The Emergency Medical Treatment and Labor Act (EMTALA) was intended to ensure that patients receive proper care in a timely manner, regardless of their financial or insurance situation. Unfortunately, implementation can be difficult for local care centers as facilities are required to provide continuous care with four to five doctors who rotate on a 24/7/365 schedule. For those healthcare systems and care facilities strapped for cash, this can be a significant strain on funding and hospital resources.
To remain compliant without the local staffing burden, many care centers are turning to virtual care solutions, especially for high-risk or high-acuity services like telestroke, teleICU and telebehavioral health. Virtual care has improved patients’ access to high specialty care, and it is only going to continue. With the Centers for Medicare & Medicaid Services (CMS) now allowing Medicare reimbursement to any emergency department or mobile stroke unit for telestroke services and its proposed flexibility for Medicare Advantage plans in 2020 to offer telehealth benefits, the acceleration in adoption is only expected to increase.
With further adoption comes more risk
While the Bipartisan Budget Act of 2018, the VETs Act and the SUPPORT for Patients and Communities Act were all major “wins” for the telemedicine community last year and more payers continue to offer telehealth benefits, the lack of federal regulation gives some reason to pause. For example, passage of section 3060(a) of the 21st Century Cures Act clarified that audiovisual connections for telemedicine, on their own, do not meet the definition of a medical device and therefore no longer fall under the purview of the U.S. Food and Drug Administration. The Federal Communications Commission may be charged with having oversight in this area, but it could be argued that the FCC is not the appropriate group to regulate technology used in medical situations. Regardless, no clear watchdog means increased risk for patient safety when using these services. This change was lobbied hard by several prominent health IT companies, and it may come back to haunt them.
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Reliance on this technology in acute care situations in my view is no different than relying on a device that is used in a medical procedure. Therefore, we must ensure that these systems work reliably and do no harm to patients. But who is the “we” you may ask, especially without government oversight? The answer: both health technology innovators and healthcare providers.
The demand for better quality
Technology-first solution providers do not always understand the complex intricacies of the healthcare industry. For this reason, solution engineers must ensure that they understand the stakes and develop solutions that do not detriment any care being provided via virtual services.
- First and foremost, the devices, software and network must have the highest level of security and reliability. Pauses or delays in streaming cannot happen, particularly in high-acuity situations where speed of care is paramount.
- Sometimes a picture can be worth a thousand dictations in the healthcare industry. It’s highly beneficial if the technologies can easily access a hospital or health system’s PACS for medical images and allow the provider to make a better clinical decision or care recommendation.
- In the same vein, the software should have the ability to seamlessly integrate with the electronic health record system. This allows patients and physicians to review records of telehealth visits without creating more work for the provider to properly document all services rendered.
- To create a system of checks and balances, all telehealth solutions should have the ability to track performance via a quality management system to minimize risk. This system holds all parties accountable and ensures that the quality of care is not diminished.
Similarly, when considering telehealth implementation, health systems will find themselves in need of partners with proven track records of developing clinical solutions with their same focus on patient safety. Beyond considering the solution’s capabilities above, health systems should:
- Partner with a virtual care solution that is purpose-built for telehealth. Oftentimes, health systems will turn to business technology—such as traditional video conferencing—to meet their virtual care needs, yet many discover that those solutions fall short due to lack of healthcare-oriented security protocols or network reliability.
- Verify that the technology partner has a quality management system not just for their software but also for devices as well, particularly when in use for high-acuity situations where the patient’s life hangs in the balance and these systems provide the link between patient and physician.
- Ensure that the technology vendor has a complaint handling system to properly triage dropped virtual care sessions, log a clinician’s inability to connect to a patient, and provide 24/7 support service for users to engage with rather than having users turn to health systems’ already limited internal IT resources.
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With the increase in reimbursement and payer interest in telehealth services, the industry is poised for an influx in adoption in 2019. However, to ensure that providers continue following the central tenet of doing no harm, patient safety must be a top priority when implementing new technologies and solutions. The lack of regulatory oversight shouldn’t cause concern; rather, it’s time for both healthcare organizations and healthcare technology solution providers to step up and take responsibility. Only then, with both sides aligned and focused on patient safety first, will we eliminate risk and provide higher quality virtual care.
Joseph DeVivo is the CEO of InTouch Health.