💻 Telehealth

With the fear of a 'twindemic' looming over health professionals heads, it's important to note the powerful role telemedicine and telehealth play in controlling the spread of infection during flu season. However, education and communication are key. How are you doing your part to educate best practices during flu season while also living in a global pandemic?  https://intouchhealth.com/curbing-the-flu-this-season-how-telemedicine-is-keeping-us-safe-from-viruses/ 

For the last 17 years I’ve been an adamant fan and promoter of telehealth, predicting that over 80% of patients’ interactions with healthcare providers could be delivered “at a distance”. And it’s only 80% because I have also learned that telehealth, in its most common form as a live audio/video conversation, has its limitations to deliver extraordinary care.

On the obvious side, telehealth is not going to replace hands-on exams, such as palpations of the stomach. Similarly, dental exams are trickier, too, though for an initial assessment and triage, telemedicine does suffice.

What’s less obvious are the limitations of telemedicine for the longer term virtual care of patients, mainly because of healthcare’s rightful reliance on the aptly named vital signs (pun intended).

One of my favorite quotes is that of Don Berwick, founder of the Institute of Healthcare Improvement, IHI: “Every system is perfectly designed to get the results it gets.” What that quote has taught me over the years is that in order to achieve different, better outcomes, one must change the system: the processes, the workflows, the technology, the incentives, the rewards, the policies, the training, etc.
In the rush into telehealth, though, many elements of the system were not changed, were not optimized for the delivery of care at a distance.

The Rush into Telehealth
When healthcare rushed into a full-throttle rollout of telehealth (albeit a lot of it still hiding as “telephonic”-only telehealth), it was definitely the right thing to do: give patients, who need care or medical advice, access to medical professionals, preferably over video.

Going over test results? Great.Ordering an interim refill? Got it.Discussing the implications of delayed surgery? Doable.Triaging your best care route with Covid-like symptoms? Perfect fit.

Where video-based telemedicine is definitely a great fit is in the behavioral health space - and has been for years. Counselling over video or the phone, including the prescription refills, offers new opportunities for continuity of care, reducing no-shows and improving engagement.

But when we enter the primary care and specialty realm of healthcare, going only by words, by live video of facial expressions and body language is not sufficient clinically in the long run. Ultimately, clinicians rely on access to good data about the clients conditions to make good care decision.

An Engineer’s Care Process
My 20 years of working with physicians has taught me that I’m oversimplifying the following (and I mean no disrespect), but today’s modern primary care and specialty care medicine is most often a simple sequence:assessing the patient’s condition and historyordering tests to confirm suspicions or hypothesesanalyzing and reviewing the resultsdeveloping and discussing a care planfollowing and monitoring the care plan (including in some cases invasive procedures)

While Telehealth is great for steps 1, 3, 4, and 5 (except the invasive part), there are limitations in the assessment of the patient’s condition in step 1 and assessment of the difference the care plan makes in step 5.

As Covid-directed physical distancing continues, what’s mostly lacking is an accurate insight into the patient’s key vital signs - those that typically would be acquired by the clinic staff in preparation for a patient’s visit. For a few visits it was definitely acceptable to “fly in the dark” and go by the patient’s vital signs’ past performance (which, as we know from the financial literature fine print, is no prediction for future performance). But now, as the health crisis lingers, we need better solutions that still keep patients and staff safe.

What’s also missing, regarding step 2, is the coronavirus-safe access to frequent tests such as lab work and imaging. While solutions available for the home exist, the logistics of deploying them to a patient’s home make most innovative solutions impractical for scaling.

Preparing a Patient for a Telemedicine Visit
Most healthcare organizations that jumped newly into telehealth in March 2020 merely gave the clinicians a video chat tool (or permission to just use the phone) and told ‘em to “go do telehealth”. What was lacking was the whole set of workflows for the scheduling, pre-visit, and post-visit steps that typically make up a complete visit experience in the in-person-care world.

Telemedicine TechCheck
One of the key hallmarks of successful “direct-to-consumer bring-your-own-device” telemedicine that we are practicing during this health crisis is the Telemedicine TechCheck, preferably conducted at the time of scheduling. I have written extensively about his unique but largely unknown practice here, here and here.

While a Telemedicine TechCheck can ensure a satisfying experience regarding the technical aspects of the telehealth visit, the clinical quality of the visit requires more than just a good connection. In addition to access to the patient’s medical history, clinicians also need to have access to a most recent set of vital signs.

TeleRooming
One best practice is to have nursing staff or MAs connect with the patient beforehand to inquire about the feasibility of obtaining up-to-date vital sign reading, such as weight, resting heart rate and blood pressure. Most patients with chronic diseases may have at least a scale and oftentimes a blood pressure cuff available. What is not obvious to many patients is that obtaining and sharing that data with their physician on their telehealth visit is quite helpful to the physician.

Thus some of our clients have now started calling patients on the morning of the telehealth visit to either collect a most recent set of vital signs or to remind them to take their measurements and share them with the physician. Oftentimes these visits, especially when conducted over video, can be excellently used to review their current medications.

A Learning Experience
For me, the rollout of telehealth has for a long time been mostly an exercise in managing the change in how clinic staff work. The Covid-necessitated shift to DTC BYOD telemedicine now also requires us to focus on helping patients to change the way they not only receive care, but how they schedule their care and how to prepare for a visit.

And guess what - after the physician ends the video call, there’s a whole new set of virtual care process steps to be defined. But that’s an article for another day.

Please post your thoughts and reactions in the comments below.

The Covid-19 crisis thrust many healthcare providers into telehealth overnight, oftentimes launching the new offering quite haphazardly. While many larger and mid-sized organizations had already launched a number of telehealth services, the unprecedented need to safely connect clinicians with patients resulted in an unprecedented demand for telehealth. This left no time for planning or coordination.

Now, six months into the health crisis, the best healthcare leaders are realizing the need for a well-defined and well-executed telehealth strategy. In order to make the most out of telehealth and to stay competitive in this new normal where over 90% of patients have had a great experience with telehealth, healthcare organizations must embrace telehealth across all clinical areas and become proficient at it.

The Scope of Telehealth

Here are the six most common misconceptions about telehealth and a hint at some of the tactics you can use to take advantage of your new understanding of the reality to launch telehealth services (even) more successfully.

Telehealth is delivering care at a distance.

This includes any interactions of the modern healthcare consumer with the healthcare organization - from scheduling appointments to downloading immunization records; from post-surgical just-in-time education to obtaining a refill.

Telemedicine, which we define as practicing medicine at a distance, is a subset of Telehealth and includes any synchronous or asynchronous interactions between patients and clinicians - either via video or telephonic visits, remote physiological monitoring (RPM), or through the store & forward mechanism, such as sending images of rashes, etc.

Without a strategy, it can be overwhelming to decide which telemedicine services to launch first.

A Telehealth Strategy's Core Elements

First of all, a well-developed Telehealth Strategy conveys a vision that aligns with the organization's overall strategy. It helps staff to find the answer to the inevitable questions "why is this important?", "why should I care?", and "why will this be different than any other change?".

Next, the telehealth strategy must demonstrate how telehealth will be used to drive the organization’s strategic objectives - again, to drive the buy-in by everyone in the organization.

Given the financial situation for most healthcare organizations, the next logical step is to ensure that the telehealth program overall has a financial case that creates a positive overall ROI across the program of all telehealth services - from direct revenues as well as indirect revenues, taking a systems point of view .

The embracing of telehealth as a care delivery mechanism is first and foremost a change management effort and only secondarily a “customer education” effort. Internal resistance, frustration, confusion and sometimes outright hostility is by far the key reason behind the failure of most telehealth programs. As such, a telehealth strategy must outline the strategies and principles behind engaging the clinicians and staff.

Last, but not least, the telehealth strategy, like any good business plan, must lay out the staffing model to support the launch of new services; support the ongoing operations; and guiding the organization through leadership.

Driving Buy-in Through a Telehealth Strategy

The primary value of a telehealth strategy lies in increased buy-in resulting in a much smoother implementation and fewer false starts. This also results in fewer wasted resources, such as the investment in the wrong technology, or the failure to establish a service because a key champion leaves the organization.

Without a telehealth strategy, the implementation of a telehealth service has numerous opportunities to encounter resistance from many sides: IT, finance, billing, nursing, providers, and even patients. Without a plan, implementations can drag on forever, especially if the opportunity of a good "first impression" is missed.

A well thought out plan engages key opinion leaders and is the key reason for immediate and lasting, sustainable success; especially if the long-term goal is to incorporate elements of telehealth and telemedicine across the organization.

How do you measure Telehealth Success?

As the quote above highlights, measuring success can be a tricky business. Not all metrics we could collect are meaningful and some relevant aspects of telehealth success are difficult to measure accurately.

With telehealth being defined as “delivering care at a distance”, telehealth cannot be simplified to the mere video chat of a clinician with a patient (or client, in the mental health world).

Rather “telehealth” is the totality of the workflows and the workplaces, the technologies and the policies, the scheduling and the billing.

But how do you measure success?

Input, Output, Quality, and Outcome Measures

Learn more about the four types of measurements on the full How To Measure Telehealth Success article

A bridge is typically a metaphor for creating a shortcut, crossing a chasm, or to overcome an obstacle like a river. A Telehealth Strategy serves the same purpose: to navigate you confidently across and through the uncertain future to get “to the other side”.

Unlike bridges though, plans and strategies are not created to last forever. They are temporary structures, intended to get you from where you are today to where you want to go.

As Dwight D. Eisenhower observed:

Strategies and the accompanying business plans exist for the same reason: to provide indispensable insights into the various facets of what it will take to arrive at a better future.  

 

Utilizing the idea of a reward system to perpetuate healthy living.
As living has now been transformed by pandemic and illness fears, a reward system will, not only motivate healthier habits, but also reinforce COVID friendly living and awareness. Through daily health tasks, users are reminded of preventative measures to strengthen their immune systems.

But one question still stands:
Even in a pandemic stricken world, do we still need rewards to make healthy decisions?

Read more here to learn about a rewards system in healthcare - let us talk about it. I want to hear your thoughts?

The Psychiatrist Will See You Online Now
 https://www.nytimes.com/2020/08/28/health/virtual-therapy-psychiatry-coronavirus.html?referringSource=articleShare

An international 60-person expert panel reviewed mobile health (mHealth) technologies and explored their use to monitor and mitigate the effects of the COVID-19 pandemic.
https://www.umass.edu/newsoffice/article/task-force-examines-role-mobile-health

Conclusions:

mHealth technologies are viable options to monitor COVID-19 patients and be used to predict symptom escalation for earlier intervention.

These technologies could also be utilized to monitor individuals who are presumed noninfected and enable prediction of exposure to SARS-CoV2, thus facilitating the prioritization of diagnostic testing. 

For those of us in this field, the answer is obviously "well, duh?".

Now the challenge becomes: 

Coming up with the technology is the cool and easy part. Integrating it into health systems and physician practices is the bigger challenge. But that's where I come in ;-).

How has Zoom’s #HIPAA compliance given your healthcare practice a second chance? Let's talk about it in our community

Virtual care simplifies routine checkups, prescription refills, and general care. Without Zoom Video Communication's comprehensive compliance and security, a simple routine checkup isn’t possible. Privacy and security are a top priority for a successful transition to virtual care.

George Lillig, Zoom's Head of Healthcare talks about what healthcare organizations can get in a quality video communications platform so that it adequately supports your virtual healthcare needs:

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Additionally, U.S. congressional leaders have agreed on a massive funding bill to address the coronavirus outbreak that authorizes Medicare to waive geographic restrictions on telehealth. It also loosens restrictions on the use of a telephone to deliver care, as long as the phone has audio-visual capabilities.

Full Article: Video Conferencing That Keeps You Connected And Compliant

How has Zoom’s #HIPAA compliance given your healthcare practice a second chance? Let's talk about it in our community

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Lessons learned from rapidly launching #telemedicine in 7 days in response to primary care appointment cancellations during the COVID-19 crisis.

Read full article by Christian Milaster on LinkedIn: Click here

Article Summary:

1. Emphasis on workflow is crucial.

2. In a time of crisis, attention to detail is limited

3. Training on telemedicine can truly occur in less than half an hour

4. Capturing Data is key.

What’s absolutely crucial during this time is to capture data - not only the volume data from the medical record, but also subjective and objective data from the providers. Did you have any audio problems? Any video problems? How do you assess the clinical quality? What suggestions do you have? Only with those data are we able to continuously change and improve the process, the training materials, the technology configuration, the messaging, the marketing, etc. I.e., everything that has to be in place for this “clinical service” to be delivered flawlessly.

5. Designing the process for long-term is easy to do, but hard to sell

6. Direct-to-Consumer Telemedicine is truly one of the most challenging telemedicine use cases

7. Clinical Leadership involvement is key

Ultimately, telemedicine is about practicing medicine at a distance. And not all patients and conditions are amenable to telemedicine. To avoid patient harm or dissatisfying telemedicine experiences (for both, providers and patients), an organization has to quickly establish clinical guidelines as to what the clinical leadership deems to be appropriate. There are also numerous clinical telemedicine guidelines published for a variety of specialties that should be consulted.

In summary, a complete successful telemedicine launch can be accomplished in as little as a week. I fully expect that by the end of this week all ~20 providers in all 5 locations to be confident in their ability to deliver great care via telemedicine, whether the providers are in the office or at home.

If you’d like to learn how you can achieve such a rapid stand up of telemedicine in the proper way, reach out to Christian Milaster directly or comment below.

Please post your thoughts and reactions and in the comments below

A “Black Swan”, a theory developed by Nassim Nicholas Taleb, is the occurrence of a highly improbable event that has a major impact on our lives.

While the Covid-19 pandemic has long been expected by researchers and (some) politicians, the impact and implications beyond the obvious was something that very few (if any) predicted.

In hindsight, these seem obvious (except probably the last one).

But lamenting the lack of foresight is pointless.

Read the full article here: Telehealth And The Black Swan

So, here are three of my current predictions:

1. Healthcare delivery will continue to become increasingly fragmented
2. Digital Health Innovation’s Shining Moment
3. Accelerate Innovation Adoption or Shrivel Up

I break down each point: Telehealth And The Black Swan: 3 Current Predictions

Healthcare’s Amazon Moment?

Dr. Klasko, the CEO of Jefferson Health, said on Becker’s Healthcare that this is Healthcare’s Amazon moment.

It is important to remember that Amazon was not about books. And this revolution is not about video chatting with your doctor. It’s about a new healthcare paradigm.

Don’t you agree? Let's discuss

The Ability to Rapidly Implement Virtual Care Practices could be the deciding factor in the length of your patients' lives. Whether it's for education, prevention, or care, the power of video communication saves lives.

What if you don't have a specialist accessible for your patients? Now is the time to build your virtual care network. Contact me at The Virtual Specialist for custom
virtual care solutions and introductions.

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