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Chasing the ROI of Telemedicine

   November 01, 2016

All Kaiser regions went live with video visits by the end of 2015, and although Stevens cannot say how many encounters now occur this way, the number is on the rise.

"We also are working on a whole national marketing program so that we can educate our members on the option and what it means and what it's like, and what they can expect from it," Stevens says.

As it expands the range and nature of conditions for which a video visit is appropriate, Kaiser is noting the efforts of a growing number of independent telehealth providers, such as American Well, Teladoc, and Doctor on Demand, Stevens says. "These companies are often limited in the conditions that they can treat, and they often have little background on the patient, unlike our virtual care physicians who have access to their patients' complete electronic medical records," she says. "As the number of video visits at Kaiser Permanente continues to increase, we'll be able to look at a variety of use cases and determine where virtual care adds the most clinical value or personal value for our members."

But like other providers, Kaiser is pursuing hard numbers to justify its investment in telemedicine.

One study published recently in Kaiser's peer-reviewed Permanente Journal quantified how neurologists performing telestroke medicine via Kaiser's infrastructure increased their use of life-saving clot-dissolving medication in patients with ischemic stroke by 73%. The study was a retrospective analysis of all ischemic stroke presentations to 11 emergency departments between 2009 and 2013 in the Kaiser Permanente Southern California region.

By using telestroke, physicians in outlying Kaiser facilities lacking in-house neurology and neurological ICUs are able to contact a neurologist at a remote location, reducing the number of minutes needed to determine whether the patient should receive tissue plasminogen activator (tPA), the FDA-approved treatment for acute ischemic stroke.

"The part I think is unique to Kaiser compared to other versions is the telestroke physicians are able to see the lab values and CT images" during the telestroke session, says Adam L. Sharp, MD, lead author of the study and a research scientist and emergency physician with Kaiser Permanente Southern California's department of research and evaluation in Pasadena. "They're even able to write the order for tPA, and that's unique to our kind of integrated health system." In other institutions, attending physicians on the patient's side of the telestroke session often must write those orders, he notes.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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