New Policy for Using Telemedicine in Stroke, Cardiovascular Care

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Telestroke care has been shown to be as safe and effective as usual care.
Telestroke care has been shown to be as safe and effective as usual care.

The American Heart Association (AHA) recently published a policy statement in Circulation on the role of telehealth in advancing care in cardiovascular disease (CVD) and stroke, barriers to telehealth implementation, and strategies to overcome these barriers.

The combined cost of CVD and stroke exceeds $350 billion per year in the United States, and this figure is projected to increase to almost $1 trillion by 2030. Telehealth, which encompasses digital telecommunications and information technologies such as telemedicine and eHealth, may help address the problem of rising healthcare spending by improving quality of care while reducing costs. By providing clinical services remotely or off-site, telehealth may increase access to care for patients with CVD and stroke who have barriers to obtaining specialty care because of location or physical limitations.

The AHA Advocacy Coordinating Committee performed a literature review to evaluate the effectiveness of telehealth for improving quality of care, to determine the barriers to incorporating telehealth in CVD and stroke care, and to suggest strategies to address said barriers.

The committee found that rates of patient satisfaction are high with telehealth services, although clear clinical benefits have been demonstrated in only a few applications. For example, remote monitoring of patients with implantable cardiac devices resulted in timely diagnosis and management of arrhythmias and heart failure symptoms, leading to better clinical outcomes. Also, using telestroke to evaluate patients with acute ischemic stroke eligible for thrombolysis provided access to acute stroke care in underserved areas and has been shown to be as safe and effective as usual care.

However, several technological, financial, legal, and regulatory barriers inhibit the implementation of telehealth interventions. Accuracy of data transmission, patient privacy and confidentiality, and security of telehealth systems remain concerns for many telehealth modalities. The startup costs for establishing a telehealth system and maintaining its infrastructure may be prohibitive for providers with limited resources, which is compounded by the lack of reimbursement models under most major insurance carriers. Finally, providing telehealth services across state lines remains a challenge given the differences in state and local laws and the administrative burden of obtaining licensure in multiple states.

The committee recommended several strategies that may help overcome these barriers. Federal and state legislators have proposed measures to address data collection, expansion of patient access, standardization of care, and reimbursement under Medicare. However, the AHA will need to work with other organizations to establish reimbursement for telehealth services, integrate telehealth with electronic health systems, and increase telehealth adoption while controlling costs and delivering high-quality care.

The authors acknowledged concerns that overcoming barriers to telehealth implementation will lead to increased telehealth use and higher short-term costs. "More studies are needed to establish the clinical efficacy of new telehealth models of care and to address concerns that reimbursement for these activities will lead to overuse of healthcare resources," they wrote.

Reference

Schwamm LH, Chumbler N, Brown E, et al; on behalf of the American Heart Association Advocacy Coordinating Committee. Recommendations for the implementation of telehealth in cardiovascular and stroke care: a policy statement from the American Heart Association [published online December 20, 2016]. Circulation. doi: 10.1161/CIR.0000000000000475 

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