The Tipping Point for Telehealth Initiative: Will it continue after Covid-19

Transforming Safety-Net Patients' Access to Care, During and Beyond the COVID-19 Pandemic

In some ways, access to healthcare improved in the current Covid-19 pandemic.  The pandemic continues to burn in a way through society first in urban areas and now in rural or less populated areas. It now appears that the novel Corona Virus will be with us in the United States during the foreseeable future.

Fortunately, telehealth systems were already in place although very underutilized due to regulatory and user resistance. The concern and likely overload of the primary care system caused an immediate reflexive response to reduce clinic overload and also allow for distancing in the clinic setting. Clinic routines were changed to eliminate waiting inside an office. These changes included online appointment booking, messaging systems that allow patients to wait outside to be called into their appointment. Sanitation measures and personal protective equipment also became a routine process.

These capabilities include phone and video visits, eConsults, text messaging, and more.

Much of this has been possible because the federal government and California, in response to the pandemic, took unprecedented action to loosen restrictions and expand coverage and payment for telehealth services. It is unclear, however, how long these changes will last. Despite enormous progress, much more must be done to ensure that the benefits of telehealth reach populations with low incomes throughout California and to ensure lasting improvements in access to care.

In May 2020, The California Health Care Foundation (CHCF) approved over $6 million to help California reach a tipping point for telehealth in the safety net. This marks CHCF’s single largest investment in close to 15 years of work focused on telehealth.

This page provides an overview of CHCF’s Tipping Point for the Telehealth Initiative and its key partners. Updates on partners, progress, and lessons learned, as well as other resources, will be added over time.

There are organizations operating to enhance continuing growth and also permanency to telehealth far after the pandemic ends.

Connected Care Accelerator

Center for Connected Health Policy.  Informational Webinar

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The Tipping Point for Telehealth Initiative - California Health Care Foundation

Future Of Telehealth

2020 witnessed amazing explosive growth in telehealth.  Although an infrastructure for telehealth developed in the prior five years by visionary entrepreneurs there was slow to non-existent adoption by providers, hospitals, and allied health providers.  Much of the reticence was due to poor reimbursement by health plans.  

During January 2020 to current times telehealth became an established and at times preferred method for outpatient visits.  This was due to an existing crisis fueled by a viral epidemic (pandemic) by a novel coronavirus (COVID-19). Social and physical distancing was mandated by public health officials globally.  This served to radically alter the health care setting. Physician office visits plummeted, even for the normal population. Elective surgical procedures were canceled and postponed. 

How COVID-19 is affecting internet performance

According to Fastly, to understand how the internet is performing with the changes in internet use brought on by the COVID-19 pandemic, we investigated two key metrics during February and March in some of the countries and states that were hit hardest by the virus: changes in the traffic volume served to those regions as a reflection of changes in internet use, and changes in download speed measured at our servers as a reflection of internet quality. In almost all regions, the largest increases in traffic volume occurred immediately after public policy announcements, such as school closures or stay-at-home orders. Similarly, the most dramatic decreases in download speed followed the official starts of those policies — presumably when populations made the shift to staying home.

Table 1 reveals the sharp uptick in internet traffic by country and state and the effect on broadband speed.  The findings reveal metropolitan areas suffered the least, most likely due to penetration and redundancy of the internet in cities.  Italy suffered the most increase in usage and the decrease in broadband speed. In the U.S.A. rural states such as Michigan saw a marked decrease in internet speed. Michigan is a rural state and the penetration and less redundancy in infrastructure caused network speeds to decrease by almost 40%.

Definition of High-speed internet

Perhaps the best modern measurement of whether an Internet connection is “high speed” is in what services are supported at that speed. Virtually any broadband, or non-dialup, connection can support a home user’s standard browsing habits. Streaming of standard-definition video, with a pixel width of 480, requires a minimum 1Mbps connection. Low-end high-definition video, with a pixel width of 720, requires at least 2.5Mbps. Streaming high-definition 1080p video needs at least a 9Mbps pipeline to avoid buffering delays. And these numbers only take into account a single device — if five users in your office network simultaneously stream separate 1080p videos, your 10Mbps will not seem “high speed.”   

If one lives in a rural area there may be severe limitations on live streaming used by telehealth.

Webinar: What is the future for telehealth?  REGISTER

There are some indications that some payor and Medicare are planning to re-institute restrictions on telehealth reimbursement once the acute pandemic ends.  However, that is a big contingency since the ongoing pandemic is still evolving.




Future Of Telehealth

The COVID 19 pandemic has magnified cyber attacks on healthcare institutions.

COVID-19 has evidently magnified the ransomware threat in the healthcare sector to manifolds. In fact, the Google threat analytics group has also recently reported that healthcare organizations, public healthcare agencies, and the individuals who work there are becoming new targets for cybercriminals as a result of the pandemic.

Cyber attackers are becoming more notorious and are unabashedly targeting governments, healthcare bodies, and healthcare professionals alike. World Health Organization (WHO) has recently revealed a fivefold increase in the number of cyberattacks directed at its staff, since the start of the pandemic. In India, the Kerala government’s e-health portal faced a similar data theft attempt in the month of April.

This article originates in India, and. probably reflects a global impact as well. With patient data being so plentiful and abound across the globe, the threat of malicious activity has never been greater in the healthcare domain. As data volumes continue to grow tremendously, keeping everything under control has become almost impossible for many healthcare institutions, leaving them ill-equipped to recover critical information in a timely manner.

The Healthcare industry has always been a favorite among cybercriminals. Who doesn’t remember the infamous WannaCry ransomware and how it cost UK’s National Health Service (NHS) a massive £92million monetary losses due to downtime? With the global healthcare market standing at a whopping $11.9 Trillion, it is a very lucrative choice for cybercriminals to ignore.

Though it’s only been just a few months since the devastating COVID19 pandemic swept the globe, the virus has inadvertently fuelled the ever-present danger posed by cybercriminals and the increasingly sophisticated tools and methods they employ.

The healthcare sector has been hit particularly hard, where stories are emerging from actual patients and caregivers who had been directly impacted by the attack: fake contact tracing apps, postponed COVID-19 treatments, delayed medication administration, hindered medicine research and so much more.

Ransomware (Wannacry) presents an acute crisis that interrupts healthcare and endangers lives in the immediate present.

Wannacry is an old malicious worm from 2017 which attacks variants of Windows. If you have regularly updated your Windows software and/or have a current antiviral program running, then you are most likely safe.

The Ransomware generously tells the victim it has encrypted your computer, but you can pay the ransom using bitcoin to unlock your system. And they even offer you a guarantee.

Here is a video example:

What to do if you have been attacked with Wannacry?

Building on our experience of working with some of the biggest healthcare entities around the world, such as John Hopkins Medicine, Centre for Sight, and Prime Healthcare to name a few, we’ve developed a list of best practices that organizations should follow to protect and recover from ransomware attacks:

Develop a program that covers all of your data needs: You must identify where your critical data is stored, determine your workflows and systems used to handle data, assess data risks, apply security controls, and plan for evolving threats. If it is not protected, it cannot be recovered.

Use proven data protection technologies: You need solutions that detect and notify of potential attacks, leverage external CERT groups, identify and prevent infection, maintain a ‘GOLD’ image of systems and configurations, maintain a comprehensive backup strategy and provide a means to monitor effectiveness.

Employ Backup and Data Recovery (DR) processes: Don’t rely solely on snapshots or replica backup. Your backup process data could just as easily be encrypted and corrupted if it is not stored in a secure way where a ransomware attack cannot get to it. If your processor vendors don’t offer ransomware protection that addresses the proper way to store your data, then your backup plan is a major risk!

Adhere to a unified clinical data archiving: The majority of hospital data comprises of medical imaging that is spread across disparate, legacy PACS applications. By having a unified archiving platform, such as Commvault Clinical Archive in place, healthcare systems can easily search and restore medical imaging data directly from medical imaging software. In fact, Commvault is one of the only few players which ensures that even if the primary system data is infected with ransomware, the archives remain completely secure and readily accessible.

Educate employees on the dangers of ransomware and how to secure endpoints: Train your staff on all DR and data security best practices to get endpoint data protected within your Information Security Program. Most breaches are from good people making simple mistakes.

Have a business continuity plan: One of the reasons healthcare systems pay a ransom is the urgent need to get up and running to care for patients. By having a detailed plan for exactly how to handle an attack, as well as how to restore data from a backup, healthcare systems can feel confident in their ability to quickly recover from an attack.

Regardless of whether the ransom is paid or not, ransomware attacks are costly to healthcare systems in terms of data loss, system downtime, and time spent in recovering data. In addition, there is the potential cost of losing the patient’s trust after the news of an attack becomes public.

Evaluating the current ransomware threat readiness and applying these key steps will ensure that healthcare institutions are in the best position possible– not having to pay the ransom in the first place.

How to Prevent Being Attacked and Recover After an Attack

Key steps to protect healthcare data - Express Healthcare

Using the Internet of Things To Fight Virus Outbreaks |

What is IoT?

IoT has opened up various opportunities in the healthcare industry. The industrial IoT is all about huge data on a large scale. This will go beyond the manufacturing as well as energy and contains implementation with such huge data and various critical applications. And one of the industries which are at the frontline of industrial IoT is medical and healthcare.

A data stream network is generally a huge publish/subscribe network that transmits raw data bi-directionally between devices, users, and servers. Combined with the Internet of Things, a data stream network is the communication layer that adds more functionality to the IoT and its millions of connected devices.

The Internet of Things, or IoT, is a scalable and automated solution that has seen explosive growth in other industries such as automated manufacturing, wearable consumer electronics, and asset management.

IoT consists of several functional components: data collection, transfer, analytics, and storage. Data is collected by sensors installed on mobile, end-user hardware like phones, robots, or health monitors. Then, the mobile data is sent to the central cloud server for analytics and decision-making, such as if a machine requires proactive maintenance to prevent unexpected breakdown or if a patient needs to come in for a check-up.

Real-Time Technology in the Medical IoT

We may have seen the internet-connected MRI, heart rate monitor, or other medical equipment in the hospital, but how are such technologies affecting those who work near these devices and their beneficiaries?

Let’s have a look at how IoT mobile real-time communication is affecting the lives of medical authorities as well as health care recipients. In this article, we have also outlined about healthcare IoT communication security and how and why a data stream network requires securing that data.

Data Delivery and Synchronization

Medical IoT has improved the quality of patient care via more authentic and effective communications among caretakers. With the help of mobile applications and secure networks, nurses are capable to immediately approach patient information, and new updates are synced in real-time across all other attached mediums. Readings and gathered information from sensors are stored or produced in real-time with their synched current status.

This is important for crucial situations where both time, as well as the accuracy of data, is at the topmost level. With mobile alert notifications medical authorities are capable to attain a new level of potency and communication efficiency, keeping the team attached, informed, and more focused towards patients. Minimize response means healthy, happier patients, and enhanced standards for responding to patients.

Real-Time Location and Presence

With emergency response units, the tracing of geolocation and effective execution of response teams could lead to a question of life or death. Physicians are frequently required to move between patients’ rooms, clinics, laboratories, operating rooms, and offices. Combining the existing legacy with real-time mapping and geolocation, mobility can be easily tracked and implemented.

Based on this, physicians can also approach to patient data and patient’s care teams at any place and anytime via real-time messaging. Real-time location technology prevents valuable time by assuring that the accurate resources are accessible at the exact location, automates tasks depends on location, and increases the discharge process as well as yield. 

It supports healthcare leaders to recognize congestion in patient care delivery and improve resource utilization and patient satisfaction. And with technology advances, the benefits also continue to evolve. For mobility and readiness, and short-term cost savings RF is the technology that might be your first choice.

Administration

When it comes to medical administration, standard, value, and efficiency are of the topmost priority. In the past, many hospital administrators faced the challenge of selection between a digital and an analog solution for clinical productivity. However, with IoT technology become more accessible and affordable, many administrators have already taken the cross over.

Speedy message delivery and automatic audit trails terminate the requirement for pagers and another wireless alternative which can frequently be substantially outdated. With real-time access to patients, data staff can expend more time caring for patients while minimizing the risk of miscommunication or data delays which are expensive occurrences in a hospital.

With the help of patient-specific and big data information, hospitals can more effectively schedule patients by accumulating and using statistics in a cloud-based scheduling application. The outcome of this is a faster turnover and more pleased patients.

Technicians

Cloud-based data usage is also proving to be helpful for medical device technicians. With the help of internet-connected devices, technicians not only come to know about exactly where the problem is, but also they can be informed instantly, potentially minimizing device downtime. In addition to that, the device integrated with the hospital’s patient scheduling system, can divert patients to a location with an access device or reschedule patients.

Safety and Confidentiality

In Medical IoT patient and medical data, confidentiality and security is the most important thing. When data is transmitting and syncing between connected devices, it must be encrypted from endpoint to endpoint. Authentication (two-factor preferably) is another factor that should be constructed into IoT applications.

Lastly, administrative security requirements and global regulations, specifically HIPAA for healthcare, are continuously emerging and need to be addressed and upgraded. By looking at securing the healthcare Internet of Things from a global regulations point of view, design patterns require to be executed to comply.

For instance, data routing needs to avoid certain areas. Utilizing a Data Stream Network, streams of data can be customized to be routed via certain regions, countries, etc. But this doesn’t just implement to the transmitting of data, but also the storage of data. All these observations need to be considering when it comes to the healthcare IoT.

In this way innovation in health surveillance technology has reshaped the speed in which we respond to a global catastrophe with the help of real-time technology.

The current applications of IoT during COVID-19

Currently, IoT is already used to manage some aspects of the COVID-19. For example, drones are already used for public surveillance to ensure quarantine and the wearing of masks. AI has also been used to predict future outbreak areas.

Using IoT to dissect an outbreak

With the numerous and diverse datasets collected by mobile devices, IoT can have many more applications during an epidemic.

IoT can be used to trace the origin of an outbreak. A recent study by researchers at MIT used aggregated mobile phone data to trace, in granular details of short distances and periods, the spread of dengue virus in Singapore during 2013 and 2014. Therefore, overlaying geographic information system (GIS) on IoT mobile data from infected patients can do two things. Upstream, it can assist epidemiologists in their search for patient zero; downstream, it can help identify all the persons who have come into contact with the infected patients and may, therefore, also be infected.


Using IoT to ensure compliance to quarantine

IoT can also be used to ensure patient compliance once the potentially infected persons enter into quarantine. Public health personnel can monitor which patients remain quarantined, and which patients have breached the quarantine. The IoT data will also help them track down who else may be exposed due to the breach.


Using IoT to manage patient care

Interactive Map from Johns Hopkins Science and Engineering  In real time 

The scalability of IoT also comes in handy for monitoring all the patients who are high-risk enough to warrant quarantine but not serious enough to warrant in-hospital care. Right now, the daily check-up of the patients is done manually by healthcare workers who go door-to-door. In one reported instance, a healthcare worker had patients standing in their apartment balconies, so that he could fly a drone up to take their temperatures with an infrared thermometer. With IoT, the patients can have their temperatures taken and upload the data with their mobile devices to the cloud for analysis. This way, healthcare workers can not only collect more data using less time but also reduce the chance for cross-infection with the patients.


In addition, IoT can provide relief to the overworked staff at the hospital. IoT has already been used in the remote monitoring of in-home patients with chronic conditions such as hypertension or diabetes. In hospitals, telemetry, the transmission of biometric measurements like heartbeat and blood pressure from wearable, wireless instruments on patients to the central monitoring has been used to monitor a large number of patients with minimal staff. Here, IoT can be used to reduce the workload and increase the efficiency of the medical staff, all the while reducing the exposure of healthcare workers to infection.

Conclusion

The underlying technology and the IoT components that can be leveraged to enable a healthcare system to deal with disease outbreaks already exist; however, they are fragmented and not yet connected. Therefore, the system needs to be able to build up its infrastructure quickly to connect the components of data collection, processing, and storage, so that the system can scale and expand for disease tracking, preventive quarantine, and the in-patient care of the infected.











Using the Internet of Things To Fight Virus Outbreaks | Technology Networks