Creating large scale telehealth network : A story from the USA by Adam Darkins, Vice President, Medical Affairs & Enterprise Technology Development, Medtronics, USA

1. 1
Creating Large Scale Telehealth Networks : A Perspective
from the USA
Adam Darkins MBChB, MPHM, MD, FRCS
Vice President of Innovation and Strategic Partnerships, Medtronic Plc

2. 2
Historical Perspective
Telemedicine
• DeBakey Houston
and Bird Boston
• eHealth
• mHealth
• Connected Care
• ?Next
Internet
• ARPA
• CSNET
• Public Internet
• eCommerce
• Streaming media
• Social Media
• Internet of Things

3. 3
Darkins A. The Growth Of Telehealth Services in the Veterans Health
Administration between 1999 and 2014: A Study in the Diffusion of
Innovation. Telemedicine and eHealth Volume 20. 2015
• Serving a population of 6.6 million people, predominantly male.
• Primary reasons for programs addressing challenges with access, cost,
quality.
• Implemented in network of 152 hospitals and >600 other sites of care.
• Covered 44 clinical specialities, including Tele-ICU, often in “shortage
specialities”
• Three modalities home telehealth, store-and-forward and clinical
videoconferencing, including directly into the home
• Sustainable revenue predominantly from realizing efficiencies/cost
avoidance
• Two thousand-fold increase to 760,000 patients per year and 2.2 million
annual consultations (not including teleradiology).

4. 4
Building Telehealth Networks by Design, not Chance
• Its does not begin with the technology.
• Start with population health need and geographic distribution served.
• Networks are initially built on high volume low cost applications not
low volume high cost.
• Set out to solve challenges that affect patients.
• Need “multi-media” patient record.
• Money “follows patients”.
• Requires building and standardizing clinical, technology and business
underpinnings.
• Clinical, technology and business champions are important, but you
cannot scale if systems are based on “relationships”.
• If a serious proposition and going to succeed “its for life”.

5. 5
Operational Issues Building Telehealth Networks
• Clinical models of care with clinical pathways.
• Clear accountability for clinical, technology and business processes.
• Associated systems for governance.
• Training of staff – interdisciplinary teams (logical to train virtually)
• Quality management with metrics.
• Program accreditation.
• Privacy and Cybersecurity.
• Help desk support
• Risk management and continuity of operations plans.
• Coding of activity with workload capture.
• Measurement of clinical, technology and business related
outcomes.
• Ongoing development to avoid becoming ones own “legacy
system”

6. 6
Academic Considerations
• New ways of assembling evidence in a rapidly changing
environment.
• Clinical, technology, social science and policy considerations.
• Lack of evidence for legacy systems.
• Is the future about incremental change in status quo or
transformation?
• Need clear vision for the future not nostalgia for the past.

7. 7
The Future: Value-Based Care
CMS - Medicare Advantage Value-Based Insurance Design
• Aside from lower cost-sharing, plans in the demo can offer
supplemental benefits, such as telehealth or nonemergency
transportation to doctor visits.
Omar Ishrak, CEO Metronic, in sponsoring a collaboration between
Harvard Business Review and the New England Journal of Medicine on
Discussing Value-Based Care:
“Today in our service-based systems, we pay for each step in patient
care regardless of outcome; however, it’s becoming increasingly clear
that we must collaborate to shift this to a model that focuses on and
rewards patient outcomes”.