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Creating large scale telehealth network : A story from the USA by Adam Darkins

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Creating large scale telehealth network : A story from the USA by Adam Darkins, Vice President, Medical Affairs & Enterprise Technology Development, Medtronics, USA

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Creating large scale telehealth network : A story from the USA by Adam Darkins

  1. 1. 1 Creating Large Scale Telehealth Networks : A Perspective from the USA Adam Darkins MBChB, MPHM, MD, FRCS Vice President of Innovation and Strategic Partnerships, Medtronic Plc
  2. 2. 2 Historical Perspective Telemedicine • DeBakey Houston and Bird Boston • eHealth • mHealth • Connected Care • ?Next Internet • ARPA • CSNET • Public Internet • eCommerce • Streaming media • Social Media • Internet of Things
  3. 3. 3 Darkins A. The Growth Of Telehealth Services in the Veterans Health Administration between 1999 and 2014: A Study in the Diffusion of Innovation. Telemedicine and eHealth Volume 20. 2015 • Serving a population of 6.6 million people, predominantly male. • Primary reasons for programs addressing challenges with access, cost, quality. • Implemented in network of 152 hospitals and >600 other sites of care. • Covered 44 clinical specialities, including Tele-ICU, often in “shortage specialities” • Three modalities home telehealth, store-and-forward and clinical videoconferencing, including directly into the home • Sustainable revenue predominantly from realizing efficiencies/cost avoidance • Two thousand-fold increase to 760,000 patients per year and 2.2 million annual consultations (not including teleradiology).
  4. 4. 4 Building Telehealth Networks by Design, not Chance • Its does not begin with the technology. • Start with population health need and geographic distribution served. • Networks are initially built on high volume low cost applications not low volume high cost. • Set out to solve challenges that affect patients. • Need “multi-media” patient record. • Money “follows patients”. • Requires building and standardizing clinical, technology and business underpinnings. • Clinical, technology and business champions are important, but you cannot scale if systems are based on “relationships”. • If a serious proposition and going to succeed “its for life”.
  5. 5. 5 Operational Issues Building Telehealth Networks • Clinical models of care with clinical pathways. • Clear accountability for clinical, technology and business processes. • Associated systems for governance. • Training of staff – interdisciplinary teams (logical to train virtually) • Quality management with metrics. • Program accreditation. • Privacy and Cybersecurity. • Help desk support • Risk management and continuity of operations plans. • Coding of activity with workload capture. • Measurement of clinical, technology and business related outcomes. • Ongoing development to avoid becoming ones own “legacy system”
  6. 6. 6 Academic Considerations • New ways of assembling evidence in a rapidly changing environment. • Clinical, technology, social science and policy considerations. • Lack of evidence for legacy systems. • Is the future about incremental change in status quo or transformation? • Need clear vision for the future not nostalgia for the past.
  7. 7. 7 The Future: Value-Based Care CMS - Medicare Advantage Value-Based Insurance Design • Aside from lower cost-sharing, plans in the demo can offer supplemental benefits, such as telehealth or nonemergency transportation to doctor visits. Omar Ishrak, CEO Metronic, in sponsoring a collaboration between Harvard Business Review and the New England Journal of Medicine on Discussing Value-Based Care: “Today in our service-based systems, we pay for each step in patient care regardless of outcome; however, it’s becoming increasingly clear that we must collaborate to shift this to a model that focuses on and rewards patient outcomes”.

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