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Broadband Connectivity Is One Key to Implementing Successful Health IT System, Experts Say

By Melissa Attias, CQ Staff

April 23, 2010 -- Although telehealth technologies have strong potential for improving patient health and decreasing U.S. health care costs, economic disincentives, inadequate broadband connectivity, regulatory uncertainty and a lack of digital literacy among seniors all create barriers to their adoption, witnesses said Thursday at a hearing of the Senate Special Committee on Aging.

The hearing examined how the Federal Communications Commission's National Broadband Plan, which was created in the 2009 economic stimulus law (PL 111-5) to ensure that all Americans have access to broadband, might aid implementation of telehealth technologies. Also known as "eCare," telehealth technologies are tools that deliver health-related services and information using telecommunications technologies to facilitate remote monitoring of people in their homes, increase access to specialty services in rural areas and allow individuals access to clinicians remotely.

"There are multiple barriers that must be resolved in order to develop the ecosystem of broadband-enabled health IT," FCC Digital Healthcare Director Mohit Kaushal said in prepared testimony. "Technology alone will not solve our health care challenges. It must be coupled with payment reform, innovation in service delivery and improved regulatory transparency before we will recognize the health benefits and cost savings promised by these technologies."

According to Kaushal, estimates show that the benefits and savings associated with telehealth technologies could be significant. One study he cited said that the remote monitoring of patients with just four chronic conditions would generate net savings of roughly $200 billion over 25 years.

In addition, the Care Coordination/Home Telehealth Program implemented by the veterans hospital system has already resulted in a 19 percent reduction in hospital admissions and a 25 percent reduction in bed days for those veterans that are admitted, Kaushal said. At $1,600 per patient per year, Kaushal said the program costs far less than the Veterans Health Administration's home-based primary care services ($13,121 per patient per year) and nursing home care rates ($77,745 per patient per year).

A study conducted by Robin A. Felder, professor of pathology and associate director of clinical chemistry at the University of Virginia School of Medicine, similarly found that monitored seniors residing in a senior living facility demonstrated a 36 percent reduction in billable medical procedures, a 78 percent reduction in hospital days and a 68 percent reduction in cost of care, Felder testified.

Yet all witnesses agreed that several major obstacles would delay the successful implementation of telehealth technologies. For one thing, the National Broadband Plan estimates that 93 million Americans are not connected to broadband, Kaushal said, and approximately 3,600 small physicians' offices are not served by the existing mass-market broadband infrastructure.

"It is imperative that hospitals and physicians offices have adequate connectivity, as any care that will be delivered to an individual's home will originate in a health care facility of some description," Kaushal said in his testimony.

Kaushal, Richard Kuebler of the University of Tennessee and Eric Dishman of Continua Health Alliance agree that another significant obstacle to successful implementation of telehealth technologies is inadequate reimbursement policies. The traditional fee-for-service reimbursement system pays for volume, not outcomes, and prevents many of these telehealth technologies from being paid for, they testified. Kuebler heads the Telehealth Department at the University of Tennessee's Health Science Center, and Dishman serves as senior policy adviser at Continua Health Alliance.

"All the promising research done on aging-in-place and telehealth solutions will never come to fruition unless we find ways to ensure that the broadband infrastructure is there to support these activities and Medicare and other health programs acknowledge the value of the services these eCare technologies provide," Dishman said in written testimony. "The acknowledgement must be in the form of reimbursement for the service or an incentive to the provider to provide eCare."

Yet another concern is whether the new technologies will fall under the jurisdiction of the Federal Communications Commission, which regulates general-purpose communications devices, or the Food and Drug Administration, which regulates medical devices, Kaushal said. Other obstacles include patient concerns with privacy and a lack of digital literacy among senior populations.

"The demand side is the key issue," Farzad Mostashari, senior adviser to the national coordinator for health information technology at the Department of Health and Human Services, said during the hearing. "People have to have a reason for getting online."

Democratic Sen. Ron Wyden of Oregon, who chaired the hearing, asserted in prepared remarks that examining telehealth technologies should be a top priority for whoever is confirmed as head of the federal Medicare program.

"Only when the United States has a reliable broadband infrastructure and policies in place to encourage the development and deployment of innovations in health care will we transform our health system into one that emphasizes health care rather than sick care," Wyden said in his opening remarks. "If we can achieve this, we can enable America's seniors the ability to comfortably age in place."

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