How to Improve Patient Care Quality with eHealth

Harvard reported the bad news: the U.S. spends twice the amount on healthcare as other industrialized nations but has poorer patient population health outcomes. That’s in part because administrative costs account for roughly 8% of our spending, compared to around 3% in other countries. Researchers also found that access to care is worse, and declining based on looming clinical provider shortages. A recent Commonwealth Fund report backs up these findings. In a study of 11 industrialized countries, the U.S. ranked last for health outcomes and quality.

How can we fix this? Many public and private organizations believe that using ehealth communications technology, or telehealth, will make a substantial dent in the high costs and poor quality scores that are plaguing our industry. While telehealth applications have been around for decades, there is increasing evidence that using these health information technologies (HIT) will optimize patient care while streamlining the costs associated with providing it.

“Over time, eHealth services have become emerging tools for supporting patients to directly engage in their health, through stimulating health behavior changes and self-management of their disease.”
Wildenbos, Peute, and Jaspers

Yearbook of Medical Informatics

The Journal of Medical Internet Research came up with a definition of ehealth (eHealth, e-health) as far back as 2001, and their interpretation holds true today:

E-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.

The term “ehealth” is now used interchangeably with “telehealth,” “telemedicine,” and “mhealth” or “mobile health.” These terms began circulating frequently around the year 2000 when the Internet began opening new doors to patient care in the United States. Today, telehealth can be delivered in via:

• Live video or synchronous doctor/patient interactions.
• Store-and-forward (asynchronous) transmission of video images that are not live.
• Remote patient monitoring.
• Mobile applications.

As we enter 2019, these phrases are used with more frequency in healthcare. What they have in common is the intersection of the Internet, communications tools, medicine, and patients. These tools are used today for:

• Healthcare prevention and education with patient populations.
• Remote patient monitoring of chronic diseases.
• Patient therapy and counseling.
• Clinical consults and care coordination.
• Diagnostics and treatment.

No matter the label, healthcare delivery has entered a new realm of virtual care that many believe will improve our efforts to save lives and cut costs.

Ironically, despite the longevity of the communications technology behind ehealth, healthcare adoption is still lagging behind its potential to improve outcomes.

The generally accepted definition of healthcare quality comes from the Institute of Medicine (IOM). The Six Domains of Healthcare Quality requires that the clinical initiative should be:

• Safe
• Effective
• Patient-centered
• Timely
• Efficient
• Equitable

Patient Safety & Quality Healthcare recently defined how ehealth initiatives meet all six of the IOM’s quality standards:

• Safe
  The idea of safety measures is inherent in the framework of ehealth initiatives. A virtual visit is a non-invasive way of interacting with a patient in the privacy and comfort of their home. It eliminates travel and the difficulties inherent for the less-than-mobile patient. It also allows for more frequent patient contact without the stressors associated with an ER or other clinical visits.
• Effective
  There are decades of data documenting improved patient outcomes, increased quality, and reduced costs by using telemedicine.
• Patient-centered
  EHealth has become the new framework for improving patient engagement in healthcare. These services bring back the physician house call via a more efficient virtual visit model. Telehealth tools used for remote patient monitoring empower patients in their own quest for health in a unique provider/client proactive partnership.
• Timely
  There is significant evidence that ehealth improves access to care by significantly reducing clinical wait times.
• Efficient
  We know that ehealth technology reduces inpatient admissions and unnecessary ER visits. eHealth technology also reduces clinical overhead, particularly in smaller practices. This reduction in wasteful spending could vastly improve the bottom line across the healthcare continuum, positively affecting patients, clinical care providers, payers, and the American economy.
• Equitable
  eHealth is particularly effective for extending care to poor and rural populations. It is the great equalizer of care, particularly in rural communities where communities face a clinical provider shortage that is only expected to worsen in the coming years.

It is clear that telemedicine or ehealth can be used to reach the quality outcomes defined within the IOM framework. Let’s conclude with a look at a few specific examples of how technology is being used in the field to improve patient care.

Today, 86% of healthcare providers in the United States want to use ehealth to improve patient quality outcomes. This is a huge leap forward for the technology that has already proven to yield better quality and lower costs. For example:

• The University of Mississippi Medical Center (UMMC) reported late last year on positive outcomes from their use of remote patient monitoring to help patients living with Type II diabetes and other chronic diseases in the region. UMMC has been a leader in the technology and was named a National Telehealth Center of Excellence by the Health Resources and Services Administration in 2017. UMMC offers telehealth at 234 locations around the state. In 2018 they announced the results of a four-year study to track improved quality outcomes for chronic patient diseases with telehealth. The study found a 1.7% reduction in A1C, which correlates with a 45% reduction in death from cardiovascular disease. Study participants also avoided hospital readmission with an annual estimated savings of $678,000.

One report suggested that enrolling just 20% of Mississippi’s diabetic population in this remote monitoring ehealth pilot could save Medicaid $180 million annually.

EHealth and the Orthopedic Practice

There is clear evidence that ehealth can improve our healthcare delivery system. OrthoLive is committed to bringing the power of ehealth to the orthopedic practice. Contact us to find out how our services could help your practice quality outcomes improve.