UC Davis: What is the future of telehealth? (part 1)

Numerous industry and economic changes are causing healthcare to incorporate telehealth and mobile health technologies. Thomas Nesbitt, MD MPH, at the University of California, Davis, spoke at our most recent monthly Health IT seminar covering the future of telehealth. He declared that the shortage of physicians, President Obama’s Affordable Care Act with its consequent increased demand for health services, and the Institute of Medicine’s focus on increasing healthcare quality.

We need more than just improvement...We need transformation.

As a result, there will be numerous transformations over the next few years: a focus on population health, treatment at home (versus institutions), integration of services, and increased usage of technology.

Areas where healthcare will transform in the next few years

What was most interesting during this seminar were the business-oriented questions folks asked. Why aren’t we seeing more innovations in the hospital? In the home?

Nesbitt reasons that a lot of innovations driven by private industry are tacked on to the current payment model of revenue per unit — say, per procedure, or per visit. But that will change.

Technology isn’t the barrier. In January 2014, this will accelerate, with incentives against readmissions for heart failure. We’re beginning to use technology in the home. We’re starting to do telestroke with hospitals paying a monthly fee. As we begin to become more captivated, it’ll be five years before you see this routinely used because there’s a lot of inertia to keep current payment model — pay by RVU versus payment by quality.”

And have healthcare providers been satisfied with telehealth technology at all? It’s a mixed bag.

In most places, it’s self-selection: [physicians] who want to do it [will adopt these technologies]. [If you wanted to do a study] you’d look to the VA, where people are forced to do it.”

Younger physicians also tend to like it, and also like the pure consultation model so that the primary care physician can take care of explaining the medications to the patient and taking the phone calls at night for emergencies, while the consultant [can move on to the next patient].”

Dr. Yellowlees noted that physicians aren’t as happy with telehealth technologies: “On the whole, provider satisfaction is significantly less than patient satisfaction.” Why?

  • More administrative hassle. Doing telehealth consultations requires faxing massive records over, b/c EMR interoperability is limited at the moment.
  • Some people really don’t like seeing themselves on TV in a picture-within-picture. This is partially ameliorated by training physicians & providers in media skills to teach them how to be good on television.

I’ll cover some of the future trends he speaks about in my next post, along with a tour of the UC Davis Medical Center’s newest Center for Health & Technology.

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