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Telemedicine Pioneers: HiTech-Doctors

Communicating With Our Physicians At Home

 

 

 

 

 

 

 

We introduced readers to HiTech-Doctors several years ago before the telemedicine boom really hit. Today, many physicians are thinking seriously about telemedicine and how adding it to their practices could meet patient demand for convenience and ease overcrowded schedules. We decided to catch up with Philip Gideon, MD, cardiologist and Chief Medical Officer of HiTech-Doctors and see what’s new.

Mary Pat: Describe HiTech-Doctors.

Dr. Gideon: HiTech-Doctors is a web-based heath care portal created to open Internet communications between provider and patient. We seek to create the safest and easiest environment for videoconferencing encounters, electronic messaging, clinical data entry, data transfer, and clinical education. Connected care is the future and is here.

 

Mary Pat: How can a practice improve patient communication using HiTech-Doctors?

Dr. Gideon: We have a high definition videoconferencing service with quality and utilities not yet seen in this industry.

  • We have developed an email service that allows safe communication with your patients.
  • For each encounter a history and physical document is generated. This data can be used in the normal workflow of generating the electronic patient chart.
  • There is a patient data entry service that allows general clinical data to be populated by the patient.
  • Interactive encounter scheduling is available to make life easier for the patient and the provider.
  • Other providers and family members can be invited into the video encounter.
  • The patients can transmit their health information in to their chart.

 

Mary Pat: How has HiTech-Doctors evolved?

Dr. Gideon: We wanted to create the next generation of electronic health record. An EHR is needed that allows the provider and patient to communicate and learn through multiple technologies in a safe easy way. We have begun to accomplish this “open chart” with our current system platform.

Additionally, the platform needed to aid providers in meeting Meaningful Use (MU) criteria for participation in government incentive programs. MU2, and particularly MU3 criteria, have some specific technological requirements that cannot at this time be fully met by most available EHR providers. We have been able to meet many of these criteria by:

  • Demographic recording and record of smoking status
  • Patient-generated data entry (medication reconciliation, BP, heart rates, blood sugars, weights, BMI, etc.)
  • Use of secure electronic messaging to communicate with patients
  • Allowing immediate ability for patients to view and download their encounter record by both document and video format.
  • Increasing after hours provider accessibility
  • Gives ability to provide summary of care record electronically

There are so many useful aspects to the platform. We believe that as MU criteria evolve and the repealed SGR mandates develop, our product will lead in the industry. We believe that, but we know HiTech-Doctors will lead in health care communication.

 

Mary Pat: What does it cost physicians and patients?

Dr. Gideon: For the provider, it is $300 for lifetime enrollment. No additional charge for individual providers.

The communications platform (secure electronic messaging or emailing) is $300 per month per practice.

For the patient, it is $20 lifetime enrollment for an individual and this includes family.

$10 will be added to the patient bill in all encounters as payment for the service to HiTech-Doctors.

 

Mary Pat: Does insurance pay for telemedicine?

Dr. Gideon: Provider practices are encouraged to notify private insurance providers of the intent to see their patients by telemedicine. The intent should state that the encounter would be billed at an appropriate level of office visit using a QT modifier. The patient would be billed a set amount which should be considered a copay or as part of the total reimbursement. A description of the service being used (HiTech-Doctors) and the cost of service should be included. Some insurance carriers may need to negotiate the fee schedule, but this is commonplace when a new service is offered in a practice.

Encounters can alternatively be billed by the provider as cash or fee-for-service. This is specifically true for Medicare and Medicaid patients using the system outside of Medicare/Medicaid telemedicine criteria (cms.gov).

Either means of payment require a credit card transaction prior to starting the encounter.

 

Mary Pat: How does a practice implement telemedicine?

Dr. Gideon: The Hitech-Doctors team has put together an implementation plan to accommodate any office or medical center.

  1. Setting up computers, tablets and phones to accommodate the best virtual experience.
  2. Modification of patient scheduling workflow to allow a choice of in office or online encounters.
  3. Acquire and categorize patient email contact list.
  4. Email, postal, and in office advertisement of the new online service.

The implementation involves strategic scheduled learning teams early in the initiation. Both in-person and online availability of the HiTech-Doctors team is present as the roll out takes place and after. This combination of staff and provider education, hardware setup, advertisement, and ongoing technical and clinical support offers the best success.

 

Mary Pat: Is there technical support?

Dr. Gideon: Yes, 24/7 technical and user support are available buy phone at 1-480-588-2512. Try it!

 

Mary Pat: Since we last talked, the national conversation about telemedicine has changed radically. How has the conversation changed HiTech-Doctors?

Dr. Gideon: HiTech-Doctors has continued to promote the use of telemedicine as another form of patient:provider communication. Many levels of acceptance and regulation of video encounters need to be in place to allow broad use of telemedicine. This is the conversation at present, and it will need to continue. HiTech-Doctors hopes to help keep the momentum in the right direction towards sustaining the patient doctor relationship.

 

Mary Pat: What do you think about the interstate telehealth licensing compact?

Dr. Gideon: The compact addresses serious questions about healthcare, such as physician shortage in both rural and urban regions and poor access to care. Telemedicine stands to be an efficient tool in the solution.

There are tremendous benefits to having interstate licensure. Electronic visits are already a proven means of healthcare communication that can be gap-filling technology where there is poor access to healthcare. The compact has had progressively more backing by states and congressional leaders. Allowing providers to have interstate license gives the ability to optimize the use of the available technology.

Recently UHC announced it would cover telemedicine services for its subscribers, however, only if the services were procured through specific telemedicine intermediaries. What are your thoughts about this development?

Insurance providers are at a stage where they need to, and can, set the physician fee schedules for telemedicine given no specific value or code has been yet assigned by CMS. Blue Cross Blue Shield of Arizona recently also consented to paying for telemedicine at only 80% of the billed visit. United Healthcare doing business with only specific telemedicine companies is a normal practice of insurance providers in this current time of managed healthcare. HiTech-doctors offers a platform that allows real medical practice to occur. It is far more than triage to keep insurance company clients out of the ER or urgent care. The real winner is the telemedicine service that allows confident and safe communication.

 

Mary Pat: What is in the future for HiTech-Doctors?

Dr. Gideon: We are excited to move with the growing pains of our healthcare system so that we stay connected to actual need. Technology through HiTech-Doctors will continue to help in producing the best health outcomes at a low cost. The other side of the HiTech-Doctors healthcare portal is better outcomes and living.

More information on HiTech Doctors is available at their website here or by calling 480-588-2512.

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A Guide to Healthcare Buzzwords and What They Mean: Part Two (M through Z)

Buzzwords in Healthcare Technology

Meaningful Use (MU)

Meaningful Use is the phrase used in the 2009 HITECH Act to describe the standard providers must achieve to receive incentive payments for purchasing and implementing an EHR system. The term meaningful use combines clinical use of the EHR (i.e. ePrescribing), health information exchange, and reporting of clinical quality measures. Achieving meaningful use also requires the use of an EHR that has been certified by a body such as CCHIT, Drummond Group, ICSA Laboratories, Inc. or InfoGuard Laboratories, Inc. The term can also apply informally to the process of achieving the standard, for example “How is our practice doing with meaningful use?”

mHealth

An abbreviation for Mobile Health, mHealth is a blanket label for transmitting health services, and indeed practicing medicine, using mobile devices such as cell phones and tablets. mHealth has large implications not only for newer devices like smartphones and high-end tablets, but also for feature phones and low-cost tablets in developing nations. Many different software and hardware applications fit under the umbrella of mHealth so the term is used conceptually to talk about future innovations and delivery systems.

NLP

An acronym for Natural Language Processing, NLP is a field of study and technology that seeks to develop software that can “understand” human speech – not just what words are being said, but what is meant by those words. By “processing” text input into an NLP program, large strings of text can be parsed into more traditionally meaningful data. For example, narrative from a doctor in a medical record could be transferred into data for research and statistical analysis. If we had every medical record and narrative in history, we could search it and look for trends – and possible new cures and symptoms. IBM’s famous Watson machine that could “listen” to Jeopardy! clues and answer is an advanced example of NLP.

ONCHIT

An acronym for “Office of the National Coordinator for Healthcare Information Technology,” the ONCHIT is a division of the Federal Government’s Department of Health and Human Services. The Office oversees the nation’s efforts to advance health information technology and build a secure, private, nationwide health network to exchange information. Although the National Coordinator position was created by executive order in 2004, the Office and its mission were officially mandated in the 2009 HITECH Act as a part of the stimulus package.

Patient Engagement

Patient Engagement is a broad term that describes the process of changing patient behaviors to promote wellness and a focus on preventative care. “Engagement” can roughly be read to describe the patient’s willingness to be an active participant in their own care and to take responsibility for their lifestyle choices. Patient Engagement efforts can be as simple as marketing campaigns for public heath and appointment reminders, and as advanced as wearable monitors that can transmit activity and exercise information so patients can track their fitness. Improving the health system’s ability to engage patients is considered key to lowering healthcare spending and attacking epidemics like obesity and heart disease.

Patient Portal

A patient portal is software that allows patients to interact, generally through an internet application, with their healthcare providers. Portals enable communication between providers and patients in a secure environment with no fear of inappropriate disclosure of the patient’s private healthcare information. Patients can get lab results, request appointments and review their own records without calling the provider. Patient portals can be sold as a standalone software module or as part of a comprehensive Practice Management/EHR package.

Patient-centered Care

Patient-centered care is a healthcare delivery concept that seeks to use the values and choices of the patient to drive all the care the patient receives. As elementary as it sounds, developing a culture that places the needs and concerns of the patient – the whole patient – at the center of the decision-making process is a new development in the healthcare system. Patient engagement is at the core of patient-centered care, because the patient is the central driver of the decisions – as is only right!

PCMH

An acronym for Patient Centered Medical Home, a PCMH is a model for healthcare delivery where most or all of a patient’s services for preventative, acute and chronic primary care are delivered in a single place by a single team to improve patient outcomes and satisfaction as well as lower costs. PCMHs may also operate under a different reimbursement structure, as they can be paid on an outcome basis or on a capitation model as opposed to fee-for-service.

PHR

An acronym for a “Personal Health Record,” a PHR is a collection of health data that is personally maintained by the patient for access by caregivers, relatives, and other stakeholders. As opposed to the EHR model, in which a single hospital or system collects all the health information generated in the facility for storage and exchange with other providers, the PHR is maintained, actively or passively with mobile data capture or sensor devices, by the patient. The PHR can supplement or supplant other health records depending on the way it is used.

PPACA

An acronym for the “Patient Protection and Affordable Care Act,” the PPACA was a federal law passed in 2010 to reform the United States healthcare system by lowering costs and improving access to heath insurance and healthcare. The PPACA uses a variety of methods – market reforms to outlaw discrimination based on gender or pre-existing condition, subsidies and tax credits for individuals, families and employers, and an individual mandate forcing the uninsured to pay penalties – to increase access to insurance and lower healthcare costs.

PQRS

An acronym for the “Patient Quality Reporting System,” PQRS is a mechanism by which Medicare providers submit clinical quality and safety information in exchange for incentive payments. Physicians who elect not to participate or are found unsuccessful during the 2013 program year, will receive a 1.5 percent Medicare payment penalty in 2015, and 2 percent Medicare payment penalty every year thereafter.

RAC

An acronym for “Recovery Audit Contractor,” a RAC is a private company that has been contracted by the Centers for Medicare and Medicaid Services to identify and recover fraudulent or mistaken reimbursements to providers. There are four regions of the United States, each with its own RAC  which is authorized to recover money on behalf of the Federal Government. A pilot program between 2005 to 2007 netted nearly $700 million dollars in repayments and the program was made permanent nationwide in 2010.

REC

An acronym for “Regional Extension Center,” a REC is a organization or facility funded by a federal grant from the Office of the National Coordinator for Health Information Technology to provide assistance and resources to providers who want to adopt an EHR and achieve meaningful use but need technical or deployment support to get their system up and running. There are currently 62 RECs in the United States who focus primarily on small and individual practices, practices without sufficient resources, or critical access and public hospitals that serve those without coverage.

Registry

A Registry is a database of clinical data about medical conditions and outcomes that is organized to track a specific subset of the population. Registries are important to track the efficacy of drugs and treatment, as well as to analyze and identify possible treatment and policy opportunities to improve care. A registry can also be used to report PQRS.

Telehealth

Telehealth is a broad term that describes delivering healthcare and healthcare services through telecommunication technology. Although the terms telehealth and mhealth can be used somewhat interchangeably, “telehealth” tends to focus more on leveraging existing technologies – phone, fax and video conferencing to deliver services over a long distance, or to facilitate communication between providers. Remote evaluation and management and robotics are both examples of care innovations that would fall under the telehealth umbrella.

Value-based Purchasing

Value-based purchasing is a reimbursement model for health care providers that rewards outcomes for patients as opposed to the volume of services provided. Both through increased payments for positive outcomes, and decreased payments for negative ones, value-based purchasing seeks to lower costs by focusing on increasing quality and patient-focus. Accountable Care Organizations and Patient Centered Medical Homes are both examples of delivery systems that rely on value-based purchasing.