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continua Newsletter - March 2008Click here to sign up for the Continua Health Alliance newsletter e-mail list.In This Issue: Featured Article In the News Upcoming Events Progress Report Membership Update Featured ArticleMoving Beyond the "Evidence" Question in TelehealthThe first chapter in the history of everything emergent, revolutionary and useful is usually dedicated to questions about its very existence or necessity. In the case of telehealth, the questions have centered around the “evidence of efficacy” and “evidence of cost benefit." Have decades of studies answered these questions adequately? And is it time to move on? Let us take a cursory look at the evidence in the public domain. A search of databases, such as PubMed, reveals tens of reports of original studies, not including surveys and opinions. These studies, largely focused on remote monitoring and tele-consultation technologies, span a range of medical indications, including cardiology, respiratory, diabetes, trauma and other specialties, and are situated in various geographies, including the U.S., EU and Canada. Many published studies typically include some form of a “trial” and/or simulation models. Studies might focus exclusively on the efficacy of the service or the cost/economic analysis or, in a few select cases, both. What do these studies reveal? In a preponderance of these studies, viewed individually, the results cast a favorable light on both the telehealth technology and service. They show improved patient satisfaction as measured by various metrics like shorter wait times to consultation with an expert, improved and easier management of the health condition, closer support/attention, etc. The economic analyses often demonstrate significant savings from reduced interventions and office visits and better resource utilization. Why then do the debates persist? When viewed in the aggregate, the studies may all lend themselves to criticism, that identifies and expounds on deficiencies in scope, scale and design. Furthermore, critics argue that it is not possible to extrapolate results obtained from a study conducted in a very specific economic model, using an equally specific healthcare practice/method of delivery system, to other, substantially different, regimes. Therefore, a conclusion such as “telehealth works cost effectively” is hard to come by. Even conceding these points, the merits of this substantial body of evidence persist and in spite of the criticism, the narrative is progressing, as indicated by these observations. The actual practitioners and beneficiaries of telehealth are increasingly breaking free of the circle of doubt. One of the largest health plans and integrated health services provider in the US, also a leading member of Continua, reported results last year for an internal study on a home telemonitoring program for congestive heart failure. Based on a population of approximately 250 CHF patients, the key metrics measured before and during the trial were:
The provider concluded that this was sufficient evidence to move beyond the research and investigation on the existential questions and to fully operationalize the telemedicine disease management program. This exemplifies the growing refrain heard from within many large provider organizations which have built their own corpus of hard evidence outside pubic view- “we are convinced”. Next, consider the changes in the regulatory/policy landscapes. Admittedly, the challenges on the policy front and the lack of regulatory clarity continue to feed the "evidence" inquisition. The 1997 Medicare defined benefit for telemedicine, with its current narrow definitions for geography, location, service, technology and provider, stands as a Three Gorges dam before telehealth’s widespread adoption. However, leaks have sprung and are flowing abundantly. Medicaid telehealth programs, state sponsored telehealth initiatives, large telehealth programs backed by government payor organizations, federal grant based programs, the use of prospective payment systems ( PPS) , the possibilities under the Medicare Advantage plans all chip away at the barrier to adoption in small but meaningful ways. When the research studies are viewed against the backdrop of more favorable regulatory environments, the results only look rosier. Finally, consider the technology for telehealth. Most of the research studies and their results, be it efficacy or cost, are significantly affected by the technology used. Continua’s raison-d’etre- cost effective consumer friendly telehealth technology through interoperability, will be the single biggest game changer in the advancement of telehealth. The widespread availability of low cost health monitoring and management devices, from a multitude of vendors, offering significantly lower set up and initial costs to the consumer and the provider, easier maintenance and support, and enabling a simplified, fully connected and efficient infrastructure leveraging existing, widely adopted consumer products, will positively impact any cost analysis and can only improve user satisfaction- be it patient or clinician. The one remaining piece to completing this technology transformation is the marrying of Continua devices to an equitable, low cost PHR/EHR solution. The first chapter- the existential angst over telehealth’s birth - is nearing conclusion it appears. The second chapter titled- “Ok, How do we make it happen?” has commenced. Therein, to be sure, there will be many more trials and technology demonstrations to report on. But the focus will be on building successful business models, and adoption of Continua-based technologies, tied to an effective, justly administered health record, for wide-ranging telehealth services. Deepak Ayyagari, PhD Editor-in-Chief Continua Health Alliance In the NewsNews continues to build for the Continua Health Alliance! Continua welcomed the Northern Ireland government to its Winter Summit in January, where delegates announced the creation of the European Centre for Connected Health:
Upcoming Industry EventsATA 2008Date: April 6-8, 2008 Venue: Washington State Convention & Trade Center The Continua Health Alliance will be hosting a Personal Telehealth Matchmaking session at ATA 2008 this year! Continua is launching an online web service to help service providers distribute personal telehealth project requests (RFPs) to the Continua vendor community. This session will describe the new service and also give the stage to some service provider companies who will make brief presentations outlining their RFP details and goals. Vendor companies will then have the chance to network with these service providers one on one to exchange information and ideas. Interested in participating? E-mail admin@continuaalliance.org . FIBO 2008 Date: April 10-13, 2008 Venue: Essen, Germany Continua Spring Summit (Members-only) Date: April 13-16, 2008 Venue: Hilton Luxembourg, Luxembourg Members click here for Summit and Plugfest information! Wireless Pharma CONTINUA PARTNER INDUSTRY EVENT Date: April 14-15, 2008 Venue: Philadelphia, PA Med-e-Tel 2008 Date: April 16-18, 2008 Venue: Luxembourg . European Connected Health Expo Day Date: May 7, 2008 Venue: Ramada Belfast, Belfast, Northern Ireland The European Centre for Connected Health recently announced allocation of $96 million to help bring 5,000 people suffering from chronic disease in Northern Ireland to a remote monitoring service by 2011. To help the procurement process and support its membership, the European Center for Connected Health & Continua are hosting European Connected Health Expo Day 2008. This unique tradeshow will allow Continua member companies to showcase their products for Northern Ireland government officials, healthcare professionals and the leadership of the European Centre for Connected Health! This event is being specifically marketed to individuals responsible for the procurement of health care and remote patient monitoring systems. This is an unparalleled opportunity to impress not only Northern Ireland and Republic of Ireland delegates with your company’s products, but the equivalent leadership from all of Europe. Don’t miss out on this great opportunity! Reserve your booth space now: http://www.continuaalliance.org/members/expo/ Working Group Progress ReportUS Payer Work GroupThe US Payer Working Group has engaged Critical Mass Consulting on a business model and barriers research project. The project inventories and assesses business models for products and services involving telehealth, patient self-management and remote disease management. It also characterizes the strengths and weaknesses of each model. Promoter member companies will be able to utilize Critical Mass' results to better develop their strategies for generating, increasing and sustaining revenues from products in those areas. Employer HR Work Group The Employer HR Workgroup has been busily drafting a Future State Concept Position Paper, which will describe personal telehealth's relevance to self-insured companies, primarily by enhancing existing Wellness programs. A first draft was completed and we received a lot of feedback from the Employer HR Workgroup members. We recently distributed the second draft to the Marketing Work Group for their review and comment. Our goal is to have the third draft distributed Continua-wide for review and comment by the end of March and Board approval by mid-April. The Employer HR Workgroup has also been progressing our thinking relative to the Case Study concept and has begun discussions with a few companies. Our goal is to have 2-3 Case Studies "live" and in progress by Fall 2008. Use Case Work Group The UCWG has been finalizing the use case material to prepare for the Continua-wide use case ballot. Following the process developed by the UC Working Group and approved by the BOD, twenty-six use cases were prepared for ballot. The ballot opened for all Continua Promoter members on March 10. Each promoter member can vote yes/no/abstain on each of the 26 use cases and thus influence the prioritization of the use cases that Continua will address in the next round of guidelines development. The ballot closes on March 28 and the ballot results will be reported to the membership at the Spring Summit in Luxembourg in April. There have been questions regarding who should submit the vote of behalf of an organization. The answer is each Promoter organization should have designated one primary contact for responding to Continua-wide (not working group) ballots. You can view your organization¹s roster and identify the primary contact from the Continua Web site: Members only > My Account > View Roster (icon near your organization¹s name) > Look at the employee type column to locate your primary contact. Please ask the UCWG leadership if you have any questions about the ballot process. Technical Work Group/Test & Certification Work Group
Membership UpdateContinua’s membership has reached more than 140 member companies and is still growing! Most recently, Centre for Global eHealth Innovation, Misys Healthcare Systems, CSR plc, Innomed Medical Zrt., VTT Technical Research Centre of Finland, Digi International, Computerized Screening, Inc., Bluegiga Technologies Oy, Continuity Health and LAXTHA Inc. joined at the Contributor level. Computer Associates and Novartis Pharma AG joined at the Promoter level. If you would like to read more about the Continua Health Alliance membership benefits please click here.Deepak Ayyagari, PhD Editor-in-Chief editor@continuaalliance.org |
