Home Telehealth - Whitepaper

The State of the Market 

The concept of home telehealth has been around for a bit more than twenty years, the concept is nothing new to many veterans of the cause. Home telehealth is greatly expanding to include far more patients than ever before, with expanding disease states and wellness care needs.  Home Telehealth has grown from simple remote vital signs monitoring to include an increasingly expanding set of peripherals and aging in place tools. The organizations using home telehealth are also rapidly changing. Today home telehealth is shifting from the traditional model of being used more by home health companies to being used by hospitals, healthcare organizations, and payors to meet healthcare regulation addressing post-acute care discharges, post-surgical care discharges and wound care management to name a few. Home telehealth use is also being driven by an increasingly aging population requiring innovation to age in place and a society of patients that are changing focus from acute care to wellness care. In short, home telehealth consumers are demanding and receiving a more holistic care model. Gaps in care have been identified and home telehealth is one of the many solutions to narrowing these gaps. Programs are increasingly able to start home telehealth programs not only for the projected revenue and cost savings, but also for the cost avoidances that it can offer.

The state of the home telehealth hardware and software market is also recently in great flux. There are many upgrades that are being made to products by vendors that have been in the market long term and many new vendors that are being introduced to the market. Small technology companies are being absorbed by larger well established companies, large well-known companies are expanding their services to include home telehealth, and some well-known companies are being edged out of the competition. The traditional model of home telehealth is being challenged as consumer demand is calling for an increase in mhealth applications and tools that will allow them to age in place. Devices are changing to accommodate use at the point of need as opposed to at a fixed location. Devices are evolving to meet the expanding broadband capability of the consumer market, as well as the mobility of today’s society. Devices are evolving to meet the expectations of the consumers and users for a rich engaging experience as opposed to a standard text based, minimally engaging experience. While much innovation is occurring, there are also many home telehealth programs that are on only in the beginning phases. These newer programs just continue to increase public awareness of the technological possibilities that home telehealth has to offer. Public policy and funding has to continue to evolve to continue to increase access to care for more citizens through subsidizing telecommunications options and covering care delivered by mobile devices and via telehealth. Clinicians are still required to hold licensure in all the states that they practice telehealth in, which is of particular consequence to call center employees.

As video is increasingly becoming part of the home telehealth repertoire, new questions are arising with this care model. The lines are being blurred between what was once a home telehealth service to simply the practice of telehealth in a patient’s home. Payment models will have to evolve as the care delivery model changes. As home telehealth blurs into mhealth, mobile video consultations will bring a whole new set of challenges and changes to the care delivery model.

As home telehealth evolves into a more holistic experience, manufactures will have to change to evolve with the needs of the consumers. Some consumers will increasingly expect to have access to their data, as well as their family members. As adult children support their parents aging in place, there will be increasing need to include the extended family in home telehealth. Enhanced home telehealth hardware and software features such as calendars, community video connections, instant messaging, email, brain games, family connection options etc… will expand the places where home telehealth devices are used. Vendors have begun to realize that home telehealth should simply utilize tools that patients already use to care for themselves in their home, and add in ways to enhance their ability to care for themselves. If they aim to take equipment and tests that were once traditionally only performed by clinicians in medical facilities and make them available in the home to consumers, they will continue to hit the development mark. Aging in place and wellness care tools may make some organizations providing home telehealth nervous that they do not appear to be providing clinical care, but this may also be related to the fact that the medical model in the United States has not recently traditionally included wellness care. Wellness care may not be a reimbursable service, but it is a value added service of home telehealth. It speaks to cost avoidance; keeping a mentally and physically healthier population will decrease the incidence of chronic illness sequelae and increasingly keep patients out of the acute care system.  

Some experts forecast that home telehealth will completely move away from the traditional model of base stations with peripherals. There is already one vendor on the market that has taken the traditional model of messaging on the base station and moved it to peripheral devices. With expanded functionality, more and more devices have the capability to be used at the point of care and can have the added capabilities that a base station has traditionally offered. With the cost of producing peripherals decreasing and the cost of manufacturing consumer electronics decreasing, more patients should be able to have access to home telehealth devices. There is also now a trend towards using patient symptomology, advanced vital signs and advanced physical data collection to better manage physical changes related to a patient’s conditions earlier. With current technological advances to ways that care can be delivered at home, new devices are being introduced that can indicate changes in patient condition much earlier than traditional vital signs. Many vendors are moving towards a model of being device agnostic, meaning their platform can run on many computing devices based on the preferences of patients and clinicians.

Another important trend in home telehealth is the movement towards standards based hardware and software development. National organizations for health IT are increasingly pushing for standardization in every level in home telehealth. Standardization will increase interoperability and allow for advanced communications. Equipment interoperability with allow for increased market competition and drive vendors to continue to manufacture superb equipment. There is still room for standardization in home telehealth software development. With a national movement towards health information data exchange vendors would be wise to migrate towards software development standardization. Standardization in software development will also make it easier for home telehealth software to interface with electronic health records.  

Home telehealth programs continue to only be as good as the program has been designed to be. Robust programs are centered around expert case management principals, utilize good clinical decision making, and focus on disease management with wellness enhancement. These programs need to continue to collect data and help make a solid case for home telehealth service expansion in the future. Robust programs know that home telehealth is a way of delivering care and utilize the tool to its fullest capacity. Making sure that all patients that are eligible for home telehealth are enrolled in the service is half the battle. For programs starting out today, there is so much to be learned through information sharing by experts in the field. It is wise to learn from previous mistakes and not try to reinvent a new model when there are elements of highly successful programs everywhere you look.

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