t work without proper broadband coverage.   “If the pipe doesn’t deliver broadband into remote areas, the devices aren’t going to work. The promise of recent times, for high-speed broadband into the bush is not yet clinically-grade reliable. And until this happens, we’re going to be held back in our next investment.” Securing the nuts and bolts in healthcare Koff said having an agile system in place would enable interoperability, allowing care at a local district level or hospital level be fully integrated with primary care and other services. “The issue around digital enablement and being agile is something health is not known for. And that’s something we struggle with at a system manager level. Whilst we’re keen to have the architecture right, we need interoperability so it can be integrated,” she said.     According to Laverty, some of the challenges of telehealth will be eradicated with the next layers of development in broadband delivery. “The problem has not been solved with the existing satellite and mobile reach of broadband connectivity. That's the difference between consumer and clinical grade. We haven't achieved clinical grade, even if we've got patchy consumer-grade broadband access across remote areas today.” Fisher said in the lead-up to a working virtual hospital system, industry needs to be designing innovative programs in partnership with other organisations. “Rather than worrying about where the money comes from, we need to invest in our organisations to bring siloed parts of our operations together to demonstrate that there is a new way of doing things to deliver good care,” she said.    Nespolon concluded the session by saying that a barrier isn’t necessarily technology, but rather, people. “You can’t force technology on to people. It’s whether people want to use it and how they use it. For example, electronic health records have the potential to do great things, but hasn’t taken people all the way through. A more gentle approach is necessary in getting this message across,” he said. Carelink Managing Director Craig Porte, who spoke at a separate session during the summit, said there is still a heavy reliance in traditional delivery models of care in rural areas of Australia, resulting in an unequal distribution of benefits. “Interoperability, unreliable internet, a lack of offline solutions and investments are only some of the problems in remote Australia. There are plenty of amazing technologies that work out there, but for true remote care, they all need to be connected,” he said. “Face-to-face care is still necessary in rural and remote Australia. Interoperability – offline and online systems working together seamlessly – is key. AI will play a role going forward too; simple things like driverless cars will be essential in delivering remote care. Mobile solutions delivering care to the home will also need to become more mainstream. “But we have to keep in mind that technology is only an enabler in keeping people in their communities. Our challenge, as an industry, is to take the next leap in delivering true remote care.”  This article first appeared on Healthcare IT News Australia.