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The Future of Telehealth: Informatics, Scalability and Interoperability

Bill Siwicki, Healthcare IT News

July 2021

A Philips executive describes what's happening now with virtual care – and what needs to happen to ensure a solid future for telemedicine and remote patient monitoring.

The COVID-19 pandemic pushed telehealth into the spotlight with exponential adoption, helping to prove its value.

The healthcare industry learned that, with the right solutions, care can extend outside hospital walls and be conducted anywhere. Further, CIOs and other health IT leaders reinvented systems and processes, and clinicians gained an improved understanding of the invaluable impact of integrated informatics on digital transformations and the quality and efficiency of care.

Even while the pandemic continues, healthcare provider organizations have begun to stabilize these infrastructures and revisit the technologies and workflows deployed earlier in the crisis and turn them into standard practices.

On this note, Karsten Russell-Wood, portfolio leader for post-acute and home at Philips, shares his viewpoints with Healthcare IT News on the biggest priorities to ensure telehealth is sustained long term.

Q. How can telehealth and remote patient monitoring technologies help support chronic and acute care anywhere?

A. With the right tools, extending care outside the hospital is not only feasible, but in many cases preferred. The Philips Future Health Index 2021 Report, which surveyed nearly 3,000 healthcare leaders across 14 countries, found that healthcare leaders expect an average of 23% of routine care to take place outside of the hospital walls within three years.

This new frontier will undoubtedly include extending real-time care to those with both acute needs and chronic conditions who benefit from consistent communication with doctors. For these patient populations in particular, COVID-19 spurred an interest in becoming a more active participant in care plans, bringing them new levels of convenience and personalization.

To meet these needs, providers must continuously work to tailor care toward the consumer, just as we're seeing happen in the banking and retail industries, and [to] advance care models from brick and mortar to "clicks and mortar." Even if the home can't be the hospital, community spaces and retail locations can fill in as connected care stations for underserved communities or patients [who] don't have an ideal setup at home.

This is only possible through the use of data-driven, connected care solutions that feed into cloud-based software and allow clinicians to maintain visibility into their patients' conditions from afar. Beyond wellness checks, remote patient monitoring enables doctors to view critical patient data on a consistent basis, helping them cater care to a patient's unique needs, as well as activate timely interventions before health deteriorates.

Traditionally, acute patients need an inpatient admission to the hospital and require continuous rounding by a physician. Approaching this patient population with a 360-degree model – monitoring them at home from pre-admission through post-discharge – could help track the different phases of acute care from outside the hospital.

The benefits here include freeing clinicians from the bedside, helping them better allocate hospital resources according to risk, and, above all, keeping patients in a more convenient, lower-cost setting.

Hospital-grade wearables equipped with secure data integration, for example, can help guide relevant, timely decisions from care teams regarding whether a patient needs to be hospitalized immediately, or can receive treatment elsewhere and remain outside the hospital for the time being.

Care teams can view daily and weekly trends via continuous biometric devices, showing everything from skin temperature, respiratory rate at rest and coughing frequency, and be notified if symptoms are worsening.

There are similar advantages of using connected devices when managing patients with chronic conditions. In the comfort of their own home, patients can remain connected to their providers in a convenient, passive manner, which can motivate them to adhere to their treatments.

Until recently, patients have traveled to their doctors to receive care. However, that doesn't mean hospitals have always been the most accessible means of delivering that care, people just didn't have a choice. The industry now has the means to deliver that same level of care in a much more accessible way, bringing it to patients wherever they may be.

For example, those with diabetes or congestive heart failure who may wish to avoid in-person visits can potentially avoid an unnecessary hospitalization if their doctors detect a change in their condition in time.

Patients with cardiac arrhythmias can remain home while being continuously monitored. Doctors can detect arrhythmias such as atrial fibrillation as they occur and intervene if necessary. Telehealth solutions can also help clinicians monitor whether a chronic condition is becoming acute.

Q. With telehealth and remote patient monitoring comes the need for interoperability and security. How does a healthcare provider organization ensure data can be accessed and shared seamlessly across settings, and that solutions are interoperable?

A. As hospitals evolve to extend care beyond their walls, telehealth and remote patient monitoring enable a hybrid continuum of care that brings an increased amount of health data. This requires secure, robust data-sharing infrastructures and a standard for technologies to work together across platforms and locations.

The Future Health Index 2021 report found that two of the biggest barriers to the adoption of digital health technologies were difficulties with data management (44%) and lack of interoperability and data standards across technology platforms (37%). Providers need to rely on a longitudinal health record to activate the right care anytime and anywhere.

For example, for remote care for patients in ICU settings, known as tele-ICUs, where integrated systems are particularly important: Without a strong backbone for smooth data integration, intensivists can only see what is happening in front of them, instead of making informed decisions based on a holistic view of a patient's health. To ensure data can be accessed and that solutions are interoperable, secure flows of data must be activated.

Solutions that are designed to work in tandem are better organized and more secure from malicious attacks. By safeguarding technologies to make sure they're interoperable across platforms and geographic locations, health systems can better protect the data that flows throughout their system and provide increased security.

Using a cloud-based platform approach will help achieve this, as well as standardize the current disparate IT landscape and allow data to be accessed anywhere. Leveraging open APIs and approved standards like IHE-HL7 can help facilitate data exchange across multiple sources and vendors across the continuum of care with minimal friction.

With the rise in cloud-based applications, software-as-a-service and virtual care solutions enabling data sharing, organizations must work to ensure systems and processes mature at the rate they are evolving. Providers should assess their current infrastructure and their performance metrics such as ROI, quality, scalability and satisfaction, which will help them develop IT models accordingly that support these emerging care pathways.

New types of executive roles will also grow in necessity to support building beyond hospital walls, such as chief digital officer and virtual health leadership supporting the informatics department.

Further, to ensure confidentiality, integrity and availability of critical data and the systems that house that data, security plans should span across organizations and industries. While updating IT systems all at once may not be realistic, health systems can start by rigorously assessing third-party vendor capabilities, only using 510k cleared medical devices and implementing policies for data protection.

Hospitals should prioritize partnerships with organizations that take a proactive approach to protecting health information across devices, systems and settings, so administrators, healthcare providers and patients have confidence about how care is delivered.

By connecting devices, unlocking data and fostering collaboration, we will empower new forms of engagement, actionable insights and better health outcomes.

Q. You have said that virtual care strategies cannot be a bandage on top of existing or new piecemeal solutions that work in silos, that a much-needed technology infrastructure must be established that not only enables faster and easier adoption of new capabilities, but also creates a transparent total cost of ownership. Please elaborate.

A. Implementing telehealth solutions during the pandemic to supplement in-person care was like building a plane while flying it. Now healthcare organizations can be strategic, stabilize these infrastructures and revisit the technologies deployed in times of crisis and transform them into standard practices.

Our world moving forward is one that embraces the best solutions available, leveraging both traditional care models as well as virtualization to provide quality care. This change isn't one that any one organization can do alone, and relies on partnerships with technology companies that enable and foster clinical creativity through co-creation and embrace the subscription economy.

Healthcare organizations are increasingly partnering with those with proven track records in implementing foundational technology infrastructures and who can serve as consultants to drive their digital transformation. The ability to co-create has never been more important in driving outcomes.

Working side by side with partners in the technology sector will help hospitals and health systems develop solutions from the ground up. There is value in disintermediated partners in this case, as they allow providers, vendors and patients to take collaboration to the next level.

And health systems should be given flexibility when it comes to implementing and exploring virtual tools that are right for them. Rather than making a big capital investment upfront, they should be able to adopt solutions in a stepwise fashion, and scale up or down in real time.

Today's healthcare organizations care more about access than they do about ownership. They want customized experiences and flexible payment options. That's why healthcare organizations are increasingly turning to subscription services, with a shift from buying a physical product to leveraging a holistic solution that provides ongoing value and engagement.

By adopting these new business models, it not only enables faster and easier adoption of new capabilities, but also creates a transparent total cost of ownership. We've seen success with software-as-a-service models as a predictive, usage-based model that allows for faster innovation, but also reduces the demand for IT maintenance, standardizes service levels and usage, and helps providers quickly scale according to need.

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