1 Issue 2 | Telemedicine www.telemedmag.com 1

3 new healthcare apps are bringing the house call back

Some of the coolest wearables won’t be available in stores

A day in the lives of five telemedicine physicians

Game on: Who will be telemedicine’s next winning bet?

telemedicine

FEAR

HAPPINESS

SADNESS

SURPRISE

ANGER

OUTSIDE INHow emotion-capture

technology could augment telemedicine...starting with

the treatment of PTSD

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veteran health

wounded, wired warriors

VA Deploys Targeted Telemedicine Programs to Improve Vet ServicesWhile the Veterans Health Administration might not be the first place you’d look for cutting edge technology, the last decade has seen the VA take bold steps in groundbreaking telemedicine solutions. To learn more, we sat down with Paul Costello, VP of Marketing at Viterion, which has been at the center of the VA’s Telehealth program. By Donna Cusano

Out of 2 million patient visits in 2014, the VA estimates that tele-medicine has led to savings of nearly $2,000 per patient while main-taining an 85 percent patient satisfaction rate. At the center of this telehealth system is Viterion Digital Health, which has been an authorized supplier to the Veterans Health Administration for its Care Coordination/Home Telehealth (CCHT) program for more than a decade. Paul Costello, Viterion’s VP of Sales and Marketing, discusses the impact the VA Home Telehealth program has had on the industry as a whole.

How did the VA’s telehealth program act as a proof of concept for the industry? The VA’s VISN 8 regional pilot (Florida, south Georgia, Puerto Rico and the USVI), with 800 veterans during 2000-2003, demonstrated the value of basic telehealth monitoring which reduced days of care, hospital readmissions and hemoglobin A1c, maintaining high levels of patient satisfaction. This became the model for the national Care Coordination/Home Telehealth (CCHT) program starting in 2003, which targeted veteran patients at high risk of entering long-term institutional care by focusing on in-home care management assisted by monitoring technology. At the time, the VA’s major care challenge was the growth of the aging veteran population; between 2000 and 2010, the number of 80+ veterans tripled.

We’ve heard that the VA’s telehealth program was suc-cessful. Give us the straight numbers. By any metric, the VA Telehealth Services program has succeeded in expanding its scope and outcomes. 690,000 patients—12 percent of the veteran population—experience 2,000,000 visits annually (FY2014). They now receive services including Clinical Video Tele-health (real time videoconferencing), Store & Forward (clinical im-aging) and Home Telehealth (home-based acute and chronic care

BY THE NUMBERS

690,000Veterans

provided with remote care

by VA in fiscal year 2014

55%Percentage of veterans re-

ceiving remote care who live in rural areas

12%Percentage of veterans

receiving tele-medicine care

in 2014

2 million+Total number of telehealth visits in the

VA system in 2014

Home Tele-health alone has grown

from 43,000 patients in

FY 2010 to 156,000 in

FY2014

management via technology). About half of veterans receiving telehealth services live in rural areas with limited access to VA care. Home Telehealth alone has grown from 43,000 patients in FY 2010 to 144,520 pa-tients in FY2013 and 156,000 in FY2014, as it becomes an increasingly attractive op-tion for veterans.

Home Telehealth has improved patient outcomes and saved money, results remark-ably consistent since the VA’s first national survey in 2007. By FY2014:• Bed days were reduced by 42 percent• Hospital admissions were reduced by 34 percent• Patient satisfaction was maintained at 85 percent• The VA also estimated that Home Tele-health saved $1,999 per patient per year in FY 2013.

Home Telehealth has also succeeded in achieving the VA goal of keeping veterans living independently in their communities. During FY 2013, 41,430 patients—over 28 percent—were supported by Home Tele-health to live independently in their homes, versus being transferred to long-term insti-tutional care.

Describe more specifically how home telehealth developed with the VAIt took time, but the VA and Viterion de-veloped methods for their care teams to utilize this newly-generated patient data in optimizing care coordination of large pop-ulations. These patients may have multiple chronic conditions—hypertension, diabe-tes, COPD, heart failure and obesity—or be in transitional care. Telehealth assists not only in clinician monitoring of patient vital signs, patient self-management, health pro-motion and disease prevention (HPDP), but also in alerts to changes in condition, reports, analysis and EHR integration. The goals are to enhance patient health, prevent decompensation and to reach the patient with the right care at the right time.

Vital signs monitoring uses medical devices to monitor blood glucose, blood

2010

2014

46 Issue 2 | Telemedicine www.telemedmag.com 47

pressure, pulse, pulse oxygen, weight, tem-perature, peak flow and pain level. These connect directly to the current V100 desk-top unit, or the patient or caregiver may enter results manually. Patient answers to customized health questions provide qualitative information for the clinician. Integrated into daily checks are medication reminders and patient education tips pre-set for their condition(s) which reinforce healthy behaviors.

Clinicians can enroll patients, assign DMPs, establish monitoring schedules with reminders, easily set up vital sign risk levels and alerts when patients are out of range or measurements aren’t taken, and can see their patient grouping with status at a glance on their home page. Viterion’s platform also facilitates individ-ual patient and population reports, analysis and risk stratification through a wide range of queries and filters. Results are also inte-grated into patient records in VistA, the VA’s EHR.

How will a new, younger veteran population change the VA’s tele-health landscape?Younger veterans—Cold War, Vietnam, Gulf War, Bosnia/Kosovo, Iraq and Af-ghanistan—are now part of or entering VA care. These veterans are often substantially more mobile and technologically sophis-ticated. Viterion’s new tablet, the Vitacast 1000, was designed to meet their needs. A 7” touch screen tablet with its own plat-form, it has wireless capability (3G/4G/Wi-Fi), Bluetooth/USB-A medical device connectivity and a rechargeable battery. Its screens, menus and icons are large, bright and intuitive; audio cues, text-to-speech option and stylus assist those with motor, hearing and visual impairments. The new technology enhances not only vital signs monitoring but also reminders for medica-tion and appointments; patient education and qualitative measurements such as pain assessment; and indicators that help with

care for PTSD and brain injury patients.

What is next for the VA’s tele-health program?The VA is piloting a digital wound manage-ment system, integrated with VISNET and VistA, where patients or caregivers take digital photos of their wounds at home, wirelessly uploading them to their patient record. Clinicians can instantly view and assess images, then document patient prog-ress over time, increasing access to care for mobility-restricted or rural veterans.

How will the VA system’s lessons impact the broader telemedicine landscape?Viterion Digital Health is now using the lessons learned over 12 years with the VA in new partnerships with ACOs, hospitals, health systems, long term care organiza-tions and health plans. A significant and positive change for telehealth this year is CMS’ introduction of a reimbursement program for chronic care management (CCM). Eligible for this are Medicare FFS patients with two or more chronic condi-tions, who are often the sickest and most costly to manage. For providers imple-menting CCM, meeting CMS’ rigorous reimbursement requirements--successfully establishing, coordinating and manag-ing comprehensive care plans for these patients, integrating non-face-to-face pa-tient care, documentation through existing practice/hospital EHRs and management systems--can be extremely important to their bottom line. It presents a new oppor-tunity for private CCM/TCM providers to integrate telehealth as part of remote care, which can lead to improved patient outcomes, convenience, satisfaction and avoidance of unnecessary care costs, as proven by our extensive history and experi-ence with the VA.

V.A. LEADS THE WAY // FROM PAGE 15

cally ill patients and developing care coordination plans utilizing telehealth. The options are robust and capabilities are truly remarkable with this newfound ability to impact patients suffering from chronic diseases. You can now take your care to the home of patients you treat, which has already shown many posi-tive outcomes in managing chronic dis-eases such as diabetes, while earning a monthly reimbursement per patient. For this type of program you need to deploy the devices necessary to monitor the pa-tients remotely. The options available on the market are diverse and even though they essentially all do the same things in regards to collecting vital signs data, the higher tiers of monitoring devices can do much more. Devices can give you an up-loaded customized series of survey ques-tions to gauge the patient’s daily condi-tion, medication adherence reminders, educational materials such as exercise and diet suggestions along with live video ca-pability, all in one unit installed into the home.

Provide Mobile DiagnosticsMobile diagnostics or imaging is an av-

enue a provider can champion and build a business off of as well. The global mo-bile imaging services market was valued at USD 10.7 billion in 2013 and is expected to grow at a CAGR of 3.2% from 2014 to 2020, to reach an estimated value of USD 13.3 billion by 2020.

The telemedicine tools are now avail-able, but the catalyst for massive change will come from those with credentials, with years of education, these vital knowl-edgeable few who have been entrusted to care for us. I dare you to embrace the revolutionary journey of becoming a tele-physician and shaping our clinical world for centuries to come.