What a year's worth of telehealth data from athenahealth can teach us

Photo: athenahealth

The COVID-19 pandemic has necessitated a new era in medicine in which telehealth appointments are a core aspect of the patient-provider relationship and provide broader access to healthcare.

So what has the healthcare industry learned about telehealth usage over the past year, and how can it use those learnings to deliver more accessible and high-quality healthcare for all?

Jessica Sweeney-Platt, vice president of research and editorial strategy at athenahealth, has telehealth insights learned from athenahealth's vast nationwide network data sourced from 18.4 million appointments held by 60,000 providers.

Healthcare IT News interviewed Sweeney-Platt on the subjects of telemedicine adoption, utilization, scheduling and permanence, seeking her expertise and lessons learned from athenahealth's treasure trove of telehealth data.

Q: In your experience, what was telehealth adoption like over the past 12 months? Where were you seeing most of the adoption, and in which specialties?

A: Despite the fact that telehealth has been around, in one form or another, since the 1950s, it was the almost total shutdown of the country in March and April of 2020 that truly established it as a mainstream access point. Not surprisingly, early adoption patterns followed the path of the most acute COVID-19 breakouts. We saw early spikes in the Northeast and the Western regions of the country, followed by the Midwest and the South.

States in the Northeast had the highest percentage (nearly 70% in April 2020) of virtual appointments initially but were overtaken by the West during the second wave of the pandemic in June and July 2020.

The Midwest has been consistently the second-lowest adopting region percentage-wise (a little over 40% in April 2020), and the South is consistently lowest in terms of percentages (roughly 30% in April 2020). The Northeast is also much more consistent than other regions, with high virtual rates throughout each state.

In all, we've seen telehealth go from less than 1% of total athenahealth network volumes to as high as 32%, before settling in at around 10-11%. The Northeast and the West lead the country for adoption and sustained volume of primary care telehealth appointments.

In terms of specialties, not surprisingly we've seen mental health and primary care use telehealth the most. Mental health has seen the largest percentage of appointments held virtually, with 33%, followed by primary care at 17%.

Q: You noticed that practices that have settled in at higher rates of utilization also tend to be practices that had some experience with telehealth pre-COVID-19. Please elaborate on what this tells you.

A: This tells us that the adoption of technologies like telehealth may be, in part, due to a trusted person that has already figured out how to make it work in that particular organization. These "IT champions" might help overcome some of the initial uncertainty that accompanies any new way of doing things – some of the basic infrastructure and knowledge may have already been in place.

This may be a helpful insight moving forward as physicians and medical groups look to implement other technologies. Never underestimate the power of a good pilot or experiment.

This pattern was just one of the observations that led us to believe that (at least from what we can see in our data) patients' use of telehealth is driven more by their practice than it is by individual preferences.

We saw some surprising findings when we looked at adoption levels across different racial and ethnic groups, and when we looked more closely, we realized that these patterns were driven by the overall adoption patterns of the practices. As is true with so many other care decisions, if your doctor or care team tells you that this is a safe and acceptable option, patients will likely follow that advice.

Q: In your experience, you noted that scheduling has a big part to play in the logistical outcomes of telemedicine services. What did you observe? What were the results?

A: Overall, the patterns that we see in the scheduling of virtual visits is quite different from the scheduling of in-person visits. We were working from a de-identified data set of 18.4 million appointments that took place between November 1, 2020, and January 31, 2021, and which covers 60,000 providers on the athenahealth network.

What we saw was that compared to in-person visits (4%), telehealth visits are more likely to occur after-hours or on weekends (7%). Telehealth appointments are almost two times as likely to be scheduled for the same day as compared to in-person appointments.

Finally, telehealth appointments are typically shorter. They are more likely to be under 15 minutes long (70%), compared to in-person visits (62%). Altogether, this paints a picture of patients integrating care on somewhat of a "just-in-time" basis, which allows for more spontaneous access, at times that are perhaps more convenient for folks trying to juggle a lot of other commitments.

We have also heard from physicians that telehealth has allowed flexibility in their own schedules. This is a little more anecdotal, but the physicians and providers that we've interviewed talk a lot about how telehealth is something that allows them to interact with patients from wherever they happen to be.

One physician talked at length about how important it was to him that he could do a telehealth visit from his car, then go in and see his son play basketball, whereas he would have missed that opportunity before. The impact on the provider schedule is something that we would actually like to dig into a little more over time from a data perspective.

Q: So, we've seen remarkable adoption of telemedicine in the past 12 months, but will it hold? What kind of permanence will it achieve?

A: On balance, we are bullish on the future of telehealth and virtual care. This is not to say that there still aren't things that the system needs to work out. One big wrinkle is long-term reimbursement for these services. It's still an open question as to how much of the regulatory and payment restrictions that were removed in early 2020 will be made permanent. So, any prognostication has to have that giant asterisk next to it.

But again, we are bullish on the future, mainly because we see that virtual care helps address real pain points. Whether it's busy people trying to squeeze a physician visit into their day, or a patient with chronic illness who just needs a check-in and med check, or as a way to make behavioral health services available to more people in more places, virtual care is a valuable addition to the care toolkit.

And for providers, virtual care has helped reduce cognitive burden and improve work/life balance. They can take telehealth appointments from the office or at home, which allows them to have more freedom, while still providing top-notch care for patients.

We may have seen adoption surge initially as a result of COVID-19. But, assuming that it remains financially viable, we think telehealth will have great staying power, because it provides flexibility, convenience and lower-cost access for those using it.

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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Study of 36.5M people reveals huge jump in pandemic telehealth use

A cohort study of more than 36 million people in the United States found a dramatic increase in telehealth use during the first four months of the COVID-19 pandemic.  

Using data from Blue Health Intelligence data repository – an independent data and analytics company that is a licensee of the Blue Cross and Blue Shield Association – researchers from the Johns Hopkins Bloomberg School of Public Health compared claims data from March through June 2019 with March through June 2020.  

During the first four months of the pandemic, telehealth visits accounted for 23.6% of all interactions – compared with 0.3% of contacts in 2019.  

“The spring of 2020 represented the first time in US history that such a large proportion of Americans had wide access to telehealth services. By undertaking this study, we sought to gain an understanding of the patterns of virtual care during this initial phase of the COVID-19 era,” wrote the researchers.  

WHY IT MATTERS

The study, which was published this week in the Journal of the American Medical Association Network Open, supports existing data showing skyrocketing telehealth rates amid the pandemic.  

Researchers limited the study population to individuals covered through employer-based, Affordable Care Act and other private health insurance plans, but not Medicare or Medicaid – an important limitation, given emerging evidence about virtual care’s role in exacerbating the digital divide.  

Still, researchers found that virtual care use rates were higher in the most “socially advantaged” neighborhoods versus the least socially advantaged neighborhoods.  

Rates were also higher in states with high rates of COVID-19 during the study and in urban locations.   

“Age and disease burden appear to be associated with telehealth uptake, with those aged 18 to 49 years and with 2 or more chronic conditions using more telehealth,” noted the study.  

Behavioral health encounters were far more likely than medical contacts to take place virtually.  

In addition, people receiving COVID-19 care had substantially increased medical costs, as well as visit rates and telehealth-use rates.  

The researchers noted that relying on claims-based data can have limitations.  

“Any claims-based research is sensitive to missing or inaccurate coding that corresponds to variations in policies or benefit structures across health plans,” they wrote.  

THE LARGER TREND  

“Telehealth is here to say,” has become a frequently cited mantra among a wide range of stakeholders, but the question still remains: how?

Although members of Congress have frequently introduced legislation to safeguard virtual care access in some capacity, none of the bills have made it into law.  

Meanwhile, the Medicare Payment Advisory Commission told policymakers earlier this month that they should temporarily continue some of the telehealth flexibilities allowed during the public health emergency to gather more evidence about the impact of telehealth on care access, quality and program spending.  

ON THE RECORD

“Although some of the associations we uncovered may be unique to the COVID-19 environment, arguably the insights we gained will be relevant to the future trajectory of telehealth no matter what direction it takes,” wrote the research team.

 

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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Malaysia’s Sunway Medical Center launches Telemedicine Command Center

Sunway Medical Center, a private healthcare provider under Malaysia’s Sunway conglomerate company, has launched a Command Center for Telemedicine Services in early 2021, the private tertiary hospital recently announced. The Command Center is located at the main hospital at Sunway City in Kuala Lumpur. Sunway also has a medical center in Velocity in KL and in the neighboring country of Singapore.

WHAT IT DOES

The first phase of the Telemedicine Command Center provides first level healthcare advisory services to patients. The center operates on a 24 x 7 basis, and patients can either call in, email or reach out through social media platforms i.e., Facebook and WhatsApp. 

Once the enquiry is received, the attending nurse or medical officer will provide advice or make recommendations to consult a specialist at Sunway Medical Center. If the patient agrees, the team can also assist in making an appointment with the respective consultant.

Future plans include connecting the Telemedicine Command Center to other hospitals, universities, or other world-class research centers for medical related education programs. Major medical related discussions, meetings and conferences can also take place digitally for education and consultation purposes.  

THE LARGER TREND

Private healthcare groups in the region have stepped up their telemedicine service offerings, especially given the ongoing current COVID-19 pandemic with examples including the Columbia Hospital Group and IHH Healthcare. 

Given the recent surge of COVID-19 cases and growing clusters in Malaysia as well as the upcoming Movement Control Order (MCO) across the country, telemedicine will continue to play an essential role in providing remote care for patients. 

ON THE RECORD

“In April 2020, the UK’s Royal College of general practitioners reported that doctors were seeing just 7% of their patients face-to-face, compared with 80% in 2019, proving that the demand for telemedicine is growing significantly. Even countries closer to home such as Indonesia and Thailand have adopted telemedicine to reach patients. With social distancing becoming the new norm, we foresee this trend increasing exponentially. On our end, we will continue enhancing our Telemedicine Command Center to keep up with this growth,” said Dr Seow Vei Ken, Medical Director, Sunway Medical Center.

Bryan Lin Boon Diann, Chief Executive Officer of Sunway Medical Center said, “We believe that necessity is the mother of innovation and as the healthcare industry evolves, we too must move in tandem to meet these growing needs. The needs of our local and regional patients and customers have encouraged us to set up this Command Center. And we pride the credibility of our Telemedicine Services as all medical or clinical enquiries will be attended by a certified nurse or medical officer. 

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Addressing telehealth's cybersecurity risk will be an industry-wide problem

Experts have repeatedly predicted that telehealth would present a major challenge for healthcare cybersecurity in the coming year.  

But it’s not enough to know telehealth is likely to be an issue – the real task is working collaboratively to address those dangers.  

At the second installment of the American Telemedicine Association’s EDGE policy conference on Tuesday, leaders in the healthcare space reiterated the importance of cybersecurity as a patient safety issue.  

“We’ve been measuring the risks and the threat for telemedicine-type services for many years,” said Christopher Logan, director of healthcare industry strategy at VMWare.   

Even before the COVID-19 pandemic, “healthcare already had a cybertarget on its back,” said Logan.

Now, with the explosion of connected devices in conjunction with the rising value of digital medical records and an increasingly remote workforce, Logan said maintaining seamless cybersecurity will be more important than ever. 

This is particularly important, he said, given that patient safety can be on the line – as we’ve seen with the fallout and continued disruption from high-profile ransomware cases over the last year. Ransomware attacks have even been linked to a patient death in Germany.  

“At the end of the day, ‘adequate security’ is not enough when you think about what we’re trying to accomplish,” said Logan.  

Of course, taking precautionary steps in terms of security-as-a-service and planning for a worst-case scenario will be paramount in developing a robust security profile. But Logan noted that “the most important aspect of any security program … is always going to be the people that are involved.”   

Mark Jarrett, chief quality officer and deputy chief medical officer at Northwell Health, agreed: “What we’re trying to … is look at it from the patient viewpoint and the provider’s viewpoint.”  

It’s not a matter of computer literacy, he said, but rather whether there are basic security measures in place.   

Providers who are associated with larger hospitals, said Jarrett, may have the privilege of an additional, institutionalized layer of security, while smaller or medium-sized providers “are basically on their own.”  

And again, this is magnified by the increasing reliance on telehealth, which frequently relies on patients’ own network security – especially when it comes to remote patient monitoring devices. 

Jarrett noted that this could be a good opportunity for the government to intervene.   

“I don’t love overregulation, but this is an area where we have to be careful, because patients will be hurt,” he said. “Cybersecurity is a patient safety issue.”

Still, said Jessica Wilkerson, a cyber policy advisor with the All Hazards Readiness, Response and Cybersecurity team at the Center for Devices and Radiological Health within the Food and Drug Administration, cybersecurity is a shared responsibility.

“FDA does not regulate telemedicine,” she reminded co-panelists. But “if there’s one thing FDA has really learned … it’s that everybody has to be doing their part.”  

Even for medical device manufacturers, she said, that device will still go into a hospital system or someone’s home, where it needs to be kept secure.   “You have to be doing your part and talking to the other person about what they’re doing and adjust on a constantly evolving basis,” she said.   

“Telemedicine is the epitome of cybersecurity issues,” she continued, in that there are varying levels of security expertise at play. “The whole ecosystem approach to cybersecurity is so critical.”  

“At the end of the day we all know technology is going to fail,” added Logan. “We have to be running a little faster than the bad guy.

“The key here is going to be people.That’s going to help reduce the risks associated with telemedicine,” he continued. “We’re going to be able to reduce that risk only if we work in harmony together.”

 

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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Most clinicians can't access telehealth directly from EHRs

According to a survey released Tuesday by the COVID-19 Healthcare Coalition, the majority of physicians and other qualified healthcare professionals say telehealth is positively influencing clinical outcomes, patient experience, cost and professional satisfaction.

Still, challenges remain: respondents are concerned about payment rates, technology and workflow issues that continue to present barriers to seamless virtual care.  

The survey is part of the Telehealth Impact Study prepared by the COVID-19 Healthcare Coalition Telehealth Workgroup, which includes the American Medical Association, American Telemedicine Association, Digital Medical Society, Massachusetts Health Quality Partners, MassChallenge Health Tech, Mayo Clinic and MITRE Corporation.   

“The strong support shown for telehealth, as evidenced in these results, reinforces the knowledge that telehealth is critical to how we deliver healthcare today,” said Dr. Steve Ommen, medical director of the Mayo Clinic Center for Connected Care, and one of the study’s coinvestigators, in a statement.   

“The use of telehealth during the COVID-19 pandemic highlights its importance in care delivery. Its continued use will be instrumental in connecting to patients everywhere,” Ommen added.   

WHY IT MATTERS  

As another COVID-19 surge rises around the United States, it’s likely that patients will again express reluctance to make or keep in-person doctor’s appointments – especially when virtual care offers an alternative.   

Survey respondents supported this, with more than 80% saying that telehealth had improved timeliness of care for patients and that patients had reacted favorably to using virtual care.  

“In addition to technology and policy change during COVID-19, we’ve had culture change. Patients will expect more virtual care even after we return to the new normal post vaccination,” said Dr. John Halamka, president of the Mayo Clinic Platform and co-chair of the coalition, in a statement.   

Clinicians, too, were largely in favor of telemedicine: more than three-quarters said telehealth had enabled them to provide quality care and 60% said it had improved the health of their patients. 

The majority also said it had decreased the costs of care for their patients and improved the financial health of their practices.  

However, many respondents also voiced concerns about barriers to access. As has been repeatedly expressed, the future of telehealth weighs in part on reimbursement. More than 70% of respondents said no or low reimbursement will be a major challenge after COVID if the current expansions do not remain in place.  

Workflow was also an issue. Nearly 60% of clinicians said they are not currently able to access telehealth technology directly through their electronic health records. They also described a lack of EHR integration and technical support.   

And, of course, the digital divide remains a problem. More than 64% of respondents cited technology challenges for patients as barriers to the sustainable use of telehealth.   

“Telehealth and remote care services have proven critical to the management of COVID-19, while also ensuring uninterrupted care for 100 million Americans with chronic conditions. How telehealth will be used after the pandemic is in the balance, and no one wants to see new access to telehealth suddenly halted,” said Dr. Susan R. Bailey, AMA president.  

“The time is now for government officials, physicians, patients, and other stakeholders to work together on a solid plan to support telehealth services going forward,” Bailey said.

THE LARGER TREND  

One interesting data point in the survey report was the continued reliance on synchronous video calls as a telehealth modality. Of those using telehealth, 80% are conducting live, interactive video visits with patients.

By contrast, only 11% said they were using remote patient monitoring technologies.

This represents, as ATA President Dr. Joe Kvedar said at the organization’s virtual conference this summer, an exciting opportunity for expansion.

“We have a lot more work to do,” he said, especially when reimagining the one-to-one, synchronous model of virtual care. “We have the opportunity to reimagine healthcare delivery.”  

ON THE RECORD  

“COVID- 19 has allowed telehealth to prove its value as a safe, effective and necessary care-delivery option that can provide quality care to patients when and where they need it,” said ATA CEO Ann Mond Johnson. 

“By extending access to care, improving efficiencies, and reducing healthcare spending, telehealth creates a hybrid care-delivery system of in-person and virtual care, bringing healthcare into the 21st century,” said Johnson.  
 

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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TriHealth switches to Zoom for pandemic, sees 3,650% increase in telehealth use

TriHealth, a health system based in Cincinnati, Ohio, had an access problem regarding patients who desired a first contact medical option that did not require a visit to a doctor’s office.

THE PROBLEM

Once TriHealth made the decision to research telemedicine platforms, from its point of view there were three major components needed for any platform to be seriously considered.

The first would be the platform’s ability to integrate into an electronic health record. TriHealth providers preferred EHR integration, as it alleviates the operational burden for front office staff and healthcare providers conducting telehealth services.

The second component was scalability. TriHealth has more than 135 locations, more than 700 providers and more than 250,000 attributed lives, so it was imperative that it have a product that could be scaled quickly and easily to meet demand.

The final component – and the one most important to TriHealth – was that the platform had to be easy to use for both healthcare providers and patients. Technology that is difficult to use can create a critical barrier to adoption and, in the case of remote care, simply would not work, the health system felt.

“During the peak of the pandemic, primary care telehealth visits accounted for more than 50% of our volume.”

Nick Kostoff, TriHealth

“Telehealth platforms can enable access and care, but without a dually focused consumerism lens toward patient and provider it should be considered a failure in design and function,” said Nick Kostoff, senior manager for telehealth at TriHealth.

PROPOSAL

TriHealth opted to go with Zoom as its telehealth platform, which it believed met all three of its major considerations. Its existing telehealth vendor would have, in part, been too difficult to implement at scale.

MARKETPLACE

There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News recently compiled a comprehensive list of these vendors with detailed descriptions. To read this special report, click here.

MEETING THE CHALLENGE

TriHealth knew it needed to meet patients where they were, in their homes, and its pre-pandemic telehealth platform could not be scaled for use to patients outside the TriHealth network, due to security and authentication concerns. For that reason, the health system pursued what Kostoff calls a click-to-video platform.

“This platform allows patients to receive a link from a healthcare provider that launches into a HIPAA-compliant call without account build and authentication,” he explained. “This greatly alleviates the support burden from an information systems resource perspective, as well as the amount of time needed to get the patient on a functioning platform.”

TriHealth brought in Zoom at the beginning of April as the pandemic was working toward a peak. Integration into the Epic EHR began immediately. Within 10 days, TriHealth had a solution that met the three mentioned major requirements, and also had a system-wide rollout plan.

“The primary focus was twofold: First, ensure that we had a plan to assist with social distancing for the safety of our healthcare providers and patients, and second, get our primary care and specialty offices up and running as quickly as possible as business had slowed dramatically,” Kostoff said. “Once Zoom was implemented within the inpatient setting to ensure our providers could remain socially distant and safe, focus shifted to our more than 250 practices.”

Telehealth visits now are being carried out across all primary and specialty care services. Zoom is integrated with Epic and with TriHealth’s Language Line interpretive services. Implementing Zoom and embedding interpretive services into the Epic workflow created a seamless scalable solution, Kostoff added. This helped staff “take the reins off” and allowed staff to rapidly change the way care was being delivered in a way that was not possible prior to the pandemic, he said.

RESULTS

TriHealth has seen an increase of 3,650% in telehealth utilization over the last six months.

“Without our new solution, we wouldn’t have been able to meet patient needs without opening our digital front door,” Kostoff said. “During the peak of the pandemic, primary care telehealth visits accounted for more than 50% of our volume.”

USING FCC AWARD FUNDS

Earlier this year, TriHealth was awarded $537,471 for tablets, video monitors, and telehealth equipment and software to conduct remote monitoring and treatment for primary, specialty, urgent care and COVID-19 response, as well as for virtual evaluations of hospitalized patients to reduce exposure for providers and patients.

“The FCC award funds will go toward reimbursing the organization for the Zoom implementation and the endpoints that were purchased to supplement the needs of the practices,” Kostoff explained. “TriHealth purchased and deployed: 600 Lenovo monitors with integrated camera and microphone, 500 iPads and poles (iPads on wheels), and 300 USB cameras.”

The telehealth program grew from a handful of inpatient use cases to scaling across the whole health system overnight. TriHealth now has telehealth technology in every corner of the organization, changing the way care is delivered.

“The FCC funds helped us bring in the technology software and hardware needed to complete a system-wide rollout of Zoom,” Kostoff concluded. “This accomplished our goal of ensuring the safety of our patients and healthcare providers by providing care from a distance, as well as aiding a business continuity plan during an unprecedented public health emergency.”

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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Digital divide remains, despite big COVID-19 tech innovation

During a presentation this past Friday as part of HIMSS Global Health Equity Week, a public health expert from the UN offered his thoughts on some of the challenges and opportunities for worldwide digital health improvement.

In the discussion, Health Equity: A Global Perspective, Ahmed El Saeed, thematic lead in health at the United Nations Technology Innovation Labs Programme (UNTIL), spoke with HIMSS CEO Hal Wolf.

They described impressive and quickly scaled advances in healthcare technologies since the start of the COVID-19 crisis – but decried the fact that an array of social factors also often conspires to keep vulnerable populations from experiencing their benefit.

“On one hand, we have a lot of innovation being thrown against the wall, a lot of people scrambling for more information and utilizing it in effectively just-in-time capture,” said Wolf. “But then we look up and we see this disproportionate impact of COVID-19. Are we fundamentally looking at a widening of a digital divide in such a situation?”

He added: “The geographic disparities, the inability to gain access, is not just a rural area and it’s not just a situation in countries with limited resources,” said Wolf. “Often there are people living in the shadows of amazing hospitals that do not have access to those facilities.”

Unfortunately, in the U.S. and around the world, a person’s income level, gender and ethnicity still have an outsized influences on their health and their access to care.

Part of the challenge, specifically with regard to the tools developed to help combat the pandemic, is the speed with which they were created and rolled out.

“We’ve seen this rapid digital transformation happen in healthcare systems and healthcare delivery systems across the world,” said El Saeed. “And it was not really something that was planned, obviously. It was something that happened as a rapid response to a health emergency.”

And in cases of rapid responses to health emergencies, “it’s very difficult sometimes to look at the different elements and factors that could potentially be propagated or affected by that type of response.”

The pressure to roll out some of these solutions very quickly, said El Saeed, may have often been to the detriment of the “key principles that we usually advocate for when we are developing similar solutions – which is the importance of designing for the user, listening to the beneficiaries more, trying to contextualize the solution, to really speak to the needs of the communities that are being served.”

For that reason, he said, “unfortunately, there has been, I think, a widening of the digital divide.”

The digital divide is not a new concept, of course. Oftentimes it’s used to describe the situations where underserved populations lack access to the broadband connections that would enable them to take full advantage of telehealth, for example.

But the global gap that El Saeed describes is “not limited to communities that have issues with connectivity,” he said.

“When we talked maybe about [the] digital divide in the past, it was primarily about connectivity issues, looking at places where access to data services was a challenge, and hence many of the smart solutions that were available were not accessible to too many people. Now we’re also looking at issues related to capacity. So if the community or the city or country lacks the capacity to be able to operate such solutions, then it will be a big issue to deliver services.

“We’re also looking at issues related to costs: If data has large costs, no matter how good – if a program is designed to deliver certain messages about COVID-19 with very well-illustrated videos, for example – there will be very low uptake because of how much it will cost the beneficiaries to actually view these illustration videos or health promotion material.”

El Saeed noted that there are “reports coming from very advanced countries who have no issue with connectivity or access to data saying that there is a digital divide happening across age groups. So a certain age group may not have access to certain solutions to be able to use certain solutions compared to others.”

When the pandemic hit, “we were caught obviously off guard on these things,” he said.

Thankfully, now there are a lot of efforts “looking at how we can close this digital divide, and how we can actually utilize some of these advances and technologies to accelerate delivery on some of the important health gaps.”

Twitter: @MikeMiliardHITN
Email the writer: [email protected]

Healthcare IT News is a HIMSS publication.

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Telehealth's digital divide is real, and members of Congress want to address it

U.S. Reps. Robin Kelly, D-Ill., and Anna Eshoo, D-Calif., convened yesterday with Dr. Gary Puckrein, president and CEO of the National Minority Quality Forum, to stress the importance of considering the barriers to healthcare people still face throughout the country.

Even as the COVID-19 pandemic has magnified telemedicine’s potential to expand access to care, said the Congress members, it has also highlighted existing disparities in our system. Broadband access is an issue, as many telehealth advocates have pointed out, but so are digital literacy and the insurance coverage of remote monitoring devices.

“Some Americans don’t have or can’t afford a phone,” said Kelly. “Will we allow them to be left behind in this revolution?”  

Eshoo, who chairs the House Energy and Commerce Subcommittee on Health, noted that she’s certainly recognized the importance of telehealth over the years, but that the novel coronavirus crisis has moved it “to the front burner.”  

Still, she said, “we know we have inequities in systems across the board,” and the healthcare system is no different.  

Kelly, chair of the Congressional Black Caucus Health Braintrust and cochair of the House Tech Accountability Caucus, pointed to her bill, the “Evaluating Disparities and Outcomes of Telehealth During the COVID-19 Emergency Act of 2020,” as a vital step forward in addressing those disparities.    

As Kelly told Healthcare IT News, when the bill was introduced in June, the legislation required the Secretary of Health and Human Services to conduct a study within a year of the end of the emergency period that would summarize healthcare utilization patterns during the coronavirus.  

Kelly said in an interview earlier this year she hopes the bill, which will call for an analysis of telehealth use broken down by race and ethnicity, geographic region and income level, will draw attention to disparities exacerbated by the digital divide.   

The legislation, currently in committee, would also require the Secretary to describe expenditures and savings as a result of telehealth, any privacy concerns, and any instances of fraud.  

Spending has been a hot-button issue among telehealth stakeholders, some of whom have proposed different fee schedules for physicians who participate in alternative payment models.

As Puckrein pointed out, telehealth goes beyond synchronous, one-on-one video or phone calls. It also encompasses remote patient monitoring devices, which can give clinicians a fuller picture of patient health. Virtual care “is going to revolutionize medicine,” he said, “but there really are important concerns.”  

“We’ve got to make sure those devices are available and that physicians can have access to that information,” said Puckrein.

In response to a question from Healthcare IT News, Puckrein elaborated that the divide is already beginning to make itself known. “The data is showing that not all patients living with diabetes have access” to devices that monitor blood glucose, for example.

“It’s showing up in healthcare outcomes. We have to pay a lot of attention to this,” Puckrein continued. If not, Puckrein said, “we’re really going to open the door up to a whole range of health disparities that will be difficult to unravel.”  

“Obviously we need the expansion of broadband,” Eshoo added. But on the Medicare side, she said, “We have to ensure that when we make [telehealth] permanent that … cutting-edge technologies are part of the reimbursement. Otherwise telehealth won’t work.”

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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Bipartisan TIKES Act would improve telehealth access for kids

This week, U.S. Reps Lisa Blunt Rochester, D-Delaware, and Dr. Michael C. Burgess, R-Texas, introduced legislation aimed at increasing telehealth access, particularly for children.  

The Telehealth Improvement for Kids’ Essential Services, or TIKES, Act of 2020 would require the Secretary of the U.S. Department of Health and Human Services to issue guidance to states about how to increase access to telehealth under Medicaid and the Children’s Health Insurance Program.   

It would also mandate a study on the impact of telehealth on healthcare access, utilization, cost and outcomes and would require the Comptroller General to submit a report evaluating collaboration between federal agencies with respect to telehealth services furnished under the Medicaid or CHIP program to those under the age of 18.  

“The COVID-19 pandemic has allowed for us to make rapid progress on expanding access to telehealth so children and families across the country, especially those in rural and underserved communities, face fewer barriers to accessing medical care,” said Rep. Blunt Rochester in a statement.   

“With the introduction of the TIKES Act, we can continue that progress by bringing better alignment and clarity to Medicaid telehealth policies, as well as provide guidance to state Medicaid programs on the opportunities telehealth services can have for children,” Blunt Rochester continued.  

WHY IT MATTERS  

Pediatric health systems issued statements in support of the legislation, saying that it creates an opportunity for the federal government to provide more clarity to states regarding telehealth expansion.  

Such guidance, as mandated by the bill, would include technical assistance and best practices regarding:  

  • Telehealth delivery of covered services
  • Recommended voluntary billing codes, modifiers and place-of-service designations for telehealth and other virtual health care services
  • The simplification or alignment of provider licensing, credentialing and enrollment protocols with respect to telehealth across states, state Medicaid plans and Medicaid managed care organizations
  • Existing strategies states can use to integrate telehealth and other virtual health care services into value-based health care models 
  • Examples of states that have used waivers under the Medicaid program to test expanded access to telehealth  

“Telehealth has facilitated the delivery of high-quality, efficient care to millions of American children,” said Dr. R. Lawrence Moss, president and CEO of Nemours Children’s Health System, in a statement. “The public health challenge of COVID-19 highlighted its effectiveness and proved that it will be valuable as a permanent part of the U.S. healthcare system.”

Nemours operates hospitals in Delaware and Florida, as well as outpatient facilities in five states. According to its website, it offers video patient visits through Nemours CareConnect.  

Moss said that the easing of restrictions related to telehealth in light of the coronavirus pandemic “demonstrated how quickly policy makers, payers and providers can work together on behalf of patients and families.”  

“While providers across the country have taken swift action to ramp up telehealth capacity during the COVID-19 pandemic, we need long-term solutions to reduce barriers to provide safe and reliable care via telehealth,” said Carey Officer, operational vice president of Nemours Center Health Delivery Innovation, in a statement. 

The TIKES Act, Officer said, is one important step toward that goal.  

THE LARGER TREND  

Federal legislators have introduced several bills – many of them bipartisan – aimed at safeguarding access to virtual care after the COVID-19 pandemic.   

Several healthcare organizations and stakeholders rallied this July in favor of the Protecting Access to Post-COVID-19 Telehealth Act in the House, which would:   

  • Eliminate most geographic and originating site restrictions on the use of telehealth in Medicare
  • Authorize the Centers for Medicare and Medicaid Service to continue reimbursement for telehealth for 90 days beyond the end of the public health emergency
  • Enable the HHS to expand telehealth in Medicare during all future emergencies and disasters; among other provisions.

That legislation has been referred to committee.   

“It’s a pretty exciting time for telehealth,” said Rep. Mike Thompson, D-Calif., at the time. “There’s a lot of enthusiasm for doing this.”  

Meanwhile, groups including the Connected Health initiative pushed the Senate to pass the Telehealth Modernization Act, introduced by Sen. Lamar Alexander, R-Tenn., this summer.  

Similarly, that legislation would amend Medicare originating site rules for telehealth to include a patient’s home and relax the geographic restrictions on telehealth provisions. It would also expand the types of practitioners eligible to furnish telehealth services and enhance telehealth services for federally qualified health centers and rural health centers, among other provisions. It has also been referred to committee.  

ON THE RECORD  
“Amidst the pain and suffering that our nation has endured throughout the COVID-19 pandemic, a major takeaway has been the advantage of telehealth. There is a convenience factor to not having to take time to physically transport yourself to the doctor’s office and have your child sit in a waiting room with other potentially sick patients,” said Rep. Burgess in a statement. 

“I urge my fellow members to support this legislation that will help build upon the telehealth foundation that we have built this year,” Burgess continued.

 

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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What do CIOs want to see from telehealth apps? More than a dozen weigh in

When the COVID-19 pandemic began to spread around the country, health systems had to pivot quickly – many within a few days – to respond to the skyrocketing need for telemedicine.

For some, this meant there wasn’t time to think deeply about which vendors were best suited to their needs; it was a question of speed and necessity.

Although the specifics are still fuzzy, it’s been made evident that telehealth isn’t going anywhere. Now that we’ve all had half a year to get used to the idea, the advantages of the modality are clear, as are the areas it still needs to improve.

Chief information officers undoubtedly are some of the best informed when it comes to the ways telehealth apps are still lacking – and the chance for innovations to fill those gaps. Fourteen IT pros told Healthcare IT News what they’d like to see from telehealth platforms in the future. 

“We moved so quickly on telehealth” that there wasn’t really time to consider optimal features, said Scott Krodel, CIO at West Tennessee Healthcare, which had to rapidly scale up its virtual care offerings as the pandemic flared in the region.

“As we move more and more into remote monitoring, we’d love to see remote monitoring tools tied into the telehealth app,” said Krodel. At this point, he said, “if the patient’s trying to show us something we’re turning our head from side to side.” 

Tanya Townsend, CIO for LCMC Health in New Orleans, raised real-time monitoring as an ideal addition too: “Continued advancement in real-time monitoring of vitals from home that can trigger immediate response or alerts” is a feature she said she’d love to see.

“For telehealth, the one thing that video cannot fully replace is the physical aspect,” argued Steven Smith, CIO at NorthShore University HealthSystem in Evanston, Illinois.

“That said, a fully integrated, easy to use medical device which can take and analyze blood, et cetera – above and beyond today’s pulse, temperature, oxygen [measuring devices] – will help bring telehealth to the next level,” said Smith.

Other experts raised the importance of patient engagement – a vital component of care that sometimes proves challenging in a virtual setting.

“If this were a perfect world, there would be complete patient engagement with video conferencing,” said Novlet Mattis, chief information officer at Orlando Health. 

“The capability would exist for patients to fully interact with the shared screen to do everything from making selections, to asking questions, and even to drawing something on the screen as part of a counseling session,” Mattis continued. 

“I would be simply elated if patients could rotate radiology images as they appear on screen in illustrating a specific area of concern during a discussion with their oncologist or surgeon,” she said.

Mattis raised the possibility of using artificial intelligence and machine learning to streamline user experience.

“Imagine the use of more advanced AI bots to act as a nurse triaging the patient before it’s determined that a provider should join the call,” Mattis said, with “fewer pre-set questions and a more conversational exchange.” 

“When I chat with ‘Sally Bot’ on a video visit about my wound, it would feel as if I’m really having a two-way conversation with a nurse. Sally Bot can then tell me if I should go to the ED or she will bring my provider into our conversation,” Mattis proposed.

“Even more, this opportunity would be a great feature for pediatric telehealth platforms. Think about it: Wouldn’t kids feel more comfortable answering questions from the Peppa the Pig character on the screen rather than a pediatrician?” she continued.

“Methodist Le Bonheur Healthcare was already in the process of expanding its telehealth program when COVID-19 began to impact our community. We sped up that expansion to better serve our patients from the comfort of their home,” said Tim Gates, acting CIO at the system headquartered in Memphis. 

“It would be wonderful if the interface of telehealth was more user-friendly,” he said. “Some patients have difficulty navigating the technology for their health appointments.”

Related issues around language barriers have frequently arisen when discussing accessibility, and Raymond Lowe, CIO at AltaMed Health Services in Los Angeles, had one prospective solution.

“At AltaMed Health Services, we serve a primarily Latino and multi-ethnic underserved patient population,” Lowe explained. 

“What we need is an integrated voice translation service that is not reliant on Google voice translation – a natural language translation that allows the provider to speak in English and allows the patient to hear their preferred language and not a machine translation,” he continued.

St. Jude Children’s Research Hospital CIO Keith Perry also pointed to accessibility issues: “I would like to see ubiquitous access to high-speed internet and technical support regardless of physical location or economic situation for telehealth.”

And for patients whose support systems may not be based in their own home,  Jason Joseph, CIO at Spectrum Health in Grand Rapids, Michigan, said it would be great to have a “‘remote help’ feature that would allow family members or others to join and help be part of the care process.” 

“So much assumes these are one-device to one-device workflows,” Joseph said.

On the clinician end of the interaction, Aaron Miri, CIO at Dell Medical School and UT Health in Austin, Texas, said he’d welcome the ability to have multiple providers for one patient.

“Virtual Integrated Practice Unit consult rooms” would give clinicians “the ability to allow multiple providers to see a patient at one time, document/chart respective to their subspecialty, and thus give the patient the opportunity to have a total healthcare experience,” Miri said.

Similarly, Jamie Nelson, CIO at HSS in New York City, raised the idea of a “multidisciplinary group chat.”

“Wouldn’t it be great to have your internist, your cardiologist and your nutritionist all speak to you simultaneously about a health problem that is best solved with input from several clinical viewpoints?” she asked. “A true clinical conversation!”

“It would be great to have a voice recognition feature so that as the provider is doing the visit and speaking with the patient/parents, the visit note is automatically being captured and transcribed into the electronic health record,” suggested Lisa Grisim, VP and associate CIO at Stanford Children’s Health. “The provider can go back into the EHR afterwards and just edit and sign it.

B.J. Moore, CIO for Providence in Renton, Washington, said he’d “like to see seamless integration of telehealth tools into a caregiver workflow and experience.”

“It would be awesome to embolden telehealth with technologies like augmented reality and real-time predictive analytics, completely recognizing the power of data,” said UPMC Chief Information Officer Ed McCallister. 

“By leveraging the full abilities of analytic insights with sensory and IOT data displayed on an electronic ‘clinician cockpit’ during a telehealth session, the timeliness, efficiency and ultimately positive patient outcomes would be taken to a new level,” he said.

And when asked “what telehealth feature would you most like to see?” Tressa Springmann, CIO at LifeBridge Health in Baltimore, responded, “Why have to choose?’ 

“A digital journey should afford synchronous, asynchronous, with voice, with video, with physiological monitoring, all in a single tool,” Springmann said. “The elements of the tool that are enlisted will depend upon patient choice and clinical need. Today, these are many (largely) different tools.”

 

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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