Clearing the Way for Telemedicine – FCC report on telehealth

In Clearing the Way for Telemedicine, the FCC’s Intergovernmental Advisory Committee (IAC) members identify state, local, Tribal, and territorial regulatory barriers to the use of telemedicine, as well as incentives that promote the adoption of telemedicine. The report discusses key issues, including state and local licensing laws or regulations that prevent telehealth providers from treating patients across state lines, and intrastate restrictions that may inhibit the provision of telemedicine.

Minnesota gets a nod for being one of three states that have specific laws that require that payers pay the same amount for a Telehealth delivered service as would have been paid had the service been provided in-person.

Here are their recommendations looking at issues or broadband access, regulatory barriers and digital equity and digital integration issues:

Broadband Recommendations

  • Broadband needs to be funded. FCC initiatives such as the recent Connected Care NPRM and the Rural Digital Opportunity Fund can support bringing Telehealth services directly to low-income patients and patients in underserved, rural, Tribal, and territorial areas
  • Coordination needs to be improved between state and federal universal service programs aimed at expanding broadband to avoid having different programs supporting service availability in the same area and to ensure that support goes to areas without broadband service and without the likelihood of receiving it in the foreseeable future.
  • Broadband Telehealth services should be independent of the technology used to provide such service, particularly in rural areas. Creative ways of deploying hybrid fiber along with wireless, satellite, and TV white spaces offer different advantages and opportunities.
  • The term “Telehealth” should be construed broadly, and should incorporate the need for software, equipment, data storage and patient record access along with the various spectrum and telecommunications solutions and broadband deployment.
  • Telehealth policy should address the deployment of necessary infrastructure, including homes of older adults, and provider offices in rural and frontier communities that are far from a hospital.
  • Improved geographic data should include the types of services that are available in various locations.
  • Providers must ensure that any equipment they purchase is interoperable and meets industry standards and can be used to connect to multiple Telemedicine platforms.
  • Data and documents should be able to be transferred in multiple formats and structures in order to be operable in the various application programming interfaces (APIs), rather than in the prevailing “PDF” format, to allow electronic transfer with full interoperability and use of the underlying data elements.
  • To be considered interoperable, software vendors should be required to open their systems to communicate electronically patient information.

Regulatory Recommendations

  • The FCC Rural Health Care Program (RHCP) program should expand eligible equipment and services to cover institutional mobile technologies that are not currently covered under the program. Mobile telephones and service should be an eligible cost item of the RHCP. 28
  • The FCC should reach out to relevant federal agencies to address reimbursement disparities for services categorized as “Telemedicine,” whether in Medicare or other medical services.
  • Telehealth, almost by definition, is a geographically dispersed, often interstate service. The complexities of interstate licensing, credentialing and privileging should be revised and simplified to allow for virtual multi-state service.
  • Malpractice insurance coverage should cover Telehealth delivered services and should extend into other states in which Telehealth services are being offered.
  • Health benefit plans should not exclude from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a Telemedicine medical service or a Telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation.
  • The FCC should work with other governmental agencies to ensure that the same standard of care and other measurements should be applied to both in-person and virtual visits.
  • HIPPA and other privacy rules should be revised to allow patients to share Telehealth information with Telehealth providers and for treating Telehealth providers to share that information with each other.
  • The FCC should encourage legislation or regulations that detail how and in what manner Telehealth can be used to establish a patient-provider relationship and when it can be used for prescribing medicine, particularly controlled substances. C.

Other Recommendations

  • The public, state, local, Tribal, and territorial governments and health care providers all need to be aware of the technologies and services available for Telehealth.
  • Telehealth considerations and the infrastructure to provide health services virtually should be integrated into all state, local Tribal and territorial emergency planning.





Mayo Clinic implements telehealth approach for neonatologists

Healthcare IT News reports, starting with the stats…

The new technology connects on the first attempt 96% of the time, compared with 73% for the previous telemedicine carts; with enhanced monitoring and support, tele-neonatology availability is 99%.

They began looking at telehealth approaches for neonatologists in 6 years ago. Here’s how it works…

In October 2016, Mayo Clinic’s tele-neonatology program transitioned from a wired telemedicine cart with hardware CODEC to a proactively monitored, fully supported wireless telemedicine product from vendor InTouch Health.

Care teams in the community hospitals activate tele-neonatology when there is a high-risk delivery or a newborn that requires advanced resuscitation. Providers at the community hospital place the wireless telemedicine device at the newborn’s bedside and call Mayo’s Admission and Transfer Center to request a tele-neonatology consult.

A Mayo Clinic neonatologist then establishes a synchronous, audio/video connection with the care team via the telemedicine device in the room. If the newborn requires transfer to Mayo Clinic’s neonatal intensive care unit (NICU), the neonatologist can dispatch the transport team to retrieve the patient as part of the tele-neonatology workflow.

They compared two solutions; the article details the results. They also posted some lessons learned…

“The focus of Mayo Clinic’s tele-neonatology program has always been the needs of our neonatal patients, whether they are located in Mayo Clinic Rochester or elsewhere in our region,” Fang said. “By leading with patient care and identifying unmet needs of patients or care teams, organizations can design telemedicine programs that are impactful, effective and highly utilized.”

When developing a tele-neonatology program, the multi-specialty team must consider many factors including service activation and workflow, staff education and training, team building and communication – and the telemedicine technology itself, she advised.

“Our recently published study (McCauley et al, Telemed and e-Health, 2019) focuses on one of these domains, the telemedicine technology,” she said. “We demonstrated that the ITH Lite improved audio quality and ability to connect on first attempt when compared with a wired telemedicine cart. Organizations should consider the reliability of connection, audio/video quality, and fit within the care environment when selecting a technology for their tele-neonatology program.”

In addition, proactive monitoring is broader than hardware and network monitoring, she cautioned. In this study, incidents were not only identified by vendor monitoring of the devices but also during care team and physician training, tele-neonatology simulation sessions, and physician on-call preparation activities.

“When developing a tele-neonatology program,” Fang concluded, “organizations should consider comprehensive support models for incident management and tracking.”

Telehealth simulation in New Ulm – practicing to give preemies best healthcare

This is broadband at it’s most heartwarming! The New Ulm Journal reports…

Nurses, respiratory therapists and pediatricians at New Ulm Medical Center’s birth center raced to restore the breathing of an infant born prematurely Tuesday as doctors and specialists watched from the Twin Cities via a virtual care cart.

Neonatologists and nurse practitioners from Children’s Minnesota watched and provided insight as a breathing tube was inserted into the rubber throat of an infant mannequin.

This medical emergency was just a simulation, as medical professionals at NUMC familiarized themselves with the birth center’s virtual care cart that’s a part of the clinic’s expanding telehealth program.

They talk about the old way…

“Historically, in situations like this the team in New Ulm would have gotten on the phone and talked with our neonatal nurse practitioners and our neonatologists in the Twin Cities at either the Children’s Minnesota St. Paul or Minneapolis NICUs,” Wenzel said. “We feel offering the ability to actually view the baby, they can provide better support than through a phone call.”

And the new way…

The virtual care cart allows hospital staff to connect with other medical professionals in real time via an audio-visual platform connected to the cart — sometimes as far away as across the country.

Director of Children’s Simulation Program Karen Mathias said telehealth resources such as the virtual care cart increase communication and can allow for quick consultation between providers and patients. During situations such as Tuesday’s simulation, physicians can decide if an infant needs extensive medical care and needs to be transported to a larger facility for care.

Aitkin Age says fund broadband to support seniors

The Aitkin Age is running a series of editorials on issues facing Minnesota’s aging population. Today they recommended some policy action points…

Fully fund the Border-to-Border Broadband Program recognized as a critical factor in the economic and social sustainability of all rural Minnesota communities, which many senior citizens call home. The $40 million in grants approved by the 2019 Legislature will give the program a substantial start in achieving the state’s 2026 goal of reaching everyone with reliable broadband internet. But more funding is needed to see the program fully developed.

UnitedHealth unveils telehealth app in employer-sponsored plans

Healthcare Drive reports on UnitedHealth’s (MN headquartered) new app…

  • The country’s largest private payer is rolling out a new virtual care app for the more than 27 million Americans covered in its employer-sponsored health plans.
  • The new UnitedHealthcare app gives users access to a practitioner via mobile device or computer. Beneficiaries can use it to schedule and conduct a virtual visit with a doctor. Physicians can diagnose a range of conditions during the visit and prescribe and send medications to local pharmacies for pickup.
  • The app will be free for the majority of people enrolled in the Minnetonka, Minnesota-based payer’s employer-sponsored plans, but consumers may have to pay additional out-of-pocket costs for telemedicine services depending on their plan and state requirements.


New study correlates lack of broadband to lack of health insurance

A Communicating for America press release reports…

Communicating for America (CA), a rural advocacy organization, has released a new study that correlates the lack of high-speed internet to the lack of health insurance coverage and access to health care. The survey, conducted in September 2019, asked nearly 500 individuals whether having the ability to connect to broadband internet in their local area affected the way they engage with the health care system.

Of those surveyed, 39% in urban and semi-urban areas said they had high-speed internet. The number dropped to 21% in rural areas. The study’s findings went on to show people without high-speed internet were significantly less likely to have health insurance (61% had coverage) compared to individuals that have broadband internet (88%). A similar disparity was shown in health care systems. Of those without broadband internet, only 5% have used low-cost telemedicine for medical treatment, whereas 22% of individuals with high-speed internet have used telemedicine in the past. In addition:

  • People without access to broadband internet are significantly less likely to use online medical records (29%) than people who have broadband internet (59%).
  • People without access to broadband internet are significantly less likely to schedule appointments online (17%) than people who do have broadband internet (36%).

I don’t know much about Communicating for America. They are based in Fergus Falls. Their mission is to promote health, well-being and the advancement of all self-employed Americans and small business owners by utilizing our acquired experience in serving rural Americans. You can find the full report online.

The report doesn’t specify what “broadband” is but 39 percent sub/urban access versus 21 percent indicate a high bar definition. (24 percent of MN has access to a Gig.)  And 500 participants isn’t a huge portion – but the results are interesting.

Best Buy looks at the business of telehealth

Forbes reports…

As Best Buy has said, health monitoring services for seniors and other digital health initiatives mark a key part of its growth strategy. The retailer over the next 10 to 20 years could generate anywhere between $11 billion and $46 billion in cumulative revenue from its commercial health business, according to Morgan Stanley analysts in a 64-page report released Monday. How significant is that? The high end of that range tops Best Buy’s roughly $43 billion in annual sales in 2018.

“This would be material,” the report said. “We don’t think the market fully grasps Best Buy’s commitment to health….The company has shifted its focus to tech- enabled senior care…. We believe Best Buy has a durable competitive advantage in senior care, its niche in the healthcare services market.”

And details a few things Best Buy needs to happen…

To be sure, for Best Buy to reap that long-term revenue opportunity, several things have to work in its favor, the report said. For one, the largest U.S. health insurers have to accept and cover Best Buy’s services, and Best Buy needs to see “a high rate” of adoption by seniors. In the nearer term, Morgan Stanley estimated the business could add as much as $2 billion in cumulative revenue for Best Buy through 2025.

Total U.S. healthcare spending is expected to reach about $3.6 trillion this year, or nearly 15 times consumer spend in Best Buy’s bread-and-butter consumer electronics category, according to the report. The number of people aged 65 or older in the U.S. is expected to grow by more than 50% from 50 million over the next two decades, the report added.

Best Buy is “evolving from sales of wearable devices and other healthcare technology to include the provision of healthcare services for seniors,” the report said. Healthcare “is shaping up to be Best Buy’s next frontier of growth.”