Table 4.

Clinic/Health System Considerations: Fact Sheet

Staffing issues

▪ Comprehensive and ongoing staff training is often required, including ongoing supervision, a careful delineation of staff roles and oversight.23,29,49 For example, who will respond to emergency alerts from downloaded CGM data.23

▪ To what extent will the demands of the program divert existing staff from other responsibilities to affect ongoing patient flow issues.2,23

▪ Will clinical contacts with users occur with existing staff or with staff external to the clinic (e.g., coaches).4

▪ Added staff burden can occur because of the need to review and respond to eHealth data through the eHealth system, record keeping, and the need to respond in real-time.27,33

eHealth data issues

▪ How are the data integrated into the EHR or other data systems, in a form easily accessible to and understandable by HCTs; most clinics lack an adequate internal technology infrastructure, making clinics dependent on external systems around which they often have little control, and ability to customize the program for their staff and patient population.2,23,74

▪ Can the data received from users be easily shared with multiple members of the care team in ways that make the data actionable.29

▪ Major concerns about data protections: confidentiality, data loss, and vulnerability to Internet hackers.4,46,49

▪ Data transfer from clinic to user and vice versa often raises issues of clinic legal liability.49

Systems and clinical cultural issues

▪ How will an eHealth system conform with clinic culture and mission.56

▪ How will an eHealth system mesh with HCT beliefs, comfort and clinical style.56,66

▪ Which important stakeholders need to be involved in the planning and execution of eHealth programs, for example, staff, payers, users, HCTs.23

▪ eHealth programs are often viewed and funded as time-limited and are rarely fully integrated into clinical care for ongoing use.27,61

▪ There is a strong need for ongoing oversight, governance, commitment of stakeholders (including HCTs), medical and other leadership, coupled with policy reform.61,74

▪ eHealth systems are not solutions in and of themselves—they are only tools that can be used to help reach clinical goals; because they are unique, they have to fit seamlessly into clinic culture and operation to be most effective.27

Costsa

▪ In general, eHealth programs demonstrate good cost-effectiveness when clinical targets are well-defined, sufficient time for data collection is available, and patient populations are well-specified.6,7,25

▪ Overall costs will increase when multiple vs. single user groups are targeted, although costs per user will decrease. This reflects the complexity of assessing eHealth system costs.56

▪ There are at least five different ways of considering eHealth costs, value and benefits, each yielding different results: cost-effectiveness analysis; cost-utility analyses, cost-consequences analyses, cost-minimization analyses; cost-benefit analyses; budget-impact analysis: full analyses are rarely done.7,25,35

▪ eHealth systems may reduce expenses for patients but not for clinics and vice versa.7

▪ In general, costs increase based on the type and number of eHealth system components, which outcome is selected and the length of time of the eHealth program.7,25

▪ Text messaging appears to be the least expensive modality, but it is one-way, not easily customizable and most impersonal.56

▪ It is hard to define a small set of eHealth goals around which costs and benefits can be easily calculated; for example, reducing care inefficiencies, time to diagnosis, complications, hospitalization, etc. can require long-term programs and relatively large investments and numbers of users.6

▪ It is difficult to get compensated for start-up, maintenance, licensing, and credentialing costs, especially when users live across state lines; eHealth programs may have to be modified to insure that they reach criteria for reimbursement.46,49,56

▪ Reimbursement varies depending on the type of staff utilized and the payment system utilized by the patient. Reimbursement also varies by the tasks involved, for example:

▪ Remote physiological monitoring

▪ Telehealth visits

▪ CGM

▪ Diabetes Education provision

▪ Level 1 E&M visits

▪ Medicare Chronic Care Management

▪ Medicare Principal Care Management

^aThe cost issues outlined above reflect a U.S. point of view only and may not be applicable to other countries where different systems of health care funding occurs.