Telehealth and Medicine Today

The Expanding Divide between Videoconferencing and Enterprise-Grade Virtual Care Platforms for Healthcare Systems

2021-04-30T06:10:12+00:00

COVID19’s silver lining in healthcare technology ushered in a massive adoption of virtual care by health systems, clinicians, and patients. In the post pandemic world, as consumer/patient adoption for digital health access exponential continues to grow—Health systems, Insurers, and clinicians all need re-evaluate strategies create larger budgets, and commitments towards Digital health. The growth and rapid adoption seen during the early months of the pandemic was stimulated by removal of legislative, financial and reimbursement barriers. Healthcare systems must carefully and strategically evaluate secure, purpose built, and strategic technological investment.

Identification of Gaps in Graduate Medical Education Telehealth Training

2021-05-16T18:55:11+00:00

Objective

To identify, describe, and address gaps in telehealth training at the graduate medical education level

Materials and Methods

We designed a 12-question survey to capture the telehealth experiences and educational opportunities for residents and fellows in the Minneapolis/St Paul, MN region.

Results

There were 213 responses from 51 different specialties across 7 levels of training (PGY1-7). 66% had previously completed a telehealth visit, 89% stated that they had not performed any telehealth prior to the COVID-19 pandemic, and only 15% of respondents had any formal telehealth training.

Conclusions & Recommendations

While telehealth volumes have seen exponential increases, training on how to effectively and efficiently carry out telehealth visits for medical trainees at the GME level has remained relatively stagnant or even non-existent. We provide examples of specialty-specific telehealth competencies, and hope that improving telehealth training quality will ultimately expand access, improve outcomes of chronic disease management and strengthen the patient-provider relationship across all specialties.

COVID-19 Telehealth Impact Study

2021-05-21T08:01:46+00:00

Importance: This three-part study characterizes the widespread implementation of telehealth during the first year of the COVID-19 pandemic, giving us insight into the role of telehealth as we enter a stage of “new normal” healthcare delivery in the U.S.

Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. Using a large claims data stream and surveys of providers and patients, we studied telehealth in all 50 states to inform healthcare leaders.

Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC), to respond to the pandemic. We report trends using a dataset of over 2 billion healthcare claims covering over 50% of private insurance activity in the U.S. (January 2019-December 2020), along with key elements from our provider survey (July-August 2020) and patient survey (November 2020 - February 2021).

Main Outcomes and Measures: There was rapid and widespread adoption of telehealth in Spring 2020 with over 12 million telehealth claims in April 2020, accounting for 49.4% of total health care claims. Providers and patients expressed high levels of satisfaction with telehealth. 75% of providers indicated that telehealth enabled them to provide quality care. 84% of patients agreed that quality of their telehealth visit was good.

Results: Peak levels of telehealth use varied widely among states ranging from 74.9% in Massachusetts to 25.4% in Mississippi. Every clinical discipline saw a steep rise with the largest claims volume in behavioral health. Provision of care by out-of-state provider was common at 6.5% (October-December 2020). Providers reported multiple modalities of telehealth care delivery. 74% of patients indicated they will use telehealth services in the future.

Conclusions and Relevance: Innovation shown by providers and patients during this period of rapid telehealth expansion constitutes a great natural experiment in care delivery with evidence supporting widespread clinical adoption and satisfaction on the part of both patients and clinicians. The authors encourage continued broad access to telehealth over the next 12 months to allow telehealth best practices to emerge, creating a more effective and resilient system of care delivery.

Healthcare Professionals and Telehealth Usability During COVID-19

2021-04-20T12:46:04+00:00

Objective: During the Coronavirus Disease 2019 (COVID-19) pandemic, many other health providers needed to rapidly adopt telehealth services to ensure continuity of patient care, without the opportunity to extensively evaluate the usability of the adopted technology. Therefore, this study aims to examine health professionals’ telehealth usability during COVID-19 in Florida.

Design: This cross-sectional study employed the Telehealth Usability Questionnaire (TUQ) to licensed healthcare providers in Florida in June 2020.

Setting and Participants: A total of 399,660 selected health professionals with Florida licensure were recruited from open-access Florida healthcare to participate in a Qualtrics web-based survey. A total of 1868 health professionals completed the survey. Multiple linear and mixed regression models were applied to analyze the overall and subdomain scores from TUQ.

Main outcome measures: Telehealth Usability.

Results: The analysis of overall TUQ score showed younger, female healthcare professionals, and participants who reported an increase of telehealth usage during pandemic had a significantly higher overall TUQ score. Compared with the score from physicians and nurses, the scores from the mental health group and social work group were significantly higher, while the score rehabilitation group was significantly lower. Analysis of the subdomain scores were consistent with the overall scores.

Conclusion: The findings from this study indicate that the health professionals’ telehealth usability is related to age, gender, and the change of telehealth usage during the COVID-19 pandemic. While pandemics represent only one possible impetus for the healthcare system to swiftly switch to telehealth platforms, each profession should consider providing adequate resources to accommodate the need for change.

Reducing Unnecessary Antibiotic Treatment for Acute Bronchitis Using Virtual Primary Care

2021-05-26T07:05:10+00:00

Objective: Reducing antibiotic overuse is a point of emphasis of the Centers for Disease

Control and Prevention (CDC). Despite this, both telemedicine and traditional in-person

medical care struggle to meet national guidelines. This study evaluates antibiotic

prescribing practices at 98point6, a Seattle-based provider of virtual primary care. This

paper reviews a novel combination of machine learning with a physician-led virtual

platform and smartphone interface to exceed published benchmarks for the avoidance

of antibiotics in the treatment of bronchitis.

Design: This retrospective cohort study looks at patients ages 18–64 who presented to

98point6 with “acute bronchitis/bronchiolitis” diagnosed between December 1, 2019

and November 30, 2020. Visits were categorized by whether systemic antibiotics were

or were not given. Cases in which systemic antibiotics were given were categorized as

“broad spectrum” or “narrow spectrum”. The results are presented as descriptive

statistics with demographic information and compared to published reports of

antibiotic use for the treatment of bronchitis.

Results: Of the 1,238 visits with a bronchitis/bronchiolitis diagnosis, 99 (8.0%) were

treated with prescribed systemic antibiotics. The rate of antibiotic avoidance of 92.0%

compares favorably with published benchmarks from the National Committee for

Quality Assurance and is significantly lower than rates in previously published samples

for telemedicine, primary care and urgent care.

Conclusion: Virtual primary care administered by 98point6 resulted in a high rate of

adherence to the established standard for the treatment of bronchitis, greatly exceeding

benchmarks and published results from both telemedicine and in-person medical

practice.

Maximizing VA Remote Patient Monitoring During the COVID-19 Response

2021-05-26T11:47:27+00:00

Abstract

Objective: The Veterans Health Administration has one of the largest remote patient monitoring programs in the United States and is supported by an enterprise-wide infrastructure for providers, clinicians, staff, Veterans, and caregivers. The COVID-19 pandemic, however, presented new challenges: a sudden need to provide large-scale remote monitoring for a new disease that did not yet have a disease management protocol. VHA needed to be ready within weeks to provide this daily monitoring for hundreds — even thousands — of Veterans.

Methods: The U.S. Department of Veterans Affairs Office of Connected Care already had a comprehensive infrastructure in place for its Remote Patient Monitoring – Home Telehealth (RPM – HT) program. Connected Care activated and built on this infrastructure to support providers, clinicians, and staff in their efforts to rapidly bring RPM – HT to Veterans across the nation when they had COVID-19 symptoms or exposure. To do this, Connected Care activated an emergency management plan, rapidly developed a new COVID-19-specific disease management protocol, added weekend monitoring, and procured critically needed monitoring supplies, such as thermometers and pulse oximeters. Connected Care’s strong foundation allowed for innovation and flexibility, such as the training of non-RPM – HT staff in RPM – HT processes, RPM – HT enrollment within acute care settings, and new strategic partnerships.

Outcomes: More than 23,500 Veterans were enrolled for COVID-19-related monitoring from March 2020 to May 2021. At points in December 2020 and January 2021, the number of Veterans being monitored in a single day topped 2,000. Even with this rapid buildup, patient satisfaction levels remained at about 90% in numerous categories. In addition, the percentage of Veterans admitted to VA facilities while on COVID-19-related home monitoring has been extremely low, at 4%, a potential indicator that the monitoring system has been helpful in enabling Veterans who did have the virus to convalesce at home. Further study is needed to determine the impact RPM – HT enrollment for COVID-19 care had on the need for inpatient care.

Conclusion: The Office of Connected Care’s established, enterprise-wide RPM – HT business, clinical, and technical infrastructure enabled VHA to enter the COVID-19 public health emergency well-positioned for the rapid deployment and growth of at-home and mobile monitoring. As the COVID-19 emergency made at-home management of Veterans increasingly important, the national RPM – HT program successfully adapted its practices to meet Veteran, caregiver, and staff needs.