ATA Takes Aim at Big Target: 'Telehealth Interoperability'

Telehealth organization provides leadership for the cause, putting health systems and payers in the 'driver's seat' to help remove barriers to safe, affordable, and effective care when and where patients need it.

Just as HIMSS became the industry association to take on interoperability of electronic health data, ATA aims to take a leading role in the push for "telehealth interoperability."

The national telehealth organization put its stake in the ground Monday morning during ATA19 in New Orleans, hoping to achieve seamless communication between all providers and systems involved in a patient's care, even when the patient and provider are in different locations and not necessarily interacting in real time.

The ATA announced the organization's desire to tackle this challenge along with the release of a white paper, Telehealth Interoperability: Driving Choice, Continuity, and Scale, which outlines the issues involved, as well as ideas to forge a path forward. ATA seeks input from those impacted by telehealth interoperability, but says that health systems and payers—versus vendors—will be the driving forces with the greatest clout.

"A critical message we’ve heard … is that the buyers of telehealth solutions, including health systems and payers, are in the driver’s seat," says ATA CEO Ann Mond Johnson. "As they implement strategic, long-term telehealth solutions rather than the siloed systems we’ve seen in the past, they’re in the position to require that vendors incorporate interoperable standards across the solutions they’re offering the market."

ATA's involvement in this issue unfolded in January with a webinar on the topic, along with a later virtual "salon" for members.

Telehealth interoperability encompasses a range of factors, but to work optimally will require technology standards that will enable clinicians to initiate workflows from within their own familiar electronic health record (EHR), rather than managing multiple logins and navigating EHRs at remote locations. As a result the patient record would be automatically updated with summarized results of consultations and captured in the integrated platform.

"For telehealth applications and systems, the availability of APIs (application program interface) is a move in the right direction," the report says, "but most of these frameworks require the developer to share revenue with the EHR vendor, and their APIs today remain limited."

Besides the need for technology standards, telehealth interoperability encompasses a broad range of issues. "While standards are clearly important," the report says, " the industry must look beyond technology for success." According to the ATA report, some of the additional challenges that telehealth interoperability must address:

• Lack of standards across payer systems, including claims, utilization management, benefit design, registration, and employee assistance programs. "Without interoperability at the payer level to support reimbursement and incentives," the report says, "the opportunity costs for telehealth can be prohibitively high, which may slow adoption and potential improvements to quality, cost, and access to care."
   
• The need to incorporate communication platforms across secure paging, texting, IM (instant messaging), chats, video, phone/VoIP (voice over internet protocol), faxing/e-faxing, and scanning.
   
• Health system leadership and governance to move telehealth from siloed programs into enterprise systems to optimize investment, workflows, and patient care.
   
• Favorable federal and state regulatory environments, advocacy to address interstate licensure, and improved financial incentives by government and private payers to advance adoption.

"The time is now to ensure telehealth interoperability between disparate telehealth systems, with existing healthcare IT and payer systems and with the exploding number of remote health and medical devices for monitoring, diagnostics, and communications," the report says.

Richard Bakalar, MD, vice president and chief strategy officer at ViTel Net, a McLean, Virginia-based telehealth company, provided input into the ATA's white paper. He explains that telehealth is the third wave of interoperability to be addressed by the healthcare industry.

• The first wave addressed PACS systems (picture archiving and communications systems), which involved digitizing medical images into a format that could be shared between clinicians.  
   
• The second, which is still in progress, involves sharing electronic health records between disparate facilities.
   
• Telehealth requires a third phase of interoperability. It adds another layer of complication with the need to share images and medical records when the patient and the provider may be in different locations and operating out of different EHRs, and the encounter does not necessarily occur in real time.

Deanna Larson, CEO of Avera eCARE in Sioux Falls, South Dakota, illustrates the problem. The virtual hospital, with a dedicated staff of 300, provides services to more than 400 facilities in 20 states. At the end of each visit, the provider sends a summary document in a PDF file format to attach to the patient's medical record at the facility where the patient is located. That information, however, does not feed into the EHR's normal display. One way around this problem is to have physicians log into the EHR where each patient is located, but that requires multiple individual logins and the knowledge to navigate dozens of systems, which all have different displays and functionality.

Being able to seamlessly integrate into the EHR is essential to realize the potential of telehealth, says Mike Baird, president of customer solutions for American Well, a Boston-based telehealth platform company. Baird also provided input into ATA's white paper.

"Health systems have made significant investments in their EMR (electronic medical record)," he says. "This is, in effect, is the operating system for the hospital, so understandably, hospitals want to get the most return on that investment." With new areas of innovation like telehealth, specific features, functionality, and advantages are required to capture data and share it seamlessly across all resources involved in a patient's healthcare. "There can't be walls between that data or a need to do frustrating, time-consuming data exchanges," says Baird. "It should be seamless."

The ATA will attempt to move the industry in that direction.

"The ATA’s mission is to make sure that all Americans have access to safe, affordable, and effective care when and where they need it, and that healthcare providers can do more good for more people," says Mond Johnson. "Interoperability—between disparate telehealth solutions, as well as with frontline health IT systems and payers’ backend systems—is critical to accomplishing that mission."

Editor's Note: Keep your eyes on HealthLeaders' Innovation page in the coming weeks for more articles about the topic of telehealth interoperability. Additional coverage from ATA includes: ATA CEO Targets Innovation to Move Telehealth Forward and Physician Telehealth Usage Wallops Early EHR Adoption Rates.