Ushering in an Era of Telehealth
By Natasa Sokolovich, Executive Director, Telehealth, UPMC
Factors that Led to the Expansion of Telehealth Services across UPMC
Our vision at UPMC is to transform healthcare delivery, developing new models of care that allow us to provide a seamless “virtual to bricks and mortar” experience. With healthcare in the midst of a disruptive transformation, we are leveraging strategic investments in technology to expand access to UPMC’s world-class clinical services. With the recent wave of electronic health record (EHR) adoption, integration of smart data analytics, mobile applications and biometric tools that capture real-time clinical information, we are advancing the care delivery process. UPMC has offered telehealth services since early 2007 through the implementation of subspecialty telestroke services across community hospitals located in Maryland and Pennsylvania. Recognizing that many patients across the region were bypassing their local emergency departments because the community hospitals lacked the neurological specialty expertise to provide optimal care, UPMC clinical leader Dr. Larry Wechsler, Vice President of Telehealth & Co-director of UPMC’s Neurological Institute, UPMC launched the UPMC telestroke program, allowing patients to receive treatment in their local community hospitals, without having to travel significant distances to urban hospital locations.
After the initial launch of the telestroke services, UPMC saw a huge demand to expand the use of telemedicine technology to accommodate the shortage of psychiatrists in the country. It was an opportunity to again leverage HIPAA-compliant technology to provide secure patient consultations with UPMC psychiatrists across many rural communities in Pennsylvania. Without the telePsychiatry visits, these patients would otherwise not have access to behavioral health services. The expansion of telemedicine beyond the emergency department continued, now providing subspecialist consultations for dermatology, maternal-fetal-medicine, rheumatology, endocrinology, diabetes education and over 25 other clinical specialty services. Through the expansion of mobile technology, UPMC provides much-needed patient access to subspecialty services in rural communities to support better management of chronic disease patients who suffer from challenging conditions, such as COPD, congenital heart failure and neurological conditions including Parkinson’s disease and multiple sclerosis, to name a few.
In November 2013, UPMC launched a 24/7, platform, called UPMC AnywhereCare, to provide on-demand access to UPMC providers for low acuity conditions, such as cold, fever, flu, urinary tract infections and many other conditions. The UPMC AnywhereCare app can be downloaded via an Android or iOS phone and provides convenient access for patients to speak with a provider to receive treatment and a prescription if deemed appropriate, without having to leave their home or office. The visits are available to anyone, regardless of health insurance plans. UPMC Health Plan patients may have a reduced rate, based on their coverage plan.
Creating the UPMC Teleconsult Centers (Virtual, multi-specialty clinic model)
The UPMC Teleconsult Center was created to allow patients who live in rural communities to receive care closer to home. The patient experience is very similar to an in-person clinic visit. The visits are documented in the patient’s electronic medical record and the patient receives an after-visit summary along with any orders for additional diagnostic tests, and/or prescriptions. As part of the patient satisfaction survey responses, some patients have shared that they would have forgone care altogether, if not for the option to be seen at a UPMC Teleconsult Center. UPMC currently has five Teleconsult Centers located across Western Pennsylvania and has developed a new model of future healthcare delivery, overcoming obstacles like interoperability and facilitating better care coordination and improved clinical outcomes for many patients. By leveraging telemedicine subspecialty care across urban locations, UPMC provides access to the same world-class clinical care available at our flagship teaching hospitals to patients living in smaller, more rural communities. As UPMC continues to expand its network to include hospitals located in Williamsport and the Harrisburg communities, UPMC is committed to expanding access to world-class clinical care and serving patients in every community.
"Through the expansion of mobile technology, UPMC provides much-needed patient access to subspecialty services in rural communities"
Challenges that Healthcare Providers Face to Leverage a Full-fledged Telemedicine Strategy
Telemedicine has emerged over the last several years, with drafting and adoption of policies, guidelines and state by state legislation which has elevated interest among providers and payors. Just a few years ago, there were many unanswered questions and concerns about medical liability, licensure, credentialing and other reimbursement and operational considerations, which made it challenging to implement telemedicine services. Each of the issues was critical to address prior to expanding beyond the initial one or two clinical specialty areas and across use cases. The issues affected UPMC as a provider whose patients and hospitals span multiple states. While the flagship hospitals are located in Pittsburgh, Pennsylvania, and the surrounding communities, employees and patients come from across the Tri-State region to see our providers and work in our hospitals and clinics. In addition, UPMC telemedicine services expand to non-UPMC locations in Maryland, Ohio, West Virginia and Minnesota, which require multi-state licensure and other legal and regulatory considerations. Each time we expand to additional out of state locations, we have to manage the issue of licensing, since physicians can practice only in the state where they hold a valid medical license. The Federation of State Medical Boards recently recommended the opportunity to adopt “medical licensing compacts”, which would allow cross-state licensure for physicians to provide telemedicine services across states lines. Another common challenge is the reimbursement complexity for telemedicine visits. While many states have recently adopted some level of parity, requiring commercial insurers to reimburse for a telemedicine visit if the same visit is reimbursed through an “in-person” visit, many states still do not have this same legislation and Medicare still imposes arbitrary rural health-provider shortage area restrictions on telemedicine visit reimbursement.
Disruption across the Telehealth Environment
Evolving technology and continued decreases in equipment hardware and software costs have boosted the adoption of virtual healthcare services. Telemedicine software vendors continue to develop new applications that enable easy consumer and provider adoption. In addition, while many of the leading vendors initially focused solely on the expansion of existing “off-the-shelf” platforms, many have started engaging with leading health systems and the provider community to focus on integration that enables a more seamless provider workflow and includes the electronic health record (EHR). These are key steps that will increase provider adoption to expand access via telemedicine to additional patient populations. By offering a single platform experience that supports virtual visits and ties into the medical record system, telemedicine becomes an extension of “in-person” care. As more patients learn about the opportunities to facilitate on-demand care and use telemedicine services, they will expect this from their providers. In addition, with consumers paying an increasing share of healthcare costs, they will look for less expensive and easier ways to access services. Telehealth is a key part of the equation to enhance efficiencies, the consumer experience and better triage patients who truly need higher acuity “in-person” services.