Cardiology News
Telemedicine Helps Cardiologists Extend
Their Reach
Bridget M. Kuehn
D
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Figure 1. A mock telecardiology consult. Increasingly, cardiologists
across the country are leveraging technology to provide remote care,
whether through virtual visits and exams, consultations, or continuous
monitoring using a growing array of implantable or wearable devices.
Increasingly, cardiologists across
the country are leveraging technology to provide remote care, whether
through virtual visits and exams, consultations, or continuous monitoring
using a growing array of implantable
or wearable devices. These tools are
allowing cardiologists to extend their
geographic reach, helping them to
identify cardiac problems before they
become catastrophic, and affording them tools to help smooth care
transitions. But as with any new technology, hurdles still exist, such as
reimbursement and integrating these
tools into care.
Circulation. 2016;134:1189–1191. DOI: 10.1161/CIRCULATIONAHA.116.025282
EMERGING TOOLS
A number of factors, including improved technology and policies that
aim to reduce rehospitalizations,
have boosted interest in the use of
telemedicine in cardiology, said Danielle Louder, program director for the
Northeast Telehealth Resource Center based in Augusta, Maine. Northeast Telehealth Resource Center is
part of a network of telemedicine
technical assistance centers across
the United States funded by the
Health Resources and Services Administration to assist clinicians and
October 18, 2016
1189
THE PULSE
uring a recent set of telemedicine consultations, Joaquin E.
Cigarroa, MD, a cardiologist at
Oregon Health & Science University
in Portland, was able to establish relationships with 4 new patients and
their families, conduct a physical examination using an electronic stethoscope, review the patients’ laboratory results, and develop a care plan.
The best part was that the patients,
who all live in coastal Lincoln City,
Oregon, were able to skip the 3-hour
drive to Portland through traffic and
often fog.
“Patients love it,” said Cigarroa.
They only need to make the trek to
Portland when they need advanced
diagnostics or procedures.
For Cigarroa and his colleagues at
Oregon Health & Science University,
providing such off-site care is “critical
to providing patient-centered care,”
he said. He explained that ≈60% of
the patients admitted to the cardiovascular service line at Oregon Health
& Science University’s hospital are
from outside of the Portland metro
area, and many are from rural regions
of the state. He and his colleagues
have increasingly made use of Oregon
Health & Science University’s telemedicine portals, which can even be used
to perform echocardiograms, to care
for patients closer to their homes.
“It’s compassionate to the patient
and their family to maintain them in
their community and only transfer
them if they need procedural or other
capabilities not available in their environment,” Cigarroa said.
Kuehn
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healthcare facilities using telehealth
technologies.
“Cardiolology is one of those areas where telemedicine is gaining a
lot more interest,” said Louder. “At
the same time, it is also a specialty
that has flown under the radar and
has been doing telehealth for many
years.”
For example, cardiologists have
long sent devices such as Holter
monitors and event monitors home
with patients to gather data on heart
rhythms over days or even months.
Emergency services also routinely
use cardiology consultations to
guide prehospital care decisions,
she noted.
“That’s really telehealth,” said
Louder.
Emerging evidence also indicates that primary care electronic
consultations with cardiologists can
reduce emergency room visits. A
study that included 36 primary care
physicians and 590 patients found
that asynchronous electronic consultations with a cardiologist could
resolve about two-thirds of cardiac
concerns without a specialist visit
and reduced cardiac-related emergency visits during the 6-month
follow-up period.
Remote monitoring of cardiac
patients has also gained traction as
many implantable cardiac devices
now continuously collect and transmit data back to clinicians, said Javier E. Banchs, MD, director of electrophysiology and pacing at Baylor’s
Scott & White Memorial Hospital in
Temple, Texas. In fact, the Heart
Rhythm Society has now made remote monitoring of implanted cardiac devices the standard of care.
Clinical trials have shown that these
devices may benefit patients by
helping detect arrhythmias or device
malfunctions more quickly, reducing
hospitalizations for arrhythmias and
strokes, and eliminating the need for
some clinic visits.
“[Remote monitoring] really took
off with implanted devices like pacemakers and defibrillators,” said
1190 October 18, 2016
Banchs. “You can take care of patients continuously.”
More recently, wearable monitors have entered the scene, providing data on movement or chest
impedance, said Banchs, who explained these devices can allow
remote diagnosis or be used to
predict decompensation in patients
with chronic heart failure. Even
more promising are implantable devices that can detect hemodynamic
abnormalities before symptoms develop. The CHAMPION trial showed
that an implantable pulmonary artery pressure sensor could reduce
hospital readmissions among patients with heart failure by 37% over
6 months.
POLICY HURDLES
Despite the promise of telehealth in
cardiology, hurdles to wider use of
these tools remain in the form of inconsistent reimbursement policy and
implementation challenges.
A recent analysis suggested that
6.8% of nonspecialty US hospitals
are participating in a telecardiology programs. Interviews conducted
with 36 hospitals participating in
telemedicine efforts of any specialty
found that the programs help them
boost access to care and keep lower
acuity patients at home. Many programs reported using a one-time
funding source to get their telemedicine programs off the ground, but
many also reported that reimbursement challenges have hampered
their efforts.
Some physicians have also been
slow to embrace the technology.
“There is a large group of skeptics and there are reimbursement issues,” said Banchs.
Medicare currently only reimburses for virtual telehealth visits for patients in rural areas, with a few exceptions, and only 0.2% of beneficiaries
in 2014 used a telehealth service,
according to Gary Capistrant, policy
chief at the American Telemedicine
Association.
“Medicare is one of the poorest
payers of telehealth,” Capistrant
said. “That’s a major barrier.”
A few Medicare programs do provide wider coverage, for example,
Medicare Advantage plans and a
Medicaid pilot, according to Capistrant and Louder. Congress is currently considering legislation that
would expand Medicare coverage for
telehealth, Capistrant noted, and the
changes could go into effect as early
as 2017.
Organizations such as the Veterans Health Administration and Kaiser
Permanente, which act as both providers and payers, have been quicker
to embrace telemedicine, Capistrant
noted. Additionally, <30 states require private insurers to cover telemedicine as they would in-person
visits, he noted.
“Providers are adopting telemedicine more,” Capistrant said. “Consumers are demanding it more.”
The types of telemedicine
services covered also vary from
state to state, Louder noted. For
example, live video visits may be
covered, whereas phone calls are
not. Reimbursement rates also may
be lower for telehealth visits, Louder
said.
Although coverage remains a
concern, the technology is rapidly
improving as vendors work to develop tools that seamlessly communicate with electronic health records,
Louder noted. Many resources are
available to help clinicians and facilities new to telemedicine get
started. The National Telehealth
Resource Center can help clinicians find their regional organization, which can provide tool kits
or can connect more experienced
telehealth users in their specialty,
Louder said.
“Please don’t re-create the wheel,
there are protocols out there,” Louder said.
Banchs encouraged clinicians to
make use of such resources, as well
as resources and guidelines available
from cardiology societies.
Circulation. 2016;134:1189–1191. DOI: 10.1161/CIRCULATIONAHA.116.025282
Cardiology News
“There is no way around it, we need
to embrace it,” Banchs said. “Patients
and payers are demanding this kind of
technology. The sooner you [put protocols in place] the better prepared you
will be to embrace it.” n
© 2016 American Heart Association, Inc.
Telemedicine Resources
The National Telehealth Resource Centers (http://www.telehealth
resourcecenter.org/) provides monthly telehealth webinars and information
on regional centers.
The Northeast Telehealth Resource Center’s Telehealth Resource Library (http://
netrc.org/resource-library/), which contains peer-reviewed articles and other
resources.
The Center for Connected Health Policy (http://www.cchpca.org/), a telehealth
policy resource center.
The National Telehealth Technology Assessment Resource Center (http://
www.telehealthtechnology.org/), which evaluates telehealth tools.
American Telemedicine Association (www.americantelemed.org)
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THE PULSE
Circulation. 2016;134:1189–1191. DOI: 10.1161/CIRCULATIONAHA.116.025282
October 18, 2016
1191
Telemedicine Helps Cardiologists Extend Their Reach
Bridget M. Kuehn
Circulation. 2016;134:1189-1191
doi: 10.1161/CIRCULATIONAHA.116.025282
Downloaded from http://circ.ahajournals.org/ by guest on July 12, 2017
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