Molly Joel Coye

Connected Health: A Review Of Technologies And Strategies To Improve Patient Care With Telemedicine And Telehealth

With the advent of national health reform, millions more Americans are gaining access to a health care system that is struggling to provide high-quality care at reduced costs. The increasing adoption of electronic technologies is widely recognized as a key strategy for making health care more cost-effective. This article examines the concept of connected health as an overarching structure for telemedicine and telehealth, and it provides examples of its value to professionals as well as patients. Policy makers, academe, patient advocacy groups, and private-sector organizations need to create partnerships to rapidly test, evaluate, deploy, and pay for new care models that use telemedicine.

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.

Remote Patient Management: Technology-Enabled Innovation And Evolving Business Models For Chronic Disease Care

Remote patient management (RPM) is a transformative technology that improves chronic care management while reducing net spending for chronic disease. Broadly deployed within the Veterans Health Administration and in many small trials elsewhere, RPM has been shown to support patient self-management, shift responsibilities to non-clinical providers, and reduce the use of emergency department and hospital services. Because transformative technologies offer major opportunities to advance national goals of improved quality and efficiency in health care, it is important to understand their evolution, the experiences of early adopters, and the business models that may support their deployment.

Vital Directions for Health and Health Care: Priorities From a National Academy of Medicine Initiative

Importance Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost. Objectives To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation’s health and fiscal integrity. Evidence Review Qualitative synthesis of 19 National Academy of Medicine–commissioned white papers, with supplemental review and analysis of publicly available data and published research findings. Findings The US health system faces major challenges. Health care costs remain high at

Academic Health Centers and the Evolution of the Health Care System

3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation’s health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities—pay for value, empower people, activate communities, and connect care—recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient- and community-focused health system. The essential infrastructure needs—measure what matters most, modernize skills, accelerate real-world evidence, and advance science—were the most commonly cited foundational elements to ensure progress. Conclusions and Relevance The action priorities and essential infrastructure needs represent major opportunities to improve health outcomes and increase efficiency and value in the health system. As the new US administration and Congress chart the future of health and health care for the United States, and as health leaders across the country contemplate future directions for their programs and initiatives, their leadership and strategic investment in these priorities will be essential for achieving significant progress.

New Technology Planning and Approval: Critical Factors for Success

Today there are approximately 135 academic health centers (AHCs) in the United States. These institutions exist to ensure sustainable health care through their multifold, integrated missions of patient care, education, and research. Yet AHCs have in some ways contributed to the intractable problems that threaten both their viability and the sustainability of health care. To flourish— indeed to survive—AHCs must reconfigure and transform rapidly and broadly in size, speed, value, and innovation, driven by self-reflection and leadership.

Medical group adoption of Internet services.

The steady evolution of technology, with the associated increased costs, is a major factor affecting health care delivery. In the face of limited capital resources, it is important for hospitals to integrate technology management with the strategic plan, mission, and resource availability of the organization. Experiences in technology management have shown that having a well-organized, consistent approach to technology planning, assessment, committee membership, approval, evaluation, implementation, and monitoring are key factors necessary to ensure a successful program. We examined the results of a survey that assessed the structure, processes, and cultural support behind hospital committees for new technology planning and approval. (Am J Med Qual 2007; 22:164-169)

A Healthcare Provider's View of Progress on the Ground

Physician leaders and office-based practicing physicians in medium and large practice organizations were surveyed regarding their use of administrative and clinical systems enabled by the Internet. More than 85% of medical groups reported using one or more Internet-enabled services and 35 reported use of more than five Internet-enabled services, including both business and clinical applications. Physician leaders and practicing physicians identified six Internet-enabled services as “essential” for the future success of their practice and indicated that reduced administrative costs, faster payments, and improved quality of care are the most important benefits derived from Internet-enabled applications. Ninety-six percent of survey respondents estimated that Internet-enabled technologies will have a significant, positive impact on the practice of medicine in general and will improve the quality of care before 2003. The lack of industrywide standards for health information and the inability of current computer systems to exchange information across health care delivery networks were cited as the most important barriers to the adoption of Internet-enabled applications by physicians. Respondents believed that action by the Health Care Financing Administration (HCFA) or major health plans to require participating physicians to use the Internet for administrative services will be needed to bring about rapid migration to Internet-enabled services.

No Toyotas in health care: why medical care has not evolved to meet patients' needs.

Some of the best minds in the state participated in the Berkeley Forum for Improving California’s Healthcare Delivery System. As individuals and organizations, they have worked for decades to improve the quality, accessibility and affordability of care in California. In the Forum they worked to define initiatives that would be feasible, evidence-driven, reflective of the realities of California, and likely to substantially reduce healthcare expenditures in California. They laid out a series of recommendations that form a clear pathway to integrated care and more effective use of resources via risk-adjusted global budgets. For provider groups and health systems eager to assume more risk as a means to integrate and improve care, it was a clarion call. Of the seven initiatives called for in the Forum Report, the first two – global budgets/integrated care systems and patient centered medical homes – promise the greatest leverage in transforming health systems and represent more than three-fourths of the total projected reductions in expenditures. Since the issuance of the report, however, the momentum of the market has swung ever more decisively against these recommendations. While Medi-Cal has steadily increased the proportion of beneficiaries in managed care, commercial enrollment in risk-based products has continued to fall, in large part because commercial HMOs have lost their price advantage and employers cannot get reliable cost and utilization data from capitated networks. For providers, transforming healthcare has proven to be a slower and less certain task than they had expected. Instead of managing risk for populations,