Health Care Field Optimistic About Innovation in Telehealth Landscape With Testing of eConsult Model

By Sarah Sonies

Despite concerns about possible challenges, telemedicine and other distance technologies such as e-consults, are developing rapidly, with many academic medical centers (AMCs) testing new models to improve patient care.

According to Michael R. Marquardt, MBA, MPH, director in the Office of the Chief Medical Officer at the University of Virginia Health System, AMCs are uniquely positioned to provide telemedicine care because of their triple mission: patient care, medical education, and research.

“Our capability for scientific innovation provides great opportunity for new innovative delivery solutions,” said Marquardt. “Gaps occur when patients are not able to access the appropriate amount or level of care. Providing them with more access points gives them opportunities to seek care when medically needed.”

Marquardt is working with his institution, as well as four other AMCs and the Association of American Medical Colleges (AAMC), on an initiative to improve care coordination between primary care and specialty physicians using remote health care technology. The AAMC, as a preliminary recipient of a Health Care Innovation Award from the Center for Medicare and Medicaid Innovation (CMMI), will support each institution as it tests the scalability of an e-consult/e-referral model for implementation. The e-consult model, developed by physicians at UCSF, is an EMR-based electronic consultation and referral platform for access to specialty input to address gaps in communication and coordination between primary care providers and their subspecialty colleagues.

“In order to deliver better care and improve accessibility, we need to be thoughtful about how we can provide delivery mechanisms that are a viable fit for people, “said Patrick Brophy, MD, pediatric nephrologist, founder of the eHealth and eNovation Center at University of Iowa Health Care (UI Health); and current assistant vice president for e-health and innovation at UI Health. “In rural systems in particular, telehealth becomes a fundamental component of delivering effective care, keeping people in their own space, and improving value. Our collaborative network is really another leg of care accessibility.”

Brophy and colleagues at the University of Iowa will be participants in the AAMC-led effort to implement e-Consults. Other AMCs in the collaborative include University of Wisconsin, Dartmouth-Hitchcock Medical Center, and the University of California-San Diego.

“For telehealth to truly become tangible, it will take disruption in medical education and practice,” said Wen Dombrowski, MD, MBA, chief medical information officer and vice president of Connected Health, VNA Health Group, said at a recent briefing. “Eliminating some of these barriers starts with more time given for training care givers in telehealth.”

Dombrowski and others say one goal is to deliver care that’s aligned with how individuals communicate in the age of technology.

“It is about translating how we use technology in our daily lives to health care,” said Dombrowski. “We must continue to get creative with technology on the academic as well as the technology side.”

According to Brophy, as hospitals continue to explore how to redefine what constitutes a face-to-face visit, payers and clinicians should be mindful of such issues as issues such as reimbursement and licensure.

“The technology basis for our ability to communicate has far exceeded the capacity of our regulatory and our legal landscape to change. That is a general rule. Technology advances very quickly and it is difficult sometimes to keep up with that pace of change,” said Brophy.

Legislation could make the process of telehealth integration easier and more affordable. CMS announced earlier this month that it had expanded the list of reimbursement-eligible health care items to include remote medical services, testing, and, non-face-to-face chronic care services. Additionally, the TELE-MED Act of 2013 would allow Medicare providers to provide telemedicine services to beneficiaries in other states.

“There is a significant push currently to look at the regulatory environment and hopefully deregulate some of the hindering components of digital health across the country,” said Brophy. “If payers realize that if you can keep patients out of the hospital, costs for care go down, and that is a really important piece of improving health for America.”

ssonies1Sarah Sonies is associate editor of Wing of Zock. She can be reached at or on Twitter @ssonies.