Telehealth Lessons Learned from the USA Experience · Teleconsultations Remote Patient Management Total Consults 2016 (K) 4,407.4 Total Lives Monitored 2016 (K) 522.3 Total Consults

Copyright © 2019 Allscripts Healthcare Solutions, Inc. 1Copyright © 2019 Allscripts Healthcare Solutions, Inc.

Telehealth Lessons Learned from the USA Experience

Andrew ForrestMarket Solutions Leader – Asia Pacific

April 2019

Copyright © 2019 Allscripts Healthcare Solutions, Inc. 2

This presentation will look at

lessons the Australian TeleHealth

Market can learn from

understanding the USA experience

and development of TeleHealth.

As the largest consumers and

market for Telehealth in the world

the USA experience can be a guide

for Australia as we begin the

adoption of Telehealth.

Introduction

PhoneVideoEmail

Use of Virtual

Health Platforms

Patient

Portals

Government

regulation/incentives

The presentation will examine:


USA Overview

Telemedicine—remote consults between physicians

Tele-ICU—the use of remote Clinicians to manage Intensive Care Services

On-demand Video services—both acute and ambulatory

Patient “Portals” for information access and sharing

“Virtual” Care services

• “Synchronous” –Realtime – Live communications (Video, Phone, Text, emails)

• “Asynchronous” – Store and Forward (digital capture of pt. Histories etc.)

• “Remote Monitoring” –Connected devices (home monitoring, fitness trackers etc.)

01

02

03

05

The USA started on the

TeleHealth Journey in approx.

2005. Since then there has

been a proliferation of

services including:

04


Factors Driving Rise in Telehealth Services in USA

Consumer driven Healthcare

As technology has progressed so has the demand from consumers to have healthcare keep pace.

Demand for Healthcare “convenience”

Government regulation and the Affordable Care Act

Medicare/Medicaid “Meaningful Use”

Shift to outcome based from episodic based funding

31% healthcare organizations

use video-based

telemedicine services

34% offer remote

patient monitoring

“Thanks to technology and shifts in

financial incentives, care will begin to

move into the palms of consumers’ hands,

providing care anywhere, anytime.”


USA by the numbers

Telehealth Market Summary: USATotal $M Revenues (2016) 1,336.3 Revenue % of Region (2016) 87%

Total $M Revenues (2022) 3,203.8 Services as a % of Rev 2016 65.7%

CAGR 2016-2022 15.7% Hardware as a % of Rev 2016 21.8%

Telehealth Development High Platforms as a % of Rev 2016 12.5%

Teleconsultations Remote Patient ManagementTotal Consults 2016 (K) 4,407.4 Total Lives Monitored 2016 (K) 522.3

Total Consults 2022 (K) 11,429.1 Total Lives Monitored 2022 (K) 1,058.6

CAGR 2016-2022 17.2% CAGR 2016-2022 12.5%

Share by Setting—2016 Key Market DynamicsOn-Demand/Direct Access 23.6%

Most evolved country market across all care settings. Video consultations

being used across primary, acute and post acute care settings, and

supported by traditional providers and telehealth specialists. Telehealth

coverage and payer parity legislation helping to drive adoption. Dept. of

VA driving RPM adoption.

Outpatient/Referral 18.7%

Tele-ICU 17.9%

Surgical/Medical Support 8.8%

Transition of Care 3.9%

Remote Patient Monitoring 27.0%

USA is the largest single TeleHealth Market in the world

both by revenue/sales/expenditure and usage


Meaningful Use

Stage 1 (2011-2012)

Eligible professionals are required to promote data capture and sharing among patients. More than 50% of patients should have online access to their health records

Stage 2 (2014)

More than 50% of the patients should have online access to their health records and 5% of the patients should use the electronic information

• The stage 2 of Meaningful Use has 17 core objectives

• An eligible provider must meet all the objectives to earn incentive

• The providers receive incentive when all the requirements are met, failure to which may lead to no incentive and even penalty

Stage 3 (2016)

This stage expects an improved outcome from the use of patient portals. Additionally, it requires eligible professionals to encourage use of patient portals

Similarly, MU stage 3 has 6 objectives, of which an eligible provider must meet at least 3

Availability of patient portals would help providers meet all these objectives

Defines the use of certified EHR’s in order to engage patients, improve quality of services and manage patient

care efficiently. Meaningful Use has three stages which were expected to evolve from 2011 to 2016:


79%

21%

Hospital Adoption Rate

Hospitals Using Patient Portal

Hospitals Not Using Patient Portal

23%

77%

Patient Usage Rate

% of Patients enrolled

% of Patients not enrolled

• High adoption of patient portals in hospitals is owing to Meaningful Use criteria

and HITECH Act. However, adoption of patient portal in patients is as low as

23% due to lack of awareness, technological obstacles and data security issues

• The adoption of patient portals is projected to rise in the future as the

awareness among patients increases and as providers encourage and educate

them about the advantages of using a portal

“Patient portal use by older patients is on the rise due not

only to chronic disease management needs, but an overall

comfort with technology. Patients in their 60s are just as

likely as younger patients to register for their patient portal,

with nearly 30% of patients over 65 reporting portal use.”

—athenaResearch (Jan 2016)

33%

22%17%

16%

12%

Reasons for Use of Patient Portals

Maintaining clinical records of patient and doctors

Maintaining patient records

Anytime access to medical history & lab results

Communication between patients, doctors and hospitals

Compliance with Meaningful Use and CMS regulations

Adoption Rates of Patient Portals & Usage Reasons

Low usage by patients offsets high adoption in hospitals


What do US Patients Want

67% Prefer email visits

Telehealth is more than just video visits and

physician offices can start with email visits as a

more economical telehealth option. Using eVisits ,

clinicians can treat patients and delegate tasks

without the administrative costs associated with

in-person office visits.

86%

Information—about everything—is at our fingertips.

We can search the Internet on any topic, and

health concerns are no exception. The need for

immediate gratification means that people will

typically turn to Google before consulting a

medical professional.

Research health before

scheduling an appointment 64%

We expect to see the number of self-scheduled

appointments to increase as consumers become

more self-reliant and physician offices seek ways

to lower administrative overhead.

Will schedule appointments

using digital tools by 2019

48%

Today’s young adults expect their providers to

offer technology that is as mobile and flexible as

they are. As a generation that grew up with the

internet, these healthcare consumers expect

convenience and accessibility.

18-24 y/o want their doctor

to offer a smartphone app 70%

Healthcare consumers recognize this task as one

that is easily automated. Prescription refills

shouldn’t involve multiple steps from them, or

their providers.

Want to request refills of

medication electronically

http://www.allscripts.com/news-insights/blog/blog/2017/05/telehealth-is-more-than-just-video-visits


Former state

• No frame of reference for selecting providers

• Limited care options

• Lack of price and care quality transparency

• Limited access to personal health information

• Lack of care coordination and communication

• Paper-based and unsystematic operations

resulting in patient dissatisfaction

Future state

• Competitive health care market

• Greater convenience and accessibility to care

• Better value for care

• Greater transparency for patient health information

• Better care outcomes

• Efficient clinical workflow and business processes

• Expansion of retail access—Walgreens/Pharmacy, etc.

Barriers

Lack of understanding

and awareness of

digital technology

Data sharing capabilities (i.e.,

data existing in a single and

seamless platform)

Lack of willingness

to share data among

providers

Cyber security

concerns

Shift in patient and

workforce

demographics

Evolving

regulations

Meeting the challenges of healthcare consumerism


• USA Telehealth initially driven by Government

regulation/incentive – Australian success will

depend on government engagement

• Adoption rates will increase over time – start

slow and build

• Age demographics are wide spread—not just

Millennials—technology must cater for older

demographics

• EHR roll out increases the use of TeleHealth –

single portal/engagement platforms make it

simpler for patients—avoid multiple platforms

for the same health system—Interoperability

is Key

• Acute/Sub-Acute/Primary/Remote Monitoring

platforms – are they the same? Will they offer

similar functions/features?

• Both Primary/Community care and Tertiary

Care need to be engaged and linked

• Its not just about Patient Portals – its

about Patients!!

Lessons for Australian Healthcare


Unsustainable and Unclear

Financing Models

• As can be seen from the USA

experience funding is

critical to the adoption and

success. Today financing for

healthcare in Australia is

fragmented across

Geographic and national line

(CSIRO – future of health

report 2018)

• Who pays for Telehealth

initiative may determine

which platform(s) are used

Funding and Financing

Telehealth Market Summary: Oceania (Australia/New Zealand)

Total $M Revenues (2016) 74.8 Revenue % of Region (2016) 16%

Total $M Revenues (2022) 167.3 Services as a % of Rev 2016 61.4%

CAGR 2016-2022 14.4% Hardware as a % of Rev 2016 24.6%

Telehealth Development Medium/High Platforms as a % of Rev 2016 14.0%

Teleconsultations Remote Patient Management

Total Consults 2016 (K) 352.2 Total Lives Monitored 2016 (K) 15.3

Total Consults 2022 (K) 762.8 Total Lives Monitored 2022 (K) 35.9

CAGR 2016-2022 13.7% CAGR 2016-2022 15.2%

Share by Setting—2016 Key Market Dynamics

On-Demand/Direct Access 11.2% Widespread use of telehealth consultations in

Australia, paid for via Medicare. Use restricted to

certain locations outside of urban areas. Significant

number of telehealth projects rolled out in New

Zealand with most DHBs using telehealth for video

consultations, although limited rollout of services

directly to patient households.

Outpatient/Referral 36.5%

Tele-ICU 3.9%

Surgical/Medical Support 21.5%

Transition of Care 14.0%

Remote Patient Monitoring 12.9%


MyHR provides a beginning platform for

single Patient record.• Virtual Platforms must integrate to provide context

for review

— “Synchronous” – Realtime – Live communications

(Video, Phone, Text, emails)

— “Asynchronous” – Store and Forward (digital

capture of pt. Histories etc)

Whether a patient is at the hospital, a

clinic, or in a virtual visit, the access to

their information should be unified and

ubiquitous. • This avoids the use of TeleHealth without context –

provides “Meaningful Use”

• Fragmented and inflexible health systems pose a

real obstacle for platform activation/integration –

can MyHR assist in this??

• Is this the role of the Tertiary and Primary EMR?

MyHR and Telehealth

“Without context it is possible that TeleHealth could potentially lead to further

fragmentation of patient care.” Winston Liaw MD UHC

Each provider could have different platforms/system that suite their needs but

do not provide consistency of care


These MBS rebates are available for:

Patient-end clinical support provided by GPs or by practice nurses and registered Aboriginal health workers on behalf of a GP specialist-end services provided by a specialist with a Medicare provider number.

MBS rebates are available for patients:

Located in remote, regional and outer metropolitan areas who access care from Aboriginal medical services.

The RACGP is of the view that there should

be no geographical restrictions on current

MBS items for collaborative third party

telehealth services. These telehealth

services should be available for anyone

unable to access their GP in person and if

there are factors other than geographical

distance (such as patient mobility) that

affect access.

Medicare and Telehealth


“In General the provision of Telehealth may require a different skill set as well as a

different level of education and management not typically found within the

traditional setting. Where possible all consult documentation should be made

available to the patients usual general practitioners”. RACGP Position Statement – May 2017

All telehealth consults should meet with the recognized standards of care in Australia

RACGP Position

On-demand telehealth services should ideally be provided by a patient’s usual GP or practice and only provided when deemed appropriate by the GP

On-demand telehealth services should only be provided by doctors with an appropriate level of education and clinical competency

On-demand telehealth services should only be provided to unknown patients when appropriate Patient notes should always be sent to the patient’s usual GP or practice

GPs should ensure they are medico-legally protected, particularly when providing on-demand telehealth services to previously unknown patients


Patient portals integrated with EMR are becoming more available—standalone patient portals have yet to

prove successful in the Australian market

Opportunities

The adoption of portals amongst patients is increasing and is expected to continue growing at a fast pace.

The major opportunities in this market include:

• Need for greater functionality—Enhancement of existing features

• Simplification of technology—Mobile applications

• Increasing usage and adoption of patient portals in physician office:

— Adoption of patient portal in small (<100 beds) and mid-size (150-300 beds) hospitals

• Compliance—Satisfying Government regulations

• Interoperability by design needs to be entrenched in regulations to avoid multiple platforms having to

be accessed by a patient

The Rise of the Patient Portal


• Australia faces some significant challenges as we

move into a Digital Health age

(technology/financial/paradigm)

• Transformation is difficult but learning what works

and doesn’t work is a good start

• We need to look globally before we act locally—just

because it worked elsewhere does not means it

provides a pathway for Australia

• Maintenance of acceptable standards is mandatory

to ensure the quality of care being provided

• For Primary health the patients usual GP should

always be provided with post consult information—

this is key for continuity of care

• Avoid the fragmentation of care by ensuring

contextual reference is always available

• Primary and Tertiary Care need to be aligned on

TeleHealth initiatives to avoid patient confusion

and multiplication/duplication of systems

• Coordination and Interoperability is the Key

Summary

Lastly its all about the patient—not the technology, the

platform or even the providers—always keep the patient 1st


Questions?

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Telehealth Lessons Learned from the USA Experience · Teleconsultations Remote Patient Management Total Consults 2016 (K) 4,407.4 Total Lives Monitored 2016 (K) 522.3 Total Consults