from NJ.com
The doctor will see you now. Or at least in the few seconds it takes AT&T to relay your vital signs over its broadband network.
The telecommunications giant has big plans to establish a foothold in the "telehealth" industry, an emerging field that links patients and physicians across the country via video and medical-information technology.
"These days, everybody is talking about medical care: Who gets it? Who pays for it? Who decides?" said Robert Miller, executive director of technical research at AT&T and a 40-year veteran at the company’s Florham Park research labs. "But few people are working on a technology solution that would lower costs and make medical care better at the same time."
AT&T scientists have spent the past year working on prototypes of products aimed at the home health care market. The idea is to make everyday household items "part of the network cloud," said Miller, holding up a pair of fuzzy bedroom slippers. They look perfectly ordinary, but they are actually one of many telehealth products in the pipeline at AT&T.
Called "smart slippers," they have pressure sensors embedded in their soles to transmit foot movement data over AT&T’s network. If something is amiss in an elderly patient’s gait, the device will alert a doctor via e-mail or text message, possibly preventing a fall and a costly trip to the emergency room, Miller said.
Such products would represent the next step in what is called "remote medical care." Sales in that sector and other telehealth services are expected to exceed $1.8 billion by 2013, up from just $77 million in 1995, according to a PricewaterhouseCoopers report.
With that much money at stake, AT&T, Verizon and medical device manufacturers such as Cisco are aggressively entering the rapidly developing market. But analysts say they must first convince all health care players — insurers, employers, doctors and patients — to get on board.
One the biggest roadblocks to growth could be limited reimbursement from Medicare and the general fee-for-service health care system, said Zachary Bujnoch, an analyst at the research firm Frost & Sullivan.
Representatives from AT&T’s business unit said it is too early to disclose the cost of upcoming telehealth products and services, but Bujnoch said costs can run up to $100 per month, per patient.
"This is virgin territory in the health care industry when you ask how we are going to pay for it," he said, adding that telehealth’s current market penetration is in the single digits. "Everyone is groping blindly in the dark to figure out what business models are going to work."
But telehealth’s potential is enormous, Bujnoch said, especially as large firms like AT&T invest heavily in research and development. Last spring, Intel and General Electric Healthcare announced they would jointly commit $250 million to develop wireless products to connect patients to physicians. And Verizon announced last month it has partnered with Cisco to deliver an audio and video consultation service that lets doctors interact with patients in real time.
Telehealth’s biggest advantage, proponents say, is its tremendous cost-saving potential. Remote patient monitoring alone can generate between 20 percent to 40 percent in savings, said Chris Wasden, managing director of health industry strategy and innovation at PricewaterhouseCoopers.
"Ironically, the United States is late to the party here," said Wasden, explaining that telehealth is much more common in developing countries such as India, where cell phones enable people to receive health care in remote areas that once lacked access to modern medicine. "They’ve already developed the ability to deliver mobile health care to their people, but we’re behind the times on that."
"Ironically, the United States is late to the party here," said Wasden, explaining that telehealth is much more common in developing countries such as India, where cell phones enable people to receive health care in remote areas that once lacked access to modern medicine. "They’ve already developed the ability to deliver mobile health care to their people, but we’re behind the times on that."
$6 BILLION INFUSION
AT&T’s push into the market comes as the Obama administration and Congress seek to overhaul the country’s health care system — partly by wiring hospitals, doctors and patients to reduce medical errors and duplication of services. As part of the effort, the federal government is putting at least $6 billion into various telehealth programs.
"The government is saying, ‘You have to go digital,'" said Tom Gregorio, chief information officer at Newark Beth Israel Medical Center, a 673-bed facility that also provides medical services to seven assisted-living centers in the Newark area.
A health care bill before the Senate would cut Medicare reimbursement for patients readmitted to hospitals up to 30 days after they were discharged. If the bill passes, Gregorio said he must find a way to curb the readmission rate at his hospital — or absorb the cost of those returning patients. Despite its uncertain cost structure, telehealth could be a solution, he said.
"Making sure that a patient isn’t readmitted — that alone is a positive return on investment," he said.
Despite telehealth’s potential, there are relatively few specific examples of how changes in the system might improve patient outcomes and reduce costs. At AT&T, Miller said the prototypes have not yet been thoroughly tested, though plans for a pilot program are under way.
A focus of those pilot programs should be to ensure that the technology is easy-to-use and reliable, Bujnoch said, since errors caused by remote medical monitoring devices could create unnecessary health care costs of their own.
"If it’s going to go off every three hours, who cares?" he said. "And that’s where they have to do the clinical studies and the research to prove that kind of stuff."
Maintaining a patient’s privacy is also a big concern as more telehealth products and services emerge, said Tim Keough, president of the New Jersey Health Information Management Association. At the very least, data should be encrypted as it moves across a service provider’s network, he added.
Miller said AT&T is using guidelines established under the Health Insurance Portability and Accountability Act of 1996, or HIPAA, as its standard while developing its telehealth portfolio, though the rule doesn’t specifically address telehealth services.
Gregorio said some doctors are also leery of telehealth, due to lack of solid evidence of a return on investment. But if the federal government succeeds in its push for health care reform, Gregorio said it would "create a revolution associated with physicians having to adopt technology that they have been rejecting for a very long time."
The hardest party to convince will be private insurers, said Bujnoch, whose agenda isn’t always in sync with those of providers and patients.
For example, Horizon Blue Cross Blue Shield of New Jersey, the state’s largest insurer, does not cover telehealth services, but the company said it is receptive to emerging technologies.
"I like to think we are progressive on these things," said Stan Harris, a pediatrician and senior medical director at Horizon. "But AT&T needs to show us that patients wearing those slippers had fewer accidents. We need clinical trials and other research objectives to prove the technology."
Miller is hopeful that AT&T’s products will eventually be covered by Medicare. He said proliferation of telehealth is inevitable as populations live longer and the demand for cost-efficient home care rises.
"A lot of people, including myself, never feel that we’re going to get sick, get old or need health care monitoring," said Miller. "The statistics are inescapable and eventually we will."
AT&T’s push into the market comes as the Obama administration and Congress seek to overhaul the country’s health care system — partly by wiring hospitals, doctors and patients to reduce medical errors and duplication of services. As part of the effort, the federal government is putting at least $6 billion into various telehealth programs.
"The government is saying, ‘You have to go digital,'" said Tom Gregorio, chief information officer at Newark Beth Israel Medical Center, a 673-bed facility that also provides medical services to seven assisted-living centers in the Newark area.
A health care bill before the Senate would cut Medicare reimbursement for patients readmitted to hospitals up to 30 days after they were discharged. If the bill passes, Gregorio said he must find a way to curb the readmission rate at his hospital — or absorb the cost of those returning patients. Despite its uncertain cost structure, telehealth could be a solution, he said.
"Making sure that a patient isn’t readmitted — that alone is a positive return on investment," he said.
Despite telehealth’s potential, there are relatively few specific examples of how changes in the system might improve patient outcomes and reduce costs. At AT&T, Miller said the prototypes have not yet been thoroughly tested, though plans for a pilot program are under way.
A focus of those pilot programs should be to ensure that the technology is easy-to-use and reliable, Bujnoch said, since errors caused by remote medical monitoring devices could create unnecessary health care costs of their own.
"If it’s going to go off every three hours, who cares?" he said. "And that’s where they have to do the clinical studies and the research to prove that kind of stuff."
Maintaining a patient’s privacy is also a big concern as more telehealth products and services emerge, said Tim Keough, president of the New Jersey Health Information Management Association. At the very least, data should be encrypted as it moves across a service provider’s network, he added.
Miller said AT&T is using guidelines established under the Health Insurance Portability and Accountability Act of 1996, or HIPAA, as its standard while developing its telehealth portfolio, though the rule doesn’t specifically address telehealth services.
Gregorio said some doctors are also leery of telehealth, due to lack of solid evidence of a return on investment. But if the federal government succeeds in its push for health care reform, Gregorio said it would "create a revolution associated with physicians having to adopt technology that they have been rejecting for a very long time."
The hardest party to convince will be private insurers, said Bujnoch, whose agenda isn’t always in sync with those of providers and patients.
For example, Horizon Blue Cross Blue Shield of New Jersey, the state’s largest insurer, does not cover telehealth services, but the company said it is receptive to emerging technologies.
"I like to think we are progressive on these things," said Stan Harris, a pediatrician and senior medical director at Horizon. "But AT&T needs to show us that patients wearing those slippers had fewer accidents. We need clinical trials and other research objectives to prove the technology."
Miller is hopeful that AT&T’s products will eventually be covered by Medicare. He said proliferation of telehealth is inevitable as populations live longer and the demand for cost-efficient home care rises.
"A lot of people, including myself, never feel that we’re going to get sick, get old or need health care monitoring," said Miller. "The statistics are inescapable and eventually we will."
