Capitol Correspondence - 08.09.19

On Telehealth: Interview with Outgoing National Health IT Deputy + Pediatricians Cautious About Telehealth Technology

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ANCOR is sharing two articles by Politico Pro because policy-makers are increasingly considering telehealth as a way to improve quality of health services while decreasing costs. While telehealth is not yet widespread in Medicaid, which funds the majority of disability supports in the United States, there is potential for its use to expand to this sector.


As written by Politico Pro:


Interview with Outgoing Jon White, Deputy Chief, Office of the National Coordinator for Health IT


You’ve been doing health IT since at least 2002, when you were chief medical information officer at Lancaster General Hospital in Pennsylvania. When you look back, what’s the biggest advance and the biggest disappointment? And the biggest surprise?


In terms of advances, it’s that there’s health IT across the country. In 2004 we were hearing, ‘there’s no return on investment for these IT systems.’ Well, the economists were right — incentives worked. That’s the biggest advance. The biggest disappointment is, we could be using that health IT so much better. There’s a whole tangle of reasons why we aren’t. If you look at the initial things laid out in meaningful use, invariably the complaint you hear from providers is, ‘I’m checking all these damn little boxes. It’s a pain in the rear and not what I want to be doing.’ There were other things we could have done, but doctors weren’t ready to do them to get incentive payments yet … If you talk to [former ONC chief] Farzad [Mostashari], he’d probably say we made a choice to incentivize use over interoperability. That has led to less interoperability than desirable and more complaints. But clearly, providers were not ready to ratchet themselves up in terms of complexity of the use of the IT systems.


The biggest surprise is patients. I have been delighted there are such vocal and committed members of the engaged, activated patient community. They have been out there as tireless advocates for access to their information, and boy am I proud of them.


As an HHS official, how often have you been able to get a feel for how the IT works in the real world?


When you do this work, you have to understand that what you see comes through a certain filter. The people you hear from on a given policy issue are motivated to come to a bureaucrat buried in a nondescript office building somewhere in D.C. because they understand you write regulations. The mechanisms we deploy—surveys, the [Certified Health IT Product List], analyzing data, are important. It’s equally important to go outside those channels to see how it’s actually working for clinicians, hospitals, pharmacies, home health care and so on. We have an incredibly complex health care delivery system. I make it a point to stop at local hospitals when traveling, or Federally Qualified Health Centers and hear how it’s going. The perspective they offer a visiting federal official is different than what you see at 3 a.m. in an ER, but it’s all important.


How come it’s so arduous to get what works in health IT out into the world? I’m thinking for example of telemedicine in nursing homes. It’s an obvious advantage to just sending a patient to an ER. Yet however many years we are into telemedicine, there seems to be no way to get that reimbursed.

As special as health IT is, it’s not the only area in which it’s hard to roll out innovation in health care. There’s research that says it takes 17 years for a proven innovation to be accepted throughout the system—the problem isn’t unique to health IT. We lined up incentives for adoption and they worked — $38 billion isn’t really that much over seven or eight years. So we have to look at the incentives to drive adoption.”


Pediatricians push for caution in telemedicine:

“Some types of telemedicine can pose unique health risks for young patients, and specific guidelines should be developed for clinicians who virtually examine children they’ve never met, pediatric health experts say.

Dialing a doctor from a smartphone instead of driving sick children to urgent care may seem convenient for harried parents. But if a doctor doesn’t know the child and makes a diagnosis based on a phone call, video chat or image, without a complete medical history, telehealth users can run serious risks, say the leaders of an American Academy of Pediatrics task force.

Their comments came after two recent studies suggested that telemedicine clinicians tend to prescribe antibiotics with more abandon than those in brick-and-mortar practices.

A Cleveland Clinic study published last week in Pediatrics found that parents are more likely to report satisfaction with video consultations for respiratory tract infections when their children are prescribed antibiotics — even if that might not be appropriate.

The lack of complete information “might make [clinicians] want to reach for some antibiotics to be safe,” said Kristin Ray, a lead author on another study, which concluded children are prescribed antibiotics more frequently through telemedicine than after in-person urgent or primary care visits.

The studies demonstrate the need for more research into safe telehealth visits for young patients and common treatment standards, said David McSwain, who chairs the American Academy of Pediatrics’ telehealth task force. AAP publishes the Pediatrics journal, where both studies were published.”