In 2015, it was estimated that over 30 million Americans had diabetes.1 The constant monitoring required of patients with this condition places considerable strain on the health system, but one solution may be the use of telehealth systems.
What is telehealth?
According to American Association of Diabetes Educators (AADE) spokesperson Dr. Deborah Greenwood, PhD, RN, CDE, “Telehealth is a broad category of remote services that can include synchronous virtual face-to face communication in real-time or the use of digital technology and tools that can facilitate asynchronous communication.”
Telehealth systems can be broken down into four basic types:2
· Synchronous: video conferencing and two-way encounters between patient and practitioner.
· Asynchronous: the transmission and storage of patient information, including pictures, audio and video media, which can be reviewed later.
· Remote Patient Monitoring: data such as vitals and progress reports are collected from chronically ill patients and sent to a health-care provider in a different location.
· Mobile Health (mHealth): the use of mobile devices to promote health-care services, including self-education and health advice.
To date, many telehealth systems have been developed and trialed to allow practitioners to remotely monitor their patients, with a particular focus on those with limited access to health care. In rural America, where there are only 39.8 physicians per 100,000 people,3 it can be difficult for some patients to keep up with their regular medical appointments. Using telehealth, practitioners can consult with patients in their own homes.
Dr. Greenwood further showcases the benefits of telehealth, stating that, “When talking about asynchronous telehealth, people with diabetes can have access to care and education at a time that is convenient for them; they don’t have to take time off work to travel, they can engage when their kids are asleep and they can focus on their own personal needs. Synchronous, virtual care can decrease the cost of driving and taking time off work and provide access to specialty services they might not have in their community.” Telehealth enables patients to keep virtual appointments through live video conferencing, while remote patient monitoring systems can be used to perform routine check-ups, using a technology-enabled self-management (TES) feedback loop to send vital patient information to their practitioner.
Dr. Greenwood explains that the TES feedback loop, managed by a care coordination team, is a “continuous process of generating and analyzing data to help people with diabetes to make changes in behaviors and treatment. The care coordination team can use technology to have access to patients in between typical primary-care visits and to have access to data 24/7 to drive the care plan in a timely manner.”
The benefits of telehealth
The American Hospital Association reported that 76 percent of patients value access to health-care over face-to-face consultations,4 and the use of virtual health monitoring systems is becoming increasingly popular with health professionals as well. Telehealth provides two major benefits for both patients and practitioners:
1. Helping more patients manage their symptoms
Telehealth systems such as technology-assisted case management and virtual face-to-face communications allow practitioners to reach more patients in different locations and record improvements in their patients’ health. An example of this is the 2017 clinical trial sponsored by the Medical College of Wisconsin.5 Participants, comprised of low-income individuals from rural backgrounds, used a technology-assisted case management program to record daily blood glucose and blood pressure readings. A nurse case manager, supervised by a physician, was assigned to virtually monitor the patients using the system, obtaining patient information and adjusting their medication in real time. Improvement in the levels of hemoglobin A1C were reported among participants who used the system. This is supported by Dr. Greenwood’s own research. “We found that when you use and analyze patient-generated health data to communicate with patients, educate and provide feedback to change treatment and behavior, A1C improves,” she shares.6
2. Reduced economic burden
The ADA estimated the cost of diabetes in 2017 as $327 billion, amounting to a quarter of all health-care expenditure.7 Patient data obtained from all types of telehealth systems are analyzed by nurses or physicians who, in real time, provide relevant feedback to their patients and assist them to seek medical help if needed. This reduces the number of hospital visits required, saving time and money for both patients and practitioners.
According to the Utilization Review Accreditation Commission (URAC), telehealth can save medical facilities thousands of dollars in operating costs, depending on their location. For example, a medical facility in California can save up to $104,564, while a Texas-based facility can save $61,000.8 Fewer patient visits also helps hospitals avoid financial penalties imposed by the Medicare Hospital Readmission Program for excessive readmission of patients.9 Meanwhile, patients can save up to $100 per event by using telehealth, with $75 saved on health care and $25 on travel.10 This is especially useful for patients in remote areas with limited access to health services, who now have access to quality health care at their fingertips.
Perceived disadvantages of telehealth
While the use of telehealth systems is growing among practitioners, some are hesitant to adopt a virtual monitoring system. According to Dr. Greenwood, one of the main reasons for this relates to reimbursement for practitioners using the system, although she notes, “The situation continues to improve as value-based payment is changing the landscape.”
Another barrier to adopting telehealth systems is the fact that industry regulations differ between states. Practitioners may remain hesitant until measures are put in place to address issues such as uniformity of regulations and guidelines, potential for misdiagnosis and reimbursement.11 There is also concern about the security of patient data.12 However, Dr. Greenwood points out, “Everything we do in life is online and our data are constantly at risk. Surveys have shown that most patients would rather share their data and have easy access to health care.”
Telehealth for the future
Telehealth services are becoming the new frontier in health delivery, providing benefits for patients with diabetes and their practitioners. As Dr. Greenwood concludes, “We need to think of people with diabetes as consumers of health care and identify how we can make their lives easier and decrease the burden of treatment associated with diabetes; and, hopefully, at the same time we can decrease the burden on primary-care staff by incorporating care coordination and team-based care enhanced by technology.”
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