Category: Telehealth Trends
Beyond EHRs: What is important in telehealth integrations?
One can take two approaches when innovating in the healthcare space. One method is highly technology-driven providing an end-to-end solution. The other is patient-centered with the focus being on the patient and clinician experience.
The latter method, Caregility’s method, is to be purpose-built. We meet our customers where they are at. Baked into our DNA, we strive to listen to our customers, their patients, and their clinicians and understand each clinical workflow, environment, or system. This guides our product development across the entire portfolio, both software and hardware. We evaluate every click a clinician must make, every voice that must be heard, and every situation that must be visually assessed. This relentless attention drives our designs, innovations, and interoperability with other solutions. Together, we are stronger.
Admittedly, I am biased as I have experienced both sides. There is a fair use case for following the first strategy. You may think of it as “soup to nuts.” Organizations that are at the absolute beginning of their journey, with minimal existing infrastructure or investment into other solutions, are often attracted to a telehealth platform that has already predefined all the workflows needed. And, that may be the right choice at the time.
But as these organizations gain momentum, they realize that their clinicians, facilities, and service lines all have their own specialty needs and unique workflows. They want customizations or solutions to meet each situation and yet they need a seamless user interface to support and maintain. The result is many solutions to manage versus one universal platform that meets all use cases escalating resource and financial consumption.
I’ve seen this scenario time and again. Either create point solutions for each individual scenario or orchestrate care leveraging all your resources seamlessly. I strongly believe in the second philosophy. Flexibility, adaptability, scalability, and interoperability should always be the governing principles in choosing any solution for delivering patient-centered care.
For telehealth, the right approach means integrating with other solutions, platforms, and technologies. But before we walk through all the ways a telehealth solution can do that, let’s take care of the obvious first integration: with your EHR.
The Devil in the EHR Integration Details
Your virtual care platform absolutely must integrate with your hospital’s EHR. But as hospital IT directors are aware, when it comes to EHR integration, the devil is in the details.
One EHR may accept a range of third-party integrations each with its own user experience, while another may require those integrations exist only within the umbrella of the EHR’s own user experience. Some publish APIs for certain workflows, but not others.
If your organization is in the process of selecting a virtual care platform, it’s important to understand these details. Ask whether the capabilities being requested by your clinical staff are limited by what the EHR allows, or what the platform provides.
But this isn’t just another EHR integration point. The EHR is undoubtedly one of, if not the biggest technology investments your organization makes. But don’t let the EHR integration question overshadow other important integrations.
There are several categories that are important to consider.
What types of integrations are important for virtual care?
As I said, part of our DNA is listening to our customers. We believe in giving them the biggest, broadest choices possible. Here are some examples where listening to our customers has driven the development of new integrations:
- Language interpretation services. Just as telehealth can be used to bring in various care specialists, sometimes specific language interpreters need to be brought in through remote video conferences as well. If these two services don’t integrate, you are faced with paying for two different systems, just to provide one consultation for a single patient. Ensuring that your language interpretation services can be integrated into existing systems avoids crowding in the patient room and duplicative investments.
- Clinical decision support. Clinical support applications are important tools for providing evidence-based, proactive care delivery for all types of patients. Having the ability to validate CDS data with real-time video analysis elevates any virtual nursing assessment. It perpetuates early intervention, improves outcomes, and provides the ability to scale resources across multiple facilities and healthcare settings.
- Remote patient monitoring & device integrations. There are several healthcare companies that specialize in remote patient monitoring to help health systems manage patients during recovery as well as long-term chronic care for patients outside the hospital. Usually, these solutions pair Internet-enabled medical devices with software applications that aggregate health information collected by the patient, analyze it, and transmit it to clinicians. Being able to integrate such a program into an enterprise-wide telehealth strategy will avoid duplication of services and help make the best use of the investment.
- Device integrations supported by Caregility: Eko
- Patient engagement platforms. Patient engagement platforms provide a range of services to patients during a hospital stay besides giving them entertainment, from showing the menu to order food, to displaying a calendar or giving information about their care team. Like many of the examples above, without proper integration the hospital will need to invest in duplicative hardware, crowding the room with additional screens and complicating the experience for patients and families.
Benefits of telehealth integration
Choosing a virtual care platform that integrates with innovative and legacy investments is a tall order.
With Caregility Cloud™️, you get an award-winning, enterprise-grade virtual care platform that offers a responsive, self-healing, purpose-built end-to-end telehealth for any use case – combined with the ability to integrate with multiple important systems.
Each offering is a story about a customer’s need satisfied, an investment maximized, a clinician’s job made easier, and a patient’s journey simplified.
This post was contributed by Jenna Walls, Vice President of Partnerships at Caregility
Telehealth News Roundup: Increasing Support for Telehealth
With current surges in new COVID-19 cases due to the highly infectious delta variant, telehealth usage will likely continue to remain strong for the foreseeable future.
Recently, the Biden Administration approved $11 million in stimulus funding to the Pediatric Mental Health Care Access Program, doubling the reach of a program that uses telehealth to help pediatric care providers access mental health specialists, as reported by mHealthIntelligence.
Telehealth services are also beginning to be offered through school districts to improve healthcare for students. In addition, the Medical University of South Carolina (MUSC) has created a Telehealth Services Implementation Model to help healthcare organizations effectively expand telehealth solutions, according to Healthcare Finance News.
Read on for our monthly roundup of the most significant developments in telehealth:
mHealthIntelligence
The federal government is adding nearly $11 million in stimulus funding for the Pediatric Mental Health Care Access Program, which will increase the program’s reach from 21 to 40 states. The program enables pediatric mental healthcare providers to train primary care providers, and one doctor commented that “these grants aim to build and improve the structures and systems in place to address those needs comprehensively and consistently.”
Healthcare Finance News
Rural communities across the country have struggled to maintain access to quality healthcare during the COVID-19 pandemic. One overlooked demographic is children, especially those living in remote areas. But one school district in Missouri has found a solution by adopting a hybrid telehealth program to help school nurses connect students with healthcare concerns to local healthcare providers. Rose Ghattas, a virtual health coordinator for the Blessing Health System, commented that “Eighty percent of students opted in during their first year…We prevented one to two absences per week. And the time they went to a school nurse to the time they saw a provider was less than 30 minutes, often around 15 minutes.”
Healthcare IT News
The Teleprimary Care Certificate program will help ensure healthcare providers receive the proper training to conduct telehealth appointments successfully. Topics will include best practices, including workflow and regulatory considerations, and is designed to help primary care providers develop virtual healthcare strategies that will last beyond the pandemic.
Healthcare Finance News
The Medical University of South Carolina (MUSC) has created the Telehealth Service Implementation Model (TSIM), which provides a framework for healthcare organizations seeking to adopt telehealth solutions. The model is broken into six phases and provides detailed support from onboarding to scaling telehealth implementations for continuous success.
Successfully Deploying Telehealth for Seniors
An estimated 10,000 Americans turn 65 every day, representing a significant challenge to the national health care system. Meanwhile, the COVID-19 pandemic has dramatically accelerated adoption of one of our primary tools to meet that challenge: telehealth.
In a recent column for McKnight’s Senior Living, Ed Mercadante called telehealth “the great equalizer, disrupting the existing paradigm barriers of geography, travel, weather conditions and other impediments that contribute to accessibility difficulties and inefficiencies of care.”
To be sure, telehealth technology does help alleviate long-standing challenges to delivering healthcare. But telehealth also comes with its own, different set of barriers. This post will explain what those barriers are, what strategies healthcare providers are employing to overcome them, and how telehealth is rising to meet the challenge of an aging population.
Seniors Are Increasing Interested and Participating in Telehealth
Across the board, seniors used more telehealth in 2020 than ever before. The percentage of adults aged 50 to 80 who had ever participated in a telehealth visit rose from 4% in May 2019 to 30% in June 2020, according to research from the National Poll on Healthy Aging.
During that same time, the number of older adults who said they were very or somewhat comfortable with video conference technology rose from 53 percent to 64 percent. The number who said they were interested in using telehealth to connect with their doctor rose from 58 percent to 72 percent. Before the pandemic, nearly half (49%) of seniors said they had concerns about the privacy of telehealth—after, that number had fallen to less than 1 in 4.
Clearly, there is a huge opportunity for care providers and health systems to reach older adults through telehealth technology. But that isn’t to say that there still aren’t barriers.
Barriers to Providing Telehealth to Seniors
The barriers in providing telehealth to older adults generally fall into two categories.
The first group of challenges generally relates to seniors themselves: Their own mental and physical capacities, plus their comfort (or lack thereof) with telemedicine technology.
As we age, most adults experience at least some mental or physical decline, both of which need to be taken into account when delivering care via teleconferencing or video conferencing. This decline can include reductions in sensory or motor function, such that they have trouble seeing, holding, or hearing devices. It can also include a decline in cognitive function impacting memory, reasoning, and multitasking.
Delivering a platform which provides true ease of use is absolutely critical to ensuring that care delivered to older adults via telemedicine is successful.
The second group of challenges generally relate to the country’s IT infrastructure, namely broadband internet access to poorer areas and rural areas. The Center for Healthcare Strategies estimated last year that 90 percent of urban areas have access to broadband, while 75 percent of non-urban areas do. That’s a good start, but unfortunately it is usually the poor and rural areas where lack of broadband and chronic, long-term care management intersect the most.
Fortunately, billions in pandemic-era federal dollars are on their way toward alleviating this problem, including money specifically earmarked to strengthen internet access for healthcare organizations looking to expand telehealth programs for underserved populations.
In order to address the first set of challenges, however, healthcare organizations are deploying a number of strategies.
Making Telehealth Work for All Adults
In 2020, researchers Umar Ikram, Susanna Gallani, Jose F. Figueroa, and Thomas W. Feeley called up four healthcare groups to ask them about the strategies they used to transition care delivery to telehealth during the COVID-19 pandemic. All four organizations predominantly served older populations, and, notably, all four organizations participated in Medicare Advantage, a capitation, value-based care payment system.
As the four researchers wrote in Harvard Business Review, the value-based payment system gave these care providers “both the flexibility and the incentive” to experiment with telehealth delivery, “including pivoting to telehealth with their challenging populations.” Of course, not all care providers need to transition to value-based care, but still, the flexibility these organizations had to experiment with different strategies can provide lessons for all healthcare providers.
Ikram, Gallania, Figueroa and Feeley identified four main challenges:
1. Lack of internet access or appropriate devices
One healthcare group surveyed its patients and found 40 percent of them either did not own a smartphone or tablet that was appropriate or didn’t have a data plan that would have allowed for video visits. Another organization reported 60-70% of its patients lacked such basic internet capability.
The solution was two-fold. In cases where patients lacked internet devices, healthcare groups either mailed or hand-delivered tablets directly to their patients. For those who lacked sufficient internet access, the solution was to send “mobile medical assistants” with personal protective equipment. These assistants would then conduct an in-person intake at the patient’s home, and coach them through the video consult with the doctor.
2. Medical conditions that impede the use of telehealth
If you predominantly serve older patients, chances are that a large percentage of them will have cognitive or physical impairment. For one of the organization’s surveyed, 40% of their patients had a hearing impairment, 15% had a vision impairment, and 10% had dementia.
Response strategies for these patients rely on actively engaging in-home caregivers, usually a family member, to help conduct the visit. “In one example, a nurse practitioner coached the spouse of a patient with lung disease on how to appropriately use a nebulizer,” the researchers wrote.
3. Patients with limited digital literacy
“Most of my video visits are spent looking at the ceiling fan,” reported one clinician, noting that a lot of patients lack the basic digital literacy to have a videoconference. And in many cases, being able to actually see the patient on screen is a critical tool for clinical assessment.
Healthcare organizations reported varied onboarding and training strategies to respond to this challenge, from using administrative staff to conduct “practice visits” to deploying “healthcare ambassadors” who visit patients at home and walk them through downloading, setting up, and using whatever telehealth platform has been chosen.
Employing these strategies can dramatically reduce both lost time due to technical difficulties and the number of missed appointments.
4. High-risk patients who need regular monitoring
All four healthcare groups interviewed reported sending or dropping off monitoring devices for their most at-risk patients, from blood pressure cuffs and pulse oximeters to weight scales. They then coached patients and in-home caregivers on how to take vital signs, identify irregularities, and call for help if needed. Many Caregility partners now provide such services.
In short, telehealth is an invaluable tool for providing healthcare to seniors all over the country. However, we must work to not only understand the unique needs of America’s aging population, but also build bridges to overcome the barriers and challenges many older adults face when it comes to taking full advantage of telehealth technology.
Learn more about expanding telehealth access to underserved rural populations.
The Difference Between Remote Patient Monitoring and Telehealth
How does healthcare delivery change? Slowly, then all at once.
The growth of remote patient monitoring technology and telehealth over the past two years is transforming the way hospitals, health systems, and clinics deliver healthcare. Remote patient monitoring technology in particular is set to explode—but with so much change happening so fast, even the terms themselves are the subject of some confusion.
So, what is remote patient monitoring exactly, and how does it differ from telehealth? As the market for these technologies is predicted to explode in the next five years, it’s important to define our terms.
Telehealth is an umbrella term
Simply put, telehealth is an umbrella term for describing the use of technology to deliver healthcare remotely.
Several organizations have published their own definitions of telehealth, though healthcare providers are usually most concerned with those released by the Centers for Medicaid and Medicare Services (CMS). In a resource on telemedicine published for healthcare providers, CMS defines telehealth as “the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across distance.”
Thus, telehealth refers to a suite of services for delivering remote care, both in and out of traditional care settings. One subset of those services is remote patient monitoring.
The definition of remote patient monitoring
Remote patient monitoring is the use of technology, often wearable devices, to monitor patients outside of clinical settings. These devices are internet-enabled and can thus send information on patient health directly to the offices of care providers. Combined with technology platforms that can aggregate and analyze the data as well as integrate it into clinical workflows for care delivery, remote patient monitoring has the potential to transform patient care for the better—and reduce its cost.
A Government Accountability Office report defines remote patient monitoring as “a coordinated system that uses one or more home-based or mobile monitoring devices that transmit vital sign data or information on activities of daily living that are subsequently reviewed by a healthcare professional.” The report notes, however, that Medicare fee-for-service does not have an explicit definition of remote patient monitoring. Rather, Medicare pays separately for some services that are used to remotely monitor patients, as well as for other remote monitoring bundled with other services.”
That said, it’s important to understand the full breadth of what remote patient monitoring includes.
Applications for remote patient monitoring
Understanding the full breadth of applications for remote patient monitoring technology will help your organization realize the full potential for expanding and improving care delivery. Essentially, any device which can monitor patient vital signs or physiological data and transmit that data to care providers can be used to manage patient conditions outside of traditional care settings.
Cancer
At the Mayo Clinic Cancer Center, cancer patients can be enrolled in a remote patient monitoring program that a recent study showed has helped them avoid unnecessary hospitalizations. The program gives patients Bluetooth-enabled blood pressure cuffs, pulse oximeters, and thermometers and a tablet that prompts them to take vital sign measurements, which are then delivered to an interdisciplinary care team.
COVID-19
Remote patient monitoring is a potent tool for measuring blood oxygen levels, which are a critical indicator of whether COVID-19 patients require hospitalization. Hospitals can enroll patients in a remote monitoring program post-discharge, use remote monitoring to manage “long-COVID,” and reduce the load on critical care resources by keeping patients who do not require hospitalization safely at home. The FDA has issued an Emergency Use Authorization for certain remote or wearable patient monitoring devices during the pandemic.
Chronic Obstructive Pulmonary Disorder (COPD)
Remote patient monitoring can help monitor patients who have several chronic conditions, including COPD. The remote monitoring may be used to predict exacerbations, which can lead to hospitalization, thus providing care teams a more proactive strategy for management.
Dementia and Falls
Patients with dementia are at risk for falls and wandering. Just as connected wearable technology can help you monitor the number of steps you take and whether you are walking, running, or in the car, the sensors on connected wearables can detect falls and alert caregivers when dementia patients may be hurt or need help.
Diabetes
Managing diabetes remotely requires ongoing control over blood pressure, weight, and blood glucose. A remote patient monitoring program can help track these and deliver results and proactive alerts to healthcare providers. A randomized control study found that diabetes management via RPM is as effective as a clinic visit once every three leading to a significant reduction in cost.
Congestive Heart Failure (CHF)
Cardiac implantable electronic devices (such as pacemakers) can deliver useful physiological data to help remote care teams identify and manage heart failure. A systematic review of 42 studies on remote patient monitoring programs for CHF found the programs improve quality of life, reduce mortality rates, and help reduce length of stay when patients are hospitalized.
The Bottom Line
The bottom line for hospitals and healthcare organizations is that RPM programs used in coordination with a broader array of telehealth services can help build new outpatient revenue streams and reduce expensive in-hospital utilization. “RPM is more than just fancy activity trackers,” wrote Katie Nunn for the Medical Group Management Association. “It is a way to reduce hospital admissions, lower healthcare costs, and provide better care and outcomes for patients.”
Learn more about howCaregility’s telehealth technology platformcan help support your healthcare organization’s needs.
Turning the Tide on Diabetes Using Telehealth
Telehealth has proven to be an effective tool that helps patients and their health care providers effectively manage chronic diseases – including diabetes. “Diabetes is an ideal medical condition for telehealth utilization because it relies heavily on patient self-management and use for home medical devices that both generate and capture data,” wrote the authors of a 2020 article in Diabetes Technology & Therapeutics.
Health care providers have been piloting diabetes-focused telehealth initiatives since the 1990s to improve patient outcomes and to help rural and underserved populations have access to high-quality diabetes care. Technological advances in videoconferencing, remote patient monitoring devices, and mobile device apps have sped the adoption of telehealth in diabetes care in recent years. Research has shown those efforts are bearing fruit. For example: A widely cited 2019 article published in Telemedicine and e-health examined data from more than 40 studies encompassing more than 6,000 patients with Type 1 and Type 2 diabetes. The studies compared outcomes for patients enrolled in telehealth interventions with those who received only in-person care. The results: “The mean reduction in HbA1c was significantly higher in the telemedicine groups” versus the in-person groups.
This post will outline some of benefits of telehealth for diabetes care, how telehealth can increase patient access to diabetes care, and steps physicians can take to incorporate telehealth into their diabetes care plans.
Benefits of Telehealth for Diabetes Care
“In the diabetes world, where data from meter, pump, and sensor downloads are critical to management, telemedicine is an ideal way to interact with patients,” stated Mark H. Schutta, medical director of the Penn Rodebaugh Diabetes Center at the University of Pennsylvania in an article for Endocrinology Advisor. “Diabetes experts can manage the majority of patients using the HbA1C test and other data the patient has recorded and downloaded to a website.”
Incorporating telehealth, therefore, can introduce several efficiencies in care planning that can promote better patient outcomes, such as:
- Medication adherence: Text message reminders or app notifications can nudge patients to take medications in the correct dose and frequency. These communications can also ensure patients fill their prescriptions in a timely manner.
- Quicker response times from care teams: Telehealth allows patients to easily report daily blood glucose readings directly to their care teams. Armed with that data, physicians or nurses can quickly identify any problems and address them—for example, through a medication adjustment—before they become emergencies.
- Reduced transportation burdens for patients: Because physicians can provide a clinical assessment and order lab tests via video consultation, patients don’t have to visit multiple facilities to receive care, which means less time away from home or work and lower transportation costs.
And the benefits aren’t limited to patients. Research has shown reduced costs for health care systems: A 2018 study published in Preventing Chronic Disease showed that “the use of telemedicine in 7 rural hospital emergency departments in Mississippi decreased the hospitals’ expenditures from $7.6 million to $1.1 million during a five-year period, with no apparent effect on clinical outcomes.”
Telehealth Increases Access to Diabetes Care
Patients who live in rural areas and other chronically underserved communities face a double-edged sword when it comes to diabetes. These populations typically have higher rates of diabetes than urban and higher-income areas while lacking access to health care—particularly diabetes subspecialists—near their homes.
Several studies have illustrated how telehealth programs have helped rural patients better manage chronic conditions, including diabetes. In one example, the Veterans Health Administration’s (VHA) Advanced Comprehensive Diabetes Care program engaged patients in telemonitoring, a module-based self-management support program, and twice-monthly phone calls with VHA staff. An analysis of 125 patients enrolled in the program showed that participants’ HbA1c levels improved from 9.25% at baseline to 7.89% after six months. The program’s administrators also reported that ACDC improved “patient engagement and awareness of diabetes control.”
“Telehealth interventions and innovative technologies can be adapted to the needs of these individuals and their local communities,” the article said. “Patients may better understand their health conditions and use their health care resources to develop optimal diabetes self-management behaviors to this lifelong condition.”
Integrating Telehealth into Diabetes Care
Because telehealth has been piloted by many diabetes care providers over the past three decades, advice for how physicians can best incorporate technology into their care plans is plentiful. A few recommendations include:
- Incorporating telehealth only after an in-person relationship has been established with a diabetes patient. In the previously mentioned Endocrinology Advisor article, Schutta says he sees his patients at least once per year in person but uses telehealth to address acute problems and medication changes.
- Preparing patients for diabetes telehealth appointments. Ensure your patients understand the technical requirements of telehealth—from the devices they need to use to the level of internet service they need to have—as well as the fact that they may need to have more frequent virtual visits for their diabetes care.
- Setting physicians up to succeed in diabetes telehealth care. “Learning a new care model can be anxiety-provoking and overwhelming for providers,” note the authors of the aforementioned Diabetes Technology and Therapeutics article. They recommend “building supportive practices,” including enhanced onboarding practices, simulated telehealth visits, and scheduling fewer patients for physicians new to telehealth until they’re confident with the modality.
- Using discretion about when using telehealth for diabetes care. Just because you can see a patient via telehealth doesn’t mean you should for every appointment. For example, the Diabetes Technology and Therapeutics authors write, a telehealth appointment may be appropriate for introducing a new exercise plan for a patient, but not for explaining a difficult diagnosis or a complicated treatment plan.
The Future of Telehealth in Diabetes Care
Although the benefits of using telehealth in diabetes care are clear, the future of the modality is blurrier. For physicians to continue deploying telehealth to supplement diabetes care plans, insurance plans will need to continue to compensate them at a rate comparable to in-person visits as they have throughout the COVID-19 pandemic. And the barriers keeping rural and underserved populations from accessing telehealth care – foremost among them the availability of broadband internet – must be addressed. But early indications are that the Biden Administration, Congress, and leaders in both political parties have an interest in making the policy changes that drove the pandemic’s telehealth expansion permanent. And that’s great news for diabetes patients and the physicians who care for them.
Contact Caregility today to learn how our telehealth solutions can help elevate diabetes care in your practice.
Telehealth News Roundup: Improvements in Treating Mental Health
After more than a year of pandemic-induced stress and anxiety, the conversation around maintaining mental health is now more public than ever.
The longstanding taboos and misinformation around mental health are slowly but surely entering the limelight, with more people feeling confident to come forward and share their own struggles. Even on an international stage such as the 2021 Olympic Games in Tokyo, we saw Team USA star gymnast Simone Biles pull out of competition and subsequently pinpoint mental health as the cause.
Recently, Fierce Healthcare reported that 49% of all Medicaid visits for mental health were conducted via telehealth, a drastic increase from pre-pandemic numbers. In addition, the Centers for Medicare and Medicaid Services have proposed to lift regulations which would allow Americans in rural and underserved communities to access telehealth services for mental health from their home, according to Healthcare Finance News.
Read on for our monthly roundup of the most significant developments in telehealth:
Healthcare Finance News
The Centers for Medicare and Medicaid Services have proposed to lift restrictions on utilizing home telehealth services, which would expand access to mental health services for rural and underserved communities. The changes would allow Medicare to pay for mental health services conducted via telehealth when provided by Rural Health Clinics or Federally Qualified Health Centers.
Healthcare IT News
The rise in telehealth services has led to an increase in the number of Americans seeking virtual treatment for behavioral and mental health. Telehealth services provide Americans living in parts of the country with few clinicians access to specialists in more populated regions.
Fierce Healthcare
A recent survey by Anthem found that before the pandemic telehealth usage for mental health services was in the single digits, but last year telehealth counted for 49% of all Medicaid mental health visits. Although not fully replacing in-person visits, telehealth for mental health services also saw increased usage among minority populations.
American Medical Association
The increase in telehealth services for mental health has become a lifeline for patients suffering from chronic conditions, as well as helped independent physician practices remain secure financially. The AMA details the advancements in mental health services offered by telehealth.
mHealth Intelligence
A recent survey from the Bipartisan Policy Center (BPC) revealed that a lack of broadband connectivity remains a barrier to telehealth access, particularly for rural and elderly Americans. Although 9 in 10 respondents were satisfied with the quality of their telehealth visit, 42% of adults over the age of 65 said that high-speed internet access remains an obstacle for care.
The Barriers and Benefits of Expanding Telehealth Access for Veterans
Veterans turned to telehealth care in droves during the COVID-19 pandemic. Data from the Department of Veterans Affairs showed that, early in the pandemic, veterans used telehealth more than 120,000 times per week via the VA’s Video Connect mobile health app. The platform, which launched in 2017, typically saw about 10,000 visits per week before the pandemic and has now become one of the most successful digital health platforms in the country.
But telehealth has been a priority for the VA since well before the pandemic. In fact, the department has been experimenting with the technology since the 1990s. This post will outline why telehealth has become a vital tool to help the VA provide essential care to the 19 million veterans living across the country, as well as what the future may hold for such technology.
What are the challenges of health care access for veterans?
Veterans have consistently named distance from health care centers and specialists as a significant barrier to acquiring necessary care. This challenge is particularly acute for rural veterans, who constitute a quarter of all veterans in the United States. Veterans, like all rural residents, have suffered disproportionate hospital closures, health care provider shortages, and limited transportation options compared with people living in or near urban centers. Additionally, veterans over age 65 represent more than half of veterans living in rural areas. They often have multiple chronic conditions and other health issues that require specialized care. Other obstacles all veterans face in accessing health care – particularly mental health care – include availability of specialized services, bureaucratic obstacles, limited hours of operation of health care centers, and perceived stigma.
What are the main benefits of telehealth for veterans?
Telehealth has been shown to alleviate some of the barriers veterans face in pursuing quality health care. A 2016 study published in the Journal of Telemedicine Primary Care Providers showed that the VA’s telemedicine program “improves access, productivity, and the quality and coordination of care.” The study also indicated that virtual care helped veterans with multiple chronic diseases attend more frequent visits with physicians, leading to better disease management.
In a 2020 study published by Public Policy and Aging, researchers found that VA telehealth programs increased quality of life for both veterans and their caregivers, improved access to resources such as durable medical equipment, and led to more timely diagnoses and care planning. Of course, throughout the pandemic, finding appropriate points of care to reduce personal COVID-19 risk for vulnerable patients, and to safeguard the community, has been critical.
What are some examples of successful telehealth programs for veterans?
The VA has successfully piloted several telehealth programs that address general preventive health care, mental health care, and specialty health care:
- In 2019, the VA launched the Advancing Telehealth Through Local Access Stations (ATLAS) program to serve veterans in rural areas. Through ATLAS, veterans in areas that were not served by a clinic could book appointments at “remote telehealth exam rooms,” designated areas in “convenient community-centric locations, including libraries, veteran service organizations, even Walmart.”
- A year later, just before the pandemic, the VA established its first telemedicine-based chemotherapy clinic, linking two VA hospitals 100 miles apart in Pennsylvania. Veterans living in the Altoona area were able to receive virtual care from experts in Pittsburgh. Impressed by the program’s progress, in June 2020, the Bristol Myers Squibb Foundation made a $4.5 million grant to the VA to further develop its virtual chemotherapy platform.
- A study published in a 2021 issue of BMC Health Services Research highlighted a national program called TeleSleep designed to diagnose and treat obstructive sleep apnea, a common condition among rural veterans. The telemedicine program, launched during the COVID-19 pandemic, included virtual clinical encounters, home sleep apnea testing, and an app that veterans and providers could use to monitor symptoms. The program’s benefits – reduced travel burdens and higher health and quality of life outcomes – “assured leaders and clinicians that the comprehensive shift in all VA sleep care to telehealth during the COVID-19 pandemic would facilitate improved access to care.”
What barriers do veterans face in using telehealth solutions?
The barriers veterans encounter when engaging in telemedicine are similar to those of the general population – especially those in underserved areas – including a lack of broadband internet access and uncertainty over reimbursement, credentialing, and other health care policies.
In the TeleSleep study, rural veterans reported difficulties in appointment scheduling, the continuity and timeliness of communication, and the process to refill their equipment. Patients and practitioners involved in another VA telehealth program highlighted in the 2020 Public Policy and Aging article described an intense start-up process (including training teams, establishing processes, and securing necessary equipment) and a high degree of staff turnover as areas of concern.
But the biggest challenge veterans and their caregivers face regarding telehealth centers on policy. To facilitate and expand telehealth services for veterans, policymakers will need to clarify, amend, and extend rules related to telemedicine reimbursement and ensure patients and physicians have access to the tools – like broadband internet and mobile devices – they need to participate in telemedicine.
What does the future of telehealth for veterans hold?
The Biden administration appears to have an interest in keeping or expanding the relaxation of regulations on telemedicine after the pandemic, for the public, and for veterans. In June 2021, VA Secretary Denis McDonough stated his intention to keep telehealth and online medical appointments as part of the VA’s health care offerings. Noting that online video appointments for veterans were 18 times higher than they were at the start of the pandemic, McDonough said, “I think, as a system, we recognize the huge efficiency gains and huge satisfaction gains from veterans spending less time traveling to our facilities while still getting good care.”
The ability to enshrine such changes as permanent, however, lies with Congress. The good news is that Congress appears receptive. In June, the House Appropriations Committee approved $279.9 billion for military construction, Veterans Affairs, and related agencies. It includes “more funding than requested” for the VA, to the tune of $100 million. That funding is intended for several causes but specifies funding for “telehealth and connected services,” including “home telehealth, telehealth prosthetics, and clinic-based telehealth.”
In short, telehealth has become an invaluable tool in providing health care to veterans no matter where they live in the country. Other large health care providers would do well to learn and where appropriate emulate the example the VA has set for effective virtual care.
Learn more about expanding telehealth access to underserved rural populations.
Telehealth News Roundup: Teaching Telehealth in Med School
The future of healthcare has become inextricably linked with ongoing developments in telehealth. With telehealth services now being offered at 38 times the pre-pandemic rate and dozens of states having altered healthcare policies to include telehealth coverage, University Business reports that medical schools must begin to offer telehealth-specific training to students so they can be prepared to offer the best care for patients. The Cancer Network says that patients receiving cancer treatment have experienced enhanced communication and continuity of care through telehealth services since the start of the pandemic, with the hope that new legislation will allow that virtual care to continue.
Read on for our monthly roundup of the most significant developments in telehealth:
University Business
As telehealth services continue to become widely adopted across the healthcare community, medical schools are beginning to offer telehealth-specific training. From learning how to properly conduct virtual interactions with patients to correctly administering visual exams online, future medical students will need the proper telehealth training to provide the best patient care.
mHeatlh Intelligence
Since the start of the pandemic, there has been a significant increase in the number of states improving access to telehealth coverage. Looking at state’s telehealth coverage policies between March 2020 and March 2021, a Commonwealth Fund study revealed that audio-only telehealth services will now be covered in 21 states, and many states are moving towards limiting cost-sharing for telehealth patients.
Cancer Network
Patients receiving hematology and oncology treatment have reported satisfaction with switching to telehealth services during the pandemic. Telehealth video and telephonic services have led to better continuity of care, enhanced communication, and improved treatment adherence, according to patients receiving cancer treatment. While many telehealth policies are due to expire, the continued use of telehealth to treat cancer patients will be essential to providing optimal care.
mHealth Intelligence
A recent survey by Medusind found that 66% of healthcare organizations will continue to provide telehealth services after the pandemic, and indicated the potential savings on overhead as a motivation for practices to continue offering telehealth consultations. One survey respondent indicated that one of the surprises of telehealth was “how many patients actually prefer it versus coming into the office.”
Healthcare Dive
Exploring new data from the past year, a study by McKinsey and Company revealed that telehealth services are now being offered at 38 times the rate before the pandemic. As of April, telehealth services are provided by 84% of doctors, and 57% said they would like to continue offering it. And venture capital funding for digital healthcare continues to grow, with $14.7 billion already brought in during the first half of this year.
Expanding Telehealth Access to Underserved Populations
As a country, we’ve long known that rural communities struggle to access quality health care. Rural hospitals are closing in large numbers, according to the Center for Health Care Strategies, with more than 120 closing in the decade preceding the COVID-19 pandemic. Health care centers that have remained open struggle to attract and retain doctors, nurses, and other medical professionals; National Conference of State Legislatures data show only 11 percent of the country’s physician workforce is located in rural communities. These dwindling resources serve populations with deep-rooted health problems exacerbated by high rates of poverty and chronic conditions.
The promise of telehealth for underserved rural communities
The rapid expansion of telemedicine during the pandemic proved a silver lining for those seeking to expand health care access to these communities.
“Before the pandemic hit, rural hospitals were struggling financially and closing at a greater rate than ever before,” Neeraj Puro, an assistant professor health administration at Florida Atlantic University, told HealthTech magazine in January 2021. “The adoption of telehealth technology has given a new lease on life to the rural hospital itself.”
Here are a handful of examples of how hospitals and medical centers have implemented telehealth solutions to serve far-flung patients.
- A pilot program in South Dakota focused on using telehealth to improve outcomes for pregnant women with gestational diabetes in rural areas of North Dakota, South Dakota, Minnesota, Iowa, and Nebraska. The study’s results, explored in Medical Economics, showed that remote blood sugar screenings and interactive video visits decreased C-section rates by 20 percent and increased vaginal deliveries without complications by 27 percent among participants.
- On its “Telehealth and Rural Communities” web page, the CDC highlights many examples of how telehealth has been used to help people successfully manage chronic conditions. A home-based cardiac rehabilitation program, supplemented with smart devices and applications that connected patients with medical staff (for remote patient monitoring), produced safety and effectiveness measurements on par with in-person programs. Similarly, participants in a telehealth-based diabetes self-management program achieved weight loss and participation rates on the same level as those enrolled in physical programs.
- A northern Michigan hospital system pivoted away from traditional home and internet-based telehealth services when it realized that nearly half of the residents in its region lacked high-speed broadband internet access. The system – highlighted in an article published by the Journal of the American Medical Informatics Association – offered telehealth access via telephone or encouraged patients to complete a visit at a designated location that had reliable internet access.
What are the challenges related to telehealth services in rural communities?
Although there are numerous success stories like these, substantial challenges remain for telehealth access in rural and underserved communities as the pandemic comes to an end. “While telehealth has helped bridge the communication gaps, allowed for the continuation of care…some longstanding barriers must be addressed to improve the effectiveness of telehealth,” wrote the American Association of Family Physicians in July 2020.
Broadband internet access
The first significant challenge to telehealth in the post-pandemic world is broadband internet access. Reliable internet access is a prerequisite for telehealth services, but the Center for Health Care Strategies estimated in June 2020 that only 75 percent of households in non-urban areas have such access – compared with nearly 90 percent in urban areas. America’s political leadership seems to recognize this problem and are taking steps to solve it. The Biden Administration committed more than $6 billion in funds from the American Rescue Plan into community health centers, which focus on medically underserved communities and vulnerable populations – including rural communities. Additionally, the administration has requested an additional $65 million over 2021’s enacted level for the Rural e-Connectivity Program, created to help increase broadband internet capacity in rural communities.
Reimbursement, credentialing, and other policy concerns
The second major challenge to telehealth in the post-pandemic environment is the uncertainty surrounding future policy. Before the pandemic, Mirna Becevic, an assistant professor of telemedicine at the University of Missouri, told US News and World Report in 2018 that the technical expansion of telehealth isn’t the biggest headache for hospitals and health care centers – it’s the question of whether they’ll be reimbursed for telemedicine just as they would in-person care. If they won’t get paid for telehealth services, hospitals and medical centers will not be incentivized to provide them.
In response to the public health emergency wrought by the pandemic, the Centers for Medicare and Medicaid Services greatly expanded the number of telehealth services it deemed reimbursable. Many states dropped “originating site” restrictions that refer to the location of the patient at the time they receive medical care. Some states relaxed licensing and credentialing requirements, allowing doctors to provide medical care across state lines through telemedicine.
At this time, no one knows for certain whether these amended policies will continue beyond 2021 – but there’s reason to hope that, at least on the federal level, some changes will live on. For example, Secretary for Health and Human Services Xavier Becerra addressed expansion of telehealth as a priority for his department during his Senate confirmation hearings earlier this year. He specifically mentioned the importance of permanently enshrining payment parity for telemedicine as a “key component” of his strategy to “decrease health inequities, particularly in remote areas where it’s difficult to get in-person access to care.”
Regardless of what happens in the halls of government, telehealth – in some way, shape, or form – will remain a vital part of any strategy to provide better medical care to underserved rural communities. Caregility looks forward to being your partner in that process, enabling your hospital or health center to better serve your patients, no matter where they live.
Contact us to learn more about our telehealth solutions and consulting services.
A Physician’s Guide to Telehealth Consultations
The past year provided a crash-course for hospitals, medical centers, and individual providers in how – and how not – to do telemedicine. Organizations and leaders across the medical profession have presented and published their hard-earned lessons about virtually providing high-quality healthcare services that benefit both the provider and the patient.
As more health systems scale up toward enterprise telemedicine solutions, it’s important that the providers who perform these virtual visits and consultations embrace new skills and best practices. Here’s a collection recommended by leading voices across the medical profession.
Pre-visit considerations for telehealth providers
Be strategic with your telehealth implementation.
Even though many states are lifting their COVID-19 restrictions, telehealth will continue to be the preferred mode of care in many situations. Think about what kinds of care – and what types of patients – most easily lend themselves to a virtual care solution. Then, consider what technology you have on hand and what you’ll need to purchase or lease to provide that level of virtual care on a long-term basis.
Properly integrate telemedicine consultations into your practice
There are many telehealth platforms on the market, but you’ll want to ensure your telehealth service works with your existing systems – not outside them. The best telehealth platforms are intuitive and easy to use, leading to more actionable consultations.
Doctors, nurses, medical assistants, and any other personnel who will be involved in patient encounters need to participate in training and practice using their hospital or health care center’s telemedicine platform. Though this may be a hodgepodge, look for a platform like Caregility’s, that can support multiple applications so staff are not faced with a handful of apps to learn and support.
After training, a checklist of tasks can be a helpful refresher and a useful resource on how to troubleshoot problems that may occur in the middle of an encounter. Consider organizing some simulated virtual care visits and then provide feedback on clinician performance.
Prepare your patients to use your telehealth solution
A pre-appointment call with medical staff can address any questions about internet connectivity and devices. Your staff can also inquire about whether a patient has access to items like thermometers, blood pressure monitors, scales, or other tools that will be required to complete the e encounter. These calls are also good opportunities to demonstrate that, although the visit will happen remotely, it will be just as private and secure as a visit to the office.
It’s a different type of medical encounter.
Providers struggle to deliver quality telemedicine experiences when “they try to take what they do in person and move it, en block, to the virtual realm.” That’s what Nele Naik, director of emergency medicine simulation education and an assistant professor of clinical emergency medicine at Weill Cornell Medicine, said during an AMA webinar.
So, how can health-care providers overcome the challenges of communicating with patients remotely?
First, providers need to develop a good “webside manner” – which means:
Making your environment look – and sound — good on camera
Obtain professional lighting and position it to avoid glare and spotlighting. Keep your office or work area free of background clutter that may appear in the frame and distract the patient. Ensure your office remains quiet for the entire visit by turning off the sound on devices whose alerts could interrupt your conversation.
Greeting the patient and putting them at ease
Introduce yourself to the patient, ask them where they’re located, and ensure any other people who may be joining them are necessary to the visit (to ensure the encounter is HIPAA compliant). Let them know you’ll be asking questions to help evaluate, diagnose, and treat their condition. Encourage them to speak up at any time if they cannot hear you or don’t understand what you’re saying. Ask for a phone number or alternative communications method to reach them in case the internet connection fails.
Remaining fully present during the telehealth visit
Review your patient’s chart before the visit or use dual monitors so you can refer to their electronic health record without looking down and shuffling papers. “The fundamentals of patient-centered communication still apply,” wrote a doctor reflecting on his experiences providing telemedicine consultations during the pandemic for Harvard Medical School. Use open-ended questions, practice active and reflective listening, and include the patient in any decisions you recommend.
Checking in with the patient after the telehealth visit
Make sure your patient had a good experience by reaching out personally or via a medical assistant for a follow-up call. Ask about any challenges the patient had with the technology or the content of the visit. Use this feedback to continually improve the quality of the telehealth experience – for both you and your patients.
The transition to telehealth can be a challenge for both new and experienced providers. Yet with careful preparation and plenty of practice, telemedicine can be a tremendous asset in helping you and your organization build strong doctor-patient relationships now and well into the future.
Learn more about how Caregility can help you optimize your virtual care and telemedicine efforts.
