Integration: The Essential Ingredient of a Sustainable Telehealth Strategy

In the early months of the COVID pandemic, medical facilities and their clinicians moved swiftly to adopt telehealth services. But those speedy transitions came at a cost, since many telehealth applications do not effectively integrate with systems already in place.

As a result, the use and management of many different solutions has given rise to what eVisit co-founder Miles Romney calls “tech tool fatigue” for providers. Shayan Vyas, now a Senior Vice President at Teladoc Health, acknowledged that integration was an oversight when his former organization, Nemours Children’s Health System, first adopted telehealth.

“While we were quick to realize the power and significance of telehealth, the lack of electronic health record (EHR) integration remained a missing component of the care delivery model,” Vyas told Becker’s Hospital Review. A few years later, Nemours sought and achieved that very integration.

As healthcare organizations discover that “cheaper,” one-trick pony tools cost more time (and lost revenue) in the end, they are turning their attention to the same level of integration that Nemours achieved. Here are three reasons why:

1. Telehealth integration improves the provider experience

The effective integration of telehealth technology into the clinical workflow has long been a concern for physicians. It was identified as a roadblock to technology adoption as early as 2016, when the American Medical Association first benchmarked the integration of digital health tools into clinical practice.

With patient care their priority, few clinicians find time to learn the nuances of multiple technology platforms, let alone leverage them to their full potential. Thus, from its inception, Caregility’s platform has enabled clinicians to launch a video visit or care team conference from a familiar interface: the system they’re already using to review a patient’s medical record or document an encounter.

Similarly, shortly after launching its telehealth platform in 2014, Nemours worked to integrate that system with its EHR. After the integration, the system “brought appropriate information right into the visit, enhancing the provider workflow while simultaneously making it easier for physicians to deliver better care,” Vyas noted. The introduction of a streamlined platform corresponded with increased adoption among the system’s physicians.

2. Integration improves patient experience and outcomes

An integrated telehealth platform provides the patient with a seamless experience. On the front end, a telehealth platform that’s integrated with an EHR platform, its scheduling program and its patient portal ensures that nearly all patient communication — from scheduling appointments to receiving appointment reminders to attending the telehealth encounter itself — can be accessed from one place. The simplicity of a “one-stop shop” helps patients to make and keep appointments, as well as communicate regularly with their care teams via the platform.

Integration can also improve the quality of patient care. When physicians use stand-alone telehealth applications, they may be unable to use other applications in the same browser window or even on the same device. This presents two problems.

First, dueling applications lead to a disjointed patient experience. The doctor may be distracted — searching through open browser windows for the patient’s EHR or shuffling through papers on their desk for lab results — instead of focusing on what the patient is saying.

Second, critical information may be incorrectly entered into the patient’s health record or lost altogether as the provider works to move notes between systems. An integrated telehealth platform can help drive efficiency and positive outcomes, while reducing the likelihood of data entry errors that could in turn lead to medical errors.

3. Integration expedites the billing process

Physicians cannot get paid if they do not correctly bill insurance companies (or, in some cases, patients directly) for their services. When documentation for telehealth visits must be manually entered into the EHR, that delays reimbursement and introduces potential errors.

“From a reporting and analytics perspective, anything that is documented outside a health system’s EHR system is difficult to track,” Vyas told Becker’s. “Being able to collect data within the EHR for long-term telehealth outcomes will make payment and billing easier for healthcare organizations, payers, and providers.”

What telehealth integrations should you consider?

Integrating a healthcare organization’s telehealth platform with its EHR is a critical move — but it’s not the only integration providers should investigate. Other technologies that can be valuable complements to a telehealth platform include language interpretation services, clinical decision support, digital health devices, patient engagement platforms, and remote patient monitoring.

Caregility’s award-winning, enterprise-grade virtual care platform offers a responsive, self-healing, purpose-built, end-to-end telehealth solution for any use case—that integrates with and adds value to EHRs, advanced analytics, practice management workflows, medical devices, and more, for a truly holistic view of the patient. To learn more about how Caregility could help your healthcare organization streamline its telehealth strategy, contact us today.

Behavioral Health Demand Spikes—Telemedicine Answers

In April 2021, the COVID-19 Healthcare Coalition released an analysis of telehealth claims data to better understand the “dramatic shifts in the locus, roles, and reasons for seeking care during the pandemic.” The data the claims were derived from represented roughly 50% of all private insurance claims, de-identified, from January 1, 2019, through December 31, 2020.

What the coalition’s analysis showed is that telemedicine visits for behavioral and mental health practically dwarfed all other diagnoses:

As health systems continue to move past ad hoc telehealth implementations and look for enterprise telehealth solutions, it’s important that they understand the rising demand for behavioral health treatment, how technology can support that rising demand, and how telehealth can increase patients’ access to behavioral health providers.

Rising demand for behavioral health treatments

Demand for all kinds of telehealth rose during the pandemic—but demand for behavioral health truly skyrocketed. According to the claims analysis above, in the first month of the pandemic, telehealth visits for behavioral and mental health rose 1,000 percent. By the next month, the peak, they had risen nearly 3,000 percent, to more than 5 million.

Use has since tapered, but in the new year, all signs point to a sustained surge in demand for mental health services delivered via telehealth. A Kaiser Family Foundation survey showed that 4 in 10 adults reported symptoms of anxiety or depressive disorders during the pandemic. And, like in other specialties, those who delayed care during the pandemic are now seeking to have those concerns addressed.

Meanwhile, a separate KFF analysis showed that the geographic distribution of mental illness in the U.S. varies considerably across states:

In Utah and West Virginia, for example, more than a fourth of adults reported some form of mental illness. States in New England, the Pacific Northwest, and scattered through the Midwest also reported higher rates of mental illness, while Texas, Florida, Georgia, Virginia, and Maryland, as well as Iowa and South Dakota, reported relatively lower incidences.

With demand rising, but also spread unevenly, telehealth is an increasingly relevant solution.

How technology can connect patients to telepsychiatry & behavioral health resources

The Commonwealth Fund categorizes the delivery of mental health into four models:

1. Hub and Spoke. A familiar model for health systems, the hub and spoke centralizes specialists in one location, such as a hospital or large medical center, and uses telemedicine technology to connect to patients who visit outpatient clinics in the surrounding community.
2. Integrated Care. In this model, primary care offices contract with a mental health provider or telemedicine technology solution to connect patients within that group practice to mental and behavioral health resources. Patients still access those resources at a clinical location.
3. Direct to Consumer. Using telemedicine technology to go direct to consumers has truly exploded in recent months, with new investment flowing into the sector and stand-alone mental health services advertising direct to consumers, who can then access a mental health provider right from their home.
4. Mobile Applications. These are similar to a Hospital at Home or remote patient monitoring program, but for mental health. In this model, patients use mobile technology to monitor their own symptoms and/or track prescribed mindfulness exercises designed to alleviate symptoms of depression or anxiety.

How telehealth options increase access to behavioral health providers

Providing remote access to behavioral health providers can dramatically improve access to care, especially for those in rural areas served by critical care access hospitals. In these locations, care providers often struggle to connect patients to the mental health resources they need.

Patients who come into the ER for a mental or behavioral health concern often need to be seen by a psychiatrist before the hospital can determine whether they should discharge them. In these cases, providing access to a psychiatrist via telehealth technology is a critical tool for hospitals to get the right care to behavioral health patients in a timely manner.

As the American Psychiatric Association reports: “There is substantial evidence of the effectiveness of telepsychiatry and research has found satisfaction to be high among patients, psychiatrists and other professionals.”

And, whereas prior to the pandemic state licensing requirements acted as a barrier to using telehealth to increase access across state lines, many of those requirements have since been dropped or temporarily waived. Now, all trends point toward safeguarding that access, especially for rural America.

Learn more about how Caregility’s telehealth technology platform can help support your organization’s mental or behavioral health program.

One Obvious and Three Unobvious Sources of ROI in Telemedicine

When it comes to calculating the return on investment for telehealth implementations, some sources of ROI are obvious, and some are not so obvious. Some are easy to calculate, and others are necessarily difficult. Some telehealth implementations deliver an immediate, transparent reduction in staff time and utilization, while other impacts may be indirect or further downstream, making them difficult to predict.

In my time talking to health systems about the ROI of a telehealth implementation, I’ve noticed there is at least one way in which the return is obvious and easy to calculate — but three which are not as obvious.

The Obvious: more efficient staffing, especially in patient sitting

By now, most health systems and physician groups understand that one of the core functions of a telemedicine solution is to deliver the ability to improve staffing efficiency and patient volume across multiple sites.

Nowhere is that ROI calculation more readily apparent and easy to calculate than when it comes to patient sitting. As my colleague Donna Gudmestad wrote in a post last year, virtual sitting both protects patients and keeps down costs:

Patient sitters traditionally provided in-room support to patients at risk of falling, injury, self-harm, or other behavioral issues. But, providing a physical sitter in each room can amount to a hefty unbudgeted expense for healthcare organizations.

Virtual patient sitting allows a health system to invest upfront in technology, and save in the long-run on that hefty unbudgeted expense of in-person patient sitters. The ROI calculation here is easy: telemedicine will offset X number of employees, paid $XX/hour, at X number of facilities.

But there are also other ways to think about the ROI of a telemedicine implementation.

The Unobvious

1. Consolidation of vendors

If 2020 was the year telehealth saw widespread acceptance and adoption amid the pandemic, 2021 is the year when health systems are figuring out how to scale those ad hoc implementations into enterprise-wide solutions. To do so, they must often consolidate vendors.

Consolidation often provides its own return by reducing the investment in staff training and resources needed to learn multiple telemedicine platforms. Consolidating vendors may also reduce the inefficiencies which come from managing interoperability between multiple platforms.

On top of these benefits, consolidation of vendors will simply make the ROI easier to calculate.

2. Ability to scale

Speaking of consolidating vendors, the ability of a telemedicine platform to scale as you leverage it for more use cases provides its own form of ROI.

Take Zoom or FaceTime as examples. Many organizations turned to these tools in an emergency at the height of the pandemic. Both can get clinicians face to face with a patient, or connect a patient to their loved ones at home. But neither can scale much into other use cases.

Each time you run into the limits of what a particular point solution can provide, you must go through the process of soliciting proposals, identifying another platform, and then implementing and training staff on its use. Choosing one platform that will scale to other use cases as your organization is ready eliminates that investment in time and resources.

3. Pricing structure

Similar to above, your vendor’s pricing structure should be taken into consideration when accounting for a potential future expansion.

A peculiar aspect of the recent boom in telemedicine solutions is that few of them are competing on price. It turns out that qualities like ease-of-use, interoperability with the hospital’s EMR, and ability to scale have been more salient factors when it comes to deciding which vendor to use.

Still, the pricing structure matters when you begin to scale: will it require big new technology investments, or a steep increase in the unit cost? These are crucial considerations in the eventual ROI calculation.

4. Returns from a better Patient Experience

Finally, don’t forget that improving the overall patient experience will provide numerous returns, both direct and indirect. As we wrote last month, ensuring a seamless patient experience will help health systems hold on to the patients with whom they have already developed a relationship as well as potentially attract new ones.

Nearly 15 million people lost their employer-sponsored health insurance as a result of the economic upheaval caused during the pandemic — and as the economy recovers and these people find new jobs, new insurance plans, and new care providers, those systems which have properly integrated telemedicine into the entire patient journey will have an edge.

In a post-pandemic world, the last thing a health system can afford is losing patients to another organization because they’ve created a better care experience.

Learn more about how the Caregility platform can help your organization.

Best Practices for Telehealth Cybersecurity During COVID-19 and Beyond

Many healthcare providers who implemented telehealth services weeks or days after the coronavirus pandemic struck may have put telehealth cybersecurity issues on hold as patient needs and the delivery of remote services took precedence. In 2021, telehealth is continuing its ascent, increasingly becoming woven into the fabric of our healthcare delivery — yet cybersecurity threats are also on the rise. Now, it is time for healthcare organizations and medical groups to give telehealth cybersecurity the attention it deserves to safeguard the privacy and security of patient health data.

There are compelling reasons for doing so. Telehealth visits grew 350-fold in April 2020 compared to pre-pandemic levels, according to the Department of Health and Human Services. The trend shows no signs of slowing, and as telehealth and telemedicine usage increases, so will the exposure of patients and healthcare organizations to cybercrime involving personal medical information.

“A rush to develop and implement telehealth technology and a host of other digital health services could make it even easier for cybercriminals looking to gain access to private medical records in the coming year,” cautions consumer credit bureau Experian in its most recent Data Breach Industry Forecast.

Noting that telehealth providers experienced a 30% increase in cybersecurity findings per domain in 2020, the organization predicts that breaches involving personal medical information will be a major data breach trend in 2021.

Although providers were given flexibility during the pandemic in using non-HIPAA-compliant platforms for telehealth services through the Emergency Use Authorization, hospitals and medical groups should still be doing everything they can to protect their patient’s health information as their telehealth services gain traction.

Here are some recommendations to avoid breaches in privacy and security even as telehealth continues to expand:

• If you are currently using a consumer videoconferencing tool, plan to transition to an enterprise video conferencing product designed specifically for healthcare. The consumer video conferencing platform Zoom experienced a 10-fold increase in usage with the onset of the pandemic, much of it by healthcare providers. With that growth came increased incidents of “Zoom-bombing,” the disruptive intrusion, often by trolls, into video conference calls.

• Posing additional risks are the potential for eavesdropping on patient visits stemming from inadequate encryption and the possibility that an eavesdropper could capture a screenshot of patient health information that is being shared during a virtual visit.

• Enterprise grade products may include security features such as encryption or a waiting room with every teleconference that allows the host (clinician) to control when a participant joins the conference. These security features can be standardized across the organization.

• Implement multi-factor authentication for providers as well as for all patients who have online accounts with the provider. This is one of the simplest and most powerful actions providers can take to boost cybersecurity using any one of several easy-to-install MFA systems currently on the market. Industry research shows that an account is more than 99.9% less likely to be compromised when MFA is used.

• Consider updating your encryption. Though most organizations are encrypting patient health information, the goal with encryption is to make it computationally harder and more expensive for hackers to spend the time and energy attempting to compromise the data that is being encrypted. This goal can be achieved with software that uses some of the more powerful and modern encryption methods developed in recent years.

• Apply the principle of least privilege, limiting access to telehealth and telemedicine platforms to the minimal level users require to carry out their duties and responsibilities.

• Change default passwords to strong passwords for all devices and systems.

• Educate and regularly re-educate clinicians, staff and patients on privacy and security best practices and sources of telehealth security threats. (A recent study published in the Journal of Medical Internet Research found that workload had the strongest impact on the rate of clicking on phishing links by employees.)

• Because healthcare hackers tend to target older legacy systems with insufficient security, consider updating your network security. Though replacing your network infrastructure may seem daunting, it pales in comparison to the costs of a data breach that could compromise your patients and their private medical information and jeopardize your organization’s reputation and trust within the community.

• Should an incident or data breach occur, be prepared with a thorough response plan that has been tested and practiced in advance to minimize the negative consequences.

• Use white hat hackers and penetration testers to find holes in your cybersecurity approach. This form of “stress testing” will help you discover your company cybersecurity’s strengths and weaknesses.

For more information, download our white paper, “Telehealth Video Application Security.”

Developing an Inpatient Virtual Care Strategy That Works

Healthcare organizations are moving beyond the ad hoc implementations which characterized virtual care and telehealth during the earlier stages of the COVID-19 pandemic. It’s now time to transform the stopgap tactical telehealth measures they deployed when COVID-19 first hit into cohesive, forward-looking, patient-centered care strategies that support their long-range goals.

The Benefits of Developing an Inpatient Virtual Care Strategy

An interoperable, platform-focused approach will provide a framework for an inpatient virtual care strategy that is scalable, secure, reliable and capable of evolving and adapting as an organization changes and grows.

As part of a comprehensive telehealth services plan, platform-based inpatient virtual care can help healthcare organizations with a number of challenges, beginning with improving safety and quality. Telehealth at the bedside can enable care teams to deliver quality inpatient and virtual medical care and expand observation while reducing contact exposure and conserving PPE.

Similarly, inpatient virtual care can reduce the care team burden. By providing interoperable solutions and an “always connected” platform, care teams are freed to focus more on meaningful contact with patients and less on redundant, time-consuming tasks.

Inpatient virtual care can shape patient engagement, by providing digital tools at the bedside, preparing for them for discharge, and minimizing the risk of readmission.

And finally, inpatient virtual care can address health inequities. Virtual remote interpretation (VRI) capabilities can be integrated into existing platforms to reduce health inequities for deaf, hard of hearing and limited English proficient patients. To overcome disparities for patients of lower socioeconomic backgrounds who do not have access to devices, organizations can provide devices to enable equitable access to virtual services.

Overcoming Obstacles

Multi-phase plans based on scalable technology can help organizations overcome common stumbling blocks as they incorporate an inpatient virtual care strategy into their overall telehealth capabilities.

These factors include:

• Legacy facilities and infrastructure. The answer here is to focus on key opportunities for digital solutions in patient rooms, with an eye on phasing in capabilities using modular platforms.
• Capital expenditure. Healthcare providers are under more financial pressure than ever. The key is to look for partners that offer cost-effective virtual care solutions and a pathway to the future. This might mean starting simply with tablets at the bedside and planning for large wall displays, cameras and microphones down the road when budgets allow.
• Patients’ own devices. Patients’ personal devices are not a reliable solution for virtual care, and not all patients have devices. Organizations should look instead to interoperable platforms that run on any device available, including enterprise hardware.
• Security and trust. The loosening of HIPAA restrictions during the beginning of the pandemic is not the way of the future. Organizations must plan for inpatient care solutions that ensure HIPAA compliance.
• Care team adoption. To ensure acceptance and consistent use by care team members, virtual care solutions should work seamlessly together to share context so clinicians can easily connect to patient rooms without additional passwords, interpreters can be instantly connected, and specialist visits can be documented in the EHR without extra steps.
• Change management. The implementation of an inpatient virtual care strategy involves some changes in routine practices. Designating an executive sponsor to introduce the platform and champion implementation can help smooth the transition.

The 4 C’s of an Effective Virtual Inpatient Care Platform

Healthcare organizations developing or searching for a virtual inpatient care platform need to keep in mind the four C’s of an effective platform: Consultation, Communication, Connection, and Control.

The platform must have the ability to consult with specialists in remote locations, as well as the ability for care teams to communicate safely with patients who are quarantined. Patients must also be able to communicate readily with care teams, and connect with friends and family, even if quarantined. And finally, a virtual inpatient care platform should deliver technology in the service of engaging and empowering patients and families during the hospital stay with everything from meal ordering and room lighting to personalized patient education and discharge planning.

Gauging the Success of Your Virtual Care Strategies

Organizations should plan to measure the effectiveness of their inpatient virtual care strategies using metrics such as:

• Language access. What percentage of encounters utilize language access? How long do patients wait for an interpreter? How do staff feel about using the solutions?
• HCAHPS scores. How do scores for patient satisfaction and experience compare before and after implementation?
• Average length of stay and readmission rates pre- and post-implementation.
• Compliance with current regulations regarding security, privacy and language access.
• Care team satisfaction. Do clinicians find the technology helpful and easy to use? What do they like and not like and how can problems be addressed?

Despite the pandemic, current technology combined with new care strategies makes it possible for providers to significantly broaden their telehealth capabilities now and to begin delivering enhanced digital resources to the bedside for the benefit of patients and care teams alike.

Expanding telehealth but don’t know where to start? Read our post: 6 Musts for Choosing a Mobile Telehealth Solution