Nadia de la Houssaye is a partner in the Jones Walker law firm's Business & Commercial Litigation Practice Group and a member of the Healthcare team. Her practice has a specific concentration in telemedicine and e-health. Her interest in telemedicine began in 1989, while studying the technical and legal aspects of telemedicine's future at Boston University, where she obtained her Masters in Communications Law. She is active in a number of healthcare organizations, including the American Hospital Association, the American Telemedicine Association and the Louisiana Hospital Association.
In 1997, she represented one of the first teleradiology companies in the state of Louisiana and acted as the company's general counsel until 2004, when the company merged with NightHawk Radiology Services, the largest teleradiology company in the United States. She continues to advise numerous physicians, hospitals and telemedicine groups on legal issues involving risk management, corporate compliance, multi-state litigation and choice-of-law issues.
Q. What’s the one promise of mHealth that will drive the most adoption over the coming year?
A. mHealth adoption will soar in the coming year. The Affordable Care Act’s penalization of uncoordinated, volume-based delivery of health services that results in high hospital re-admission rates, coupled with the ACA’s incentives for integrated, patient-centric, value-based healthcare delivery models, mandates the adoption/integration of mHealth into the healthcare provider’s delivery model, particularly in the area of chronic disease management. The capacity of new technologies to remotely monitor chronic health problems in an effective, secure and real-time manner is an essential component to value-based reimbursement. The goal is to remotely control the advancement of chronic illnesses – to keep the patient well and at home, rather than sick and in the hospital. Because remote monitoring of chronic medical conditions unequivocally reduces hospital readmissions and hospital-acquired conditions, the telemedicine delivery model avoids the penalties imposed by the ACA.
Q. What mHealth technology will become ubiquitous in the next 5 years? Why?
A. For mHealth technology to survive, the technology must have an integrated system that transfers device data from the remote setting into the patient’s electronic medical records. Patients, physicians and other healthcare providers need access to comprehensive, meaningful information to effectively manage healthcare. Connectivity is critical, and silo systems that work well but do not integrate with other systems will become obsolete in the next five years, if not sooner.
Q. What’s the most cutting-edge application you’re seeing now? What other innovations might we see in the near future?
A. At the recent American Telemedicine Association conference, I saw a number of cutting-edge applications that I predict will have great success. My favorite is called WoundMatrix, a HIPPA-compliant, cloud-based telehealth solution utilizing patient or clinician smartphones to securely capture and instantly transfer wound images via a secure WoundMatrix App. The images are directly uploaded to the patient’s file for immediate assessment, measurement and data analytics that can be used to improve patient outcomes, provider efficiencies and therapeutic interventions and also reduce care costs. WoundMatrix is a bi-directional communication system that integrates the device data with the leading healthcare electronic medical record systems. The image quality, as well as the entire application, greatly impressed me.
Q. What mHealth tool or trend will likely die out or fail?
A. With over 100,000 healthcare apps and mHealth products on the market, a large percentage will fail due to device user confusion, poor marketing and performance and the inability to integrate device data into the consumers’ electronic medical records. For an mHealth tool to survive, it must be user-friendly, HIPPA-compliant, FDA-approved, compatible, integratable and connective.
Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?
A. In the early years of mHealth, great criticism existed within the medical profession based on the premise that the mHealth delivery model failed because the remote provider did not actually ‘lay hands’ on the patient. However, mHealth consumer studies offer evidence that the majority of mHealth users prefer this healthcare delivery model over traditional office exams. mHealth physicians find that patients are more willing to discuss “embarrassing” problems when seeking treatment via video vs. in person. Likewise, millennium kids who have grown up with smartphones choose the mHealth delivery model over in-office visits, particularly in the field of behavioral telemedicine. They feel more relaxed, open and honest about their feelings when they are not face-to-face with a psychiatrist, psychologist or social worker, and have more productive outcomes.
Q. What’s your biggest fear about mHealth? Why?
A. The current state of the law governing mHealth causes me the greatest fear and frustration. Competing state laws, coupled with conflicting regulatory issues between state laws and state medical boards, present one of the greatest barriers for interstate telemedicine implementation and adoption. All 50 states currently have different regulatory requirements, as well as 50 different licensing board requirements. Moreover, state law is evolving and changing daily. A telemedicine provider may be compliant today and non-compliant tomorrow, as occurred recently in Texas. As an attorney working with these healthcare companies, this is one of the most challenging areas facing the telemedicine industry today.
Q. Who’s going to push mHealth “to the next level” – consumers, providers or some other party?
A. All of the above. Healthcare is in a seismic state of transition. As mentioned, the ACA’s shift from “fee for service” to “fee for value,” and the competitive pressures to drive continued improvement in the quality/cost value curve, are pushing mHealth to the next level. Years of device tracking data indisputably establishes that telemedicine provides higher quality, more affordable healthcare options. The players in the push “to the next level” include private investors, consumers, healthcare providers, IT specialists and innovative thinkers. The private sector is investing significant funds and entering into collaborative partnerships to alleviate costs, accelerate program implementation and drive innovation. Consumers are investing significant funds to proactively manage their own health, as evidenced by rapid growth in the direct-to-consumer telemedicine market. Hospitals and healthcare providers recognize that the integration of telemedicine is the only way to comply with the ACA’s value-based reimbursement model. Entrepreneurs are embracing the quickly evolving mHealth market and are closely monitoring medical devices, recognizing that telemedicine is essential to the future of healthcare.
Q. What are you working on now?
A. I currently assist numerous healthcare entities with the structuring and integration of mHealth systems. Regulatory compliance is critical, whether at the state licensing level or navigating the legal issues in mHealth technology at the federal level (FDA, FCC, and the Office of National Coordinator for Health Information Technology). My practice ranges from consultations to actual integration of systems in a regulatory compliant manner.
Previous installments in our mHealth masters series:
Make it invisible and intuitive
Counting on consumers to fuel innovation
