Telehealth is poised for exponential growth, with a projected market value of $ 3.5 billion by 2020 . Fueled by reimbursement and demographic shifts, healthcare organizations must have a clear vision of the goals of their telehealth infrastructure as they grow.
Where care happens, a successful telehealth system must be available and must have flexible components that integrate easily with existing technology, all while maintaining proper patient data security. HIPAA compliance and security can be challenging with the rise of healthcare apps and providers using their own devices.
Telehealth systems must be scalable to accommodate a growing amount of data and technological components in order to prepare themselves for this projected growth. The aim of this article is to help define which characteristics make a telehealth infrastructure program successful in reaping the rewards of this revolution in healthcare.
With a reported annual growth rate of 40% for the next five years , the telehealth market is expanding in the U.S.. Healthcare organizations are playing catch-up in how they will supply and integrate telehealth services into their programs.
In order to integrate telehealth services, healthcare organizations will have to assess and construct a program with the six essential components of a successful telehealth infrastructure including IT infrastructures, software, hardware, IoT, scalable design, and patient and data security.
It is crucial to first understand five factors fueling the expansion of the market to build this telehealth infrastructure. Those factors include the increase in the U.S. population of the elderly, upcoming changes in regulatory policies, those with chronic diseases, patient and provider receptivity, and budgetary constraints.
Knowing how these factors affect new and existing telehealth systems will help prepare organizations for this growth in telehealth services.
U.S. demographic shifts
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The first driving factor of growth in telehealth is the demographic shifts in the U.S. population. The number of people aged 65 or older is estimated to reach 71 million by 2030 according to the CDC, making up almost 20% of the population, as compared to only 12% of the population in 2000.
This increase is particularly prominent in those aged 80 years or over, with a growth from 9.3 million in 2000 to 19.5 million in 2030 . This shift has led to healthcare organizations rethinking the way in which they provide care. They are adopting and adapting the utilization of technology to augment care and improve workflow to accommodate this growing requirement.
The second key factor of the current growth of telehealth is the growing proportion of Americans with a chronic disease. 133 million people, or forty-five percent of Americans, have at least one chronic illness.
These chronic diseases account for almost 75% of all healthcare spending in the U.S. and are responsible for 7 out of every 10 deaths in the U.S., killing over 1.7 million Americans every year. These numbers are only expected to increase, with estimates of chronic diseases affecting 164 million people, or 49% of Americans, by 2025 .
These chronic diseases need an increased frequency of doctor visits, disease monitoring, and screenings, which can all be facilitated and managed through telehealth services.
The change in regulatory policies is the third contributing factor to the growth in telehealth. Over 150 pieces of telehealth legislation were introduced Over the last few years . These changes in policy are resulting in an improvement in reimbursement for telehealth and digital healthcare.
As of late 2018, according to the Center of Connected Health Policy, 50 states supplied reimbursement for live video in Medicaid fee-for-service, a payment model that is dependent on the quantity of care rather than the quality of care. While only 11 states reimbursed for store-and-forward, the collection of clinical information and electronic transmission to another site for evaluation .
The biggest barrier to adopting telehealth services was cited as the lack of reimbursement; any alterations in the reimbursement policy will further fuel and increase adoption rate growth . A new proposal by the Centers for Medicare & Medicaid Services to reimburse virtual check-ins may indicate a shift in policy towards telehealth.
Patient and provider receptivity
The fourth factor motivating the increase in telehealth services is patient and provider receptivity of telehealth. More than three-quarters of consumers (77%) have shown interest in using telehealth programs, and more than 65% are willing to use telehealth to manage their chronic diseases .
Once they use these systems, this positive feeling toward telehealth services continues. Sixty-seven percent of patients who utilized telehealth services stated that it increases their satisfaction with medical care .
For providers, implementing telehealth systems is seen as crucial for healthcare leaders. Fifty-eight percent of healthcare leaders placed a high priority on providing telehealth services . 86% of healthcare executives who have not already adopted telehealth into their operations say that it is a medium to high priority .
According to Teladoc's second annual state of consumer telehealth benchmark survey, three-quarters of U.S. hospitals either have consumer telehealth services in place or plan to implement the capability by the end of 2019 .
Lastly, as there is a gap between the requirement for telehealth services and services currently being provided and the available budget in place, budgets play a key role in the expansion of telehealth.
With most healthcare organizations surveyed reporting budgets less than $ 250,000 per year, investments in telehealth programs are modest. Generally, budgets are expected to grow next year, with more than half of executives expecting growth of up to 25%.
Of healthcare leaders who identify the requirement for telehealth services, only 14% said they have those capabilities. This gap demonstrates the continuing growth of telehealth services .
Six essential components for building a successful telehealth infrastructure
When building their telehealth infrastructure, understanding the five contributing factors and how they impact telehealth expansion can help healthcare organizations make informed decisions.
Organizations must assess the six essential components of any successful telehealth infrastructure in order to create a fluid infrastructure. These components are made up of seamless integrations of all the necessary IT infrastructure, hardware, software, IoT, patient data, security and scalability to achieve telehealth operability.
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When enhancing or building out a telehealth program, it is best to look at the hardware components currently in inventory first that can be integrated into a telehealth program to determine the gap of what is required.
Hardware pieces to evaluate and incorporate are items like medical carts, bedside terminals, medical tablets, and personal devices. As they can be mobile, these are ideal pieces to incorporate into a program. Mobility enables healthcare providers to perform consultations in areas where care needs to happen.
The reason is that healthcare professionals spend almost 90% of their time moving from place to place, providing patient care. The hardware outlined below assists healthcare providers in achieving that constant mobility without breakdown in operations or detrimental impacts.
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Medical tablets provide the mobility to access health data and consult with patients from any location through the ease of a lightweight device. Medical tablets also have the function of working as an entertainment device for patients.
Twenty percent of hospitals in the U.S. supply tablets for patients to access their medical information with the added enhancements of entertainment apps .
Tip: Medical grade tablets, which are classified as medical grade, contain antimicrobial enclosures to help prevent bacterial growth. Rugged medical tablet designs are ideal for accidental mishandlings and demanding work environments to withstand drops.
Medical carts enable healthcare providers to bring clinical records and insights from room to room. These carts could be to access electronic health records (EHR), give care, record medical data, or to consult with a specialist at another location.
These carts enable the utilization of computers, monitors, cameras, keyboards, and mobile medical devices at the patient's bedside, with a wireless connection to access patient records.
Tip: Carts, which are classified as medical grade or EN/IEC 60601-1 certified, supply medical electrical equipment compliance to meet safety regulations. And IPX1 rated carts provide the added benefit of water resistance with protection against drippings.
Bedside terminals also enable telehealth to be available where the patient is located. Depending on the type of application in telehealth on the patient and provider side, the utilization of bedside terminals can vary.
They can function as a remote monitoring or document exam and laboratory findings device, or a nurse call station to alert staff. For patients, they can act as a communication and entertainment device with individuals outside the facilities. These can be essential pieces in a hospital's infrastructure by being available where care is provided.
Tip: Bedside terminals classified as medical grade or EN/IEC 60601-1 certified for near-patient use have an antibacterial coating that can be easily sanitized to prevent bacterial growth.
A successful telehealth infrastructure must be flexible enough to handle the 'bring your own device' or BYOD, trend. The BYOD revolution, in which healthcare providers and their patients utilize their personal devices to access telehealth systems, will increase demand on telehealth infrastructure.
With the increase of smartphone use and the number of smartphone users worldwide at over 5 billion by 2019, more healthcare providers and patients are going to be employing these devices to engage with telehealth .
A recent study shows widespread BYOD among those in healthcare, including 51% of nurses, 91% of doctors, and 79% of healthcare executives. The benefits of BYOD for healthcare providers include improved workflow and time savings, in addition to cost savings .
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Tip: It is crucial to consider a BYOD regulated program to decrease potential security breaches for programs favoring BYOD.
Once new or existing telehealth programs possess the necessary hardware selected, it is vital to have the accompanying telehealth software that can easily integrate with all current healthcare platforms and hardware components.
The most crucial asset relative to program success was cited as telehealth technology among healthcare personnel . To ensure no interruptions of operational workflows, healthcare facilities must possess the appropriate software and technology that easily integrates with existing and future platforms. Below are attributes of telehealth software which are ideal for creating program success and fluidity.
Like all technology in the hehalthcare space, to protect patient privacy all aspects of a telehealth infrastructure must be compliant with the Health Insurance Portability and Accountability Act (HIPAA). To maintain patient data security, tese regulations pertain to the transmission or storage of electronic health data by a HIPAA covered entity.
Electronic prescriptions of controlled substances
To enable providers to submit a prescription easily, telehealth software should include electronic prescription features.
Healthcare providers must be able to provide care remotely with software that can integrate with current EHR systems. Telehealth programs cannot be executed efficiently and successfully without this vital integration.
Together with creating a telehealth program, it is necessary to track and manage operations by previously defined goals to establish the programs progress.
Similar to HIPAA compliance, it is vital for telehealth software to use the latest encryptions to ensure patient data security meets HIPAA security standards and guidelines.
As mentioned previously, many U.S. states new policy changes permit reimbursement for telemedicine services. Yet, each visit must be well-documented to receive reimbursement. A platform that documents care properly will help with reimbursement procedures.
3. IT infrastructure
An effective telehealth infrastructure includes all of the parts needed for implementation, consisting of hardware and software with the ability to configure these pieces in ways that adapt to various healthcare environments.
Two attributes of a successful I.T. infrastructure must be met in order to adapt to these multiple healthcare environments. In an ICU setting for instance, clinical information systems integrate patient care applications and data management tools to enable real-time decision making at the point-of-care.
These systems can be used at patient bedsides and in ICUs. They can be accessed via the hospital network or online, and improve access to a patient's EHR or other data. This type of integration enables patient health data to be gathered and shared with maximum efficiency in any healthcare environment.
The first attribute is that the technology has to be available where care happens, and the second is that it has to be reliable. The first is achieved using the proper hardware and software pieces that supply mobility, so that telehealth services can be available where care happens.
Another must-have for telehealth infrastructure is reliable technology. According to a recent survey of healthcare executives, almost 70% consider reliability a "must have", yet nearly half estimate that their current telehealth solution fails 15% of the time.
One of the top three reasons stated by providers as to why they are slow to adopt telehealth programs is a lack of confidence in the reliability of the technology . The second is attained through a reliable I.T. network made up of open system integrations and a reliable broadband internet connection.
Access to robust digital infrastructure is one key to successful telehealth services. Reliable technology is a must-have for telehealth infrastructure. Healthcare organizations must supply adequate infrastructure during the planning stages to ensure that networks can handle the demands of telehealth applications.
The American Telehealth Association Practice Guidelines recommend sufficient transmission speed to ensure, "the smooth and natural communication pace necessary for clinical encounters."
When performing telehealth services, a minimum bandwidth of 384 Kbps or higher is suggested . With reliable broadband connectivity, this makes sure that where care is provided, it can be available and dependable.
Open system integrations
In addition to connectivity, the second attribute of a telehealth IT infrastructure is the ability to integrate into the current IT infrastructure and is composed of components that integrate easily. Healthcare executives prioritize that telehealth solutions are easy to navigate, easy to use, and compatible with their current systems .
When developing telehealth infrastructure, integration with EHR is also a priority. The ability to integrate with EHR was rated as valuable by almost 80% of respondents in a 2017 survey of healthcare personnel.
Integration with other systems is also vital, with a majority (73%) of healthcare executives placing a priority on the ability to access PACS images (such as CT Scans) directly from the telehealth system .
For facilities planning their telehealth infrastructure, integration with remote monitors, lab systems, and all communications systems are also vital. The provision of open APIs and SDKs ensures smooth integration with existing infrastructure and management systems.
Hardware and software integration can decrease latency and optimize performance for users. Having these components work together is advantageous to any system integration.
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With a flexible IT infrastructure in place, the foundation is set to incorporate IoT into telehealth programs. Healthcare networks are increasingly investing in the Internet of Things, or everyday devices that are connected to the internet as the reliance on smartphones and BYOD's grows.
These include wearable technology like smart sensors or wrist watches that track a patient's movements. Doctors and hospitals are employing this technology to connect with patients and enhance the overall visibility of their operations.
Data shows that more than half (60%) of healthcare organizations surveyed have already introduced IoT devices into their facilities, citing an increase in innovation and cost savings as advantages of this adoption.
Further to the increase in IOT adoption, IoT devices can help practitioners monitor their patients remotely and can help administrators track bed occupancy .
For instance, using IoT real-time location services (RTLS) is a way to use the IoT to help keep components of telehealth infrastructure secure by tracking equipment throughout the healthcare facility. RTLS helps to improve workflow and decrease profit loss through misplacement or theft.
This technology can also help track patients in elder care facilities to prevent injury or patients wandering off. By equipping hospitals and elder care facilities with connected monitors and devices, providers can give bedside care more conveniently, for both the provider and the patient.
5. Scalable design
The design must possess the capacity for growth when designing a healthcare IT infrastructure along with IoT integrations. Healthcare organizations need to have a telehealth system that can grow with them as regulatory, demographic, and reimbursement shifts happen.
This scalability includes possessing a broadband service and servers that can be upgraded easily to support more devices. Capacity for growth follows the trend in telehealth with systems moving from fragmented, siloed initiatives into an enterprise approach, which takes a systemwide view and pulls disparate elements into one cohesive system.
The 2018 REACH Health survey states that nearly half of the respondents are taking an enterprise approach to telehealth, which is a 23% increase compared to 2017. Over half of hospitals that began with a departmental method have already transitioned or are evolving toward a holistic operation.
With those healthcare institutions that use an enterprise model achieving 30 more of their goals than ones that are managed out of separate departments, this approach is an effective tactic .
One way to achieve this approach is to choose portable devices that are able to integrate with software and hardware outside of its manufacturer. This stops the dependence on a single provider and ensures future scalable growth.
Whether with current or new connective and telehealth software vendors, it is vital to check if services can support additional components or increased utilization. For future growth, healthcare organizations should ask about any potential limits of components or users to achieve an enterprise approach to scaling a telehealth program.
6. Patient data and security
Even though it was covered previously in hardware and software, patient data and security cannot be iterated enough. Any system which provides for the patient, the provider, and the healthcare system is a vital part of a telehealth infrastructure.
A vulnerability may result in inappropriate access to patient information, medical device malfunction, or a breakdown in healthcare services if the infrastructure is open to a breach in security. These breaches can have a profound effect on patient safety and care.
This, plus violations to regulations can be costly for healthcare institutions. A recent data security firm report estimated that security breaches cost the healthcare industry $ 6.2 billion in 2016, while HIPAA Security and Privacy rule violation penalties for providers range from $ 50,000 per breach incident up to $1.5 million .
Security concerns are also significant to patients, thirty-five percent of respondents are concerned about the security and privacy of their health information . Two of the reasons why protection is critical to any successful telehealth infrastructure are the cost to both bottom line and reputation.
It is crucial to acknowledge the BYOD trend and its potential impacts on data breaches along with the detrimental impacts of data breaches. While due to its ease and cost savings, the BYOD movement has gained popularity, it also increases the risk for both non-compliance and data breaches.
These devices enable healthcare providers to be productive from any location, but telehealth providers must focus on how they can secure the devices being utilized and create a secure infrastructure.
The mobile devices must have HIPAA-compliant software with both their operating system and any third-party applications that are utilized. In order to limit access to sensitive information by people outside the healthcare environment mobile devices should be two-factor authentication secured.
Should the device be lost or stolen, infrastructure should also include the ability to remotely disable and remove data from any mobile device containing protected health information, to prevent potential breaches. Securing your telehealth from all possible threats is vital to the success of any program.
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It is necessary for healthcare organizations to build out a telehealth program with seamless integration of all six essential components of a successful telehealth infrastructure aforementioned as they play catch up to the rapidly growing telehealth services.
Fluid telehealth operability can be achieved by preparing a program with the appropriate IT infrastructure, hardware, software, IoT devices, and patient and data security. The structure of these six components is not without the affects of outside factors shaping how programs are being built.
U.S. demographic shifts of the elderly continue to increase, and the growth of individuals with a chronic disease, telehealth technology and service will adapt to augment care and service these growing requirements.
As they explore this route, slow investments into telehealth programs currently constrain healthcare organizations. Alterations to state policies will further increase adoption as reimbursements are recognized via these services. Lastly, both providers and patients highly approve of and are willing to adapt to telehealth services.
It is important to consider the outside influences and the six essential components of a successful telehealth infrastructure to understand how it will impact operations and telehealth services both now and in the future.
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