New ATA Report Makes Integration a Necessity for Telehealth Adoption

April 15, 2019 – The American Telemedicine Association kicked off its annual conference this weekend in New Orleans with a call for interoperability, saying connected care won’t happen unless providers, patients and payers are actually connected.

As the conference entered its second day on Monday, the ATA released a white paper outlining how everyone should be working together and sharing data, instead of dealing with fragmented processes, wasted resources and siloed information.

“As telehealth services expand and mature – from an exceptional alternative for enhanced access in limited-care settings to integrated routine care, management, and reimbursement across the care continuum – they will continue to advance in efficiency, productivity, quality, and financial sustainability,” the organization said. “Interoperability is the key to making that happen. And it has impacts for all stakeholders – providers, payers, and patients/plan members, as well as the telehealth vendors who support them.”

The white paper is the latest effort by the ATA to get everyone to play together in the same sandbox. For this to happen, the organization points out, everyone needs the same tools.

To make that happen, the ATA outlined seven required categories of telehealth operability:

1. Unique patient/member ID. This must be implemented throughout the entire care continuum, including telehealth and onsite services and payment, with rules for registration throughout.
2. Patient/member health data. “Must be securely shared with enterprise data warehouse (EDW), electronic health record (EHR), picture archiving and communication systems (PACS), telehealth platforms, and claims and utilization management systems for timely access and reimbursement, population health management, and performance reporting,” the white paper asserts.
3. Telehealth workflows. These must be accessible from both care management platforms (the EHR) and cross-vendor platforms.
4. Remote examination. This must be accessible from any platform, including video.
5. Patient data capture. This must be accessible through remote patient monitoring solutions as well as diagnostic medical devices.
6. Patient/member communication. These functions should be accessible through communication platforms, scheduling services and communication devices and capabilities.
7. Interstate licensure. This is required, the ATA says, to enable care providers to practice across state lines without hassles or delays.

Telehealth interoperability also gives providers more authority to demand standards-based technology and platforms.

“This situation puts buyers of telehealth technology- payers, employers, post-acute care, and health systems that are investing in long-term telehealth enterprise programs – in the driver’s seat,” the ATA says. “When buyers were willing to invest in siloed telehealth systems, vendors of those or broader health IT systems had little incentive to work toward interoperability. But that’s changing with increased understanding of the value of interoperability and the long-term risk of non-interoperable systems. Today’s buyers must drive the implementation and adoption of standards and require vendors – of both telehealth systems and EHRs – to incorporate standards-based interoperability support across heterogeneous solutions.”

It’s a significant challenge, coming at a time when providers are struggling to define value in value-based care, patients are demanding more and more control over their care options and payers are waiting to be convinced that this is the path to care coordination.

”Widespread telehealth interoperability within health systems requires governance initiatives that are driven by leadership and that incorporate advisory groups and committees to take telehealth out of individual clinical silos and into horizontally integrated, enterprise-wide programs,” the ATA maintains. “This leads to the development of workflows and processes that integrate these telehealth programs into routine care that is optimized for the benefit of both patients and clinicians. In addition, these systems must document compliance with HIPAA security and patient privacy laws, state and federal regulations, and medical accreditation guidelines and must be financially sustainable through integration with plan designs as well as payer systems and programs.”

To achieve that goal, the organization lays out a four-point plan for interoperability success:

1. People, governances and payment models. “Interoperability and data-sharing represent a potential threat to the heterogeneous care-delivery system and fee-for-service (FFS) payment models in the US, so this must be addressed up front,” the ATA says. “While physicians are dedicated to their patients’ well-being, the business reality is that face-to-face clinical services are a higher source of revenue in a FFS payment environment, and patient/member records are critical in processing claims at that higher revenue. Leadership and governance must address those issues during the transition to alternative payment models that incentivize high-quality outcomes over high-volume services. Longitudinal and episodic clinical outcome measures require interoperability between onsite and remote patient-care systems on a larger scale.”
2. Process, workflows and policies. “Clinical design and multidisciplinary collaboration approaches are often overlooked and underestimated as a key element of telehealth success,” the ATA notes. “Focus may be put on a provider’s workflow but fail to mimic the intake process in the office. … Clinical practice guidelines … provide a basis for these processes that can be successfully adapted for a range of specific work environments. A key consideration is the impact of disparate, siloed systems on clinician burnout. Telehealth processes and workflows must be seamlessly integrated within the systems that care providers already use and cannot compete with established front-line systems and workflows.”
3. Interface standards and modular platform solutions. “With these enterprise foundations laid, specific requirements can be defined and telehealth technologies can be evaluated based on how they support near and longer-term enterprise-wide goals while providing the capabilities needed for specific departmental programs,” the ATA says. “The ideal approach is a telehealth technology platform with a flexible, modular design that maintains interoperability even as programs and resources scale and change over time. … This kind of configurable, connected modular design becomes a technology enabler for scalable telehealth initiatives that can reduce complexity and technical risk, even during periods of rapid change and that support long-term programs, even without a clear view of future clinical or business objectives.”
4. Performance reporting and resource management. “To achieve scale in integrated multi-specialty, multi-care telehealth services with financial sustainability, health systems need greater transparency to confirm business assumptions, measure performance, and plan appropriate new investments for staff and technology,” the ATA says. “Aggregated data from interoperable systems feeds performance dashboards and reports to inform both business and clinical decisions. It also gives providers, payers, and patients/members timely access to standardized outcome results of clinical quality metrics for telehealth services by provider, by location or care setting, and by medical specialty.”

The challenge, the ATA says, is to create a platform that meets everyone’s goals. And that’s where collaboration comes into play. It’s much easier to create value-based care if everyone is on board with the concept.

“Experienced health systems are defining near-term clinical requirements and connecting with like-minded technology vendors and payers,” the white paper concludes. “Investments and aligned financial incentives are creating an environment to demonstrate the value of integrated clinical services that leverage interoperable platform technologies. And government and private payers, along with policy advocates, are working to increase incentives and favorable reimbursement models for broad-based telehealth implementations to help drive continued improvements in cost, quality, and access.”

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