When Caregility launched in 2019 we had no idea just how quickly telehealth and hybrid care would prove to be essential aspects of healthcare delivery. What we found during and since the COVID-19 pandemic is that, above and beyond connecting providers with patients at home, telehealth is also a lifeline for clinicians working within acute care settings. Provider-to-provider telemedicine kept isolated care teams connected during the pandemic and it continues to help healthcare organizations bridge care gaps today.
For many health systems, provider-to-provider telemedicine sprouted in high-acuity units like the ICU, where virtual specialists were brought in to help support care for critically ill patients. Today that hybrid care model is being replicated in additional hospital units where clinical teams are understaffed and looking for clinical reinforcement. As workforce shortages persist, provider-to-provider telemedicine allows hospitals to add specialist and nursing capacity quickly, reducing recruitment burdens and costs associated with staff relocation.
As you evaluate your health system’s telemedicine strategy moving forward, here are five technology factors to keep in mind.
Single Platform – Look for a centralized telehealth platform that is adaptable enough to support a variety of clinical use cases to avoid investment redundancies. Begin by launching one virtual workflow and then expand virtual care programs out organically over time to keep changes manageable.
Device Fleet – Identify the key telehealth endpoint features needed for various care acuity settings: Will you use mobile carts, tablets, or wall-mounted systems? Do you need cameras that zoom in enough for virtual clinicians to read a syringe or wristband, or is a camera that gives a broad view of the room and its participants acceptable? Look for solutions that centralize and simplify fleet management.
Connected Health Integrations – EHR-integrated telehealth keeps internal clinicians in their native environment and brings clinical data into the virtual visit for remote clinicians. Consider what additional peripheral resources you want to include, such as digital stethoscopes, remote patient monitoring devices, clinical decision support tools, and language interpreter services.
Network Assessment – Early on in the process, conduct an assessment of your IT infrastructure to ensure that your network is optimized for always-on virtual care environments. Be mindful of the ways wi-fi and security protocol can disrupt virtual care and plan accordingly to guard against downtime.
Ease of Use – Look for a platform that allows care team members to easily bring other clinicians into calls. Device-agnostic platforms that offer a consistent user experience across desktop and mobile devices promote adoption. This can be particularly valuable in hybrid staffing models that require collaboration between on-site and remote clinical staff.
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
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.”
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
Behavioral health video visits skyrocketed during the COVID-19 pandemic
In April 2021, the COVID-19 Healthcare Coalition released an analysis of millions of claims data in an effort to describe “dramatic shifts in the locus, roles, and reasons for seeking care during the pandemic.” The data represented roughly 50% of all private insurance claims, de-identified, from January 1, 2019 through December 31, 2020.
By now, everyone is aware that the use of telemedicine skyrocketed during this time—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
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.
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.
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.
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.
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.
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.
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.
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.
Hospital-at-Home Programs: The New Frontier for Treating Chronic Conditions
With hospitals strained to their breaking points with COVID patients and people across the country wondering whether it was wise to go to the emergency room, many systems turned to hospital-at-home programs as part of the solution.
Remote monitoring and telehealth tools effectively extended the triage process for COVID patients into the patients’ own homes, easing the burden on hospitals and helping make sure only the patients who were most sick came in to get care.
Now, the growing hospital-at-home model is showing promise for addressing another critical health problem, one that is the single biggest driver of U.S. healthcare costs and mortality: chronic conditions.
Social determinants of health — the environmental conditions in which people live and work — play a much bigger role in causing and reinforcing chronic conditions.
By combining telehealth with a care-at-home program, hospital systems can begin to develop an awareness of and data on patients’ environmental circumstances.
“Normally it’s hard to uncover data on social determinants of health. But we think that telehealth will make collecting this data a little bit easier,” explained Peter McLain, Caregility’s Chief Strategy Officer and SVP of Business Development.
Vision for the future of care for chronic conditions
In the near future, care for those with chronic disease will rely not only on social determinants data but also patient data points that go well beyond the standard measurements of blood pressure, weight, and blood oxygen levels to include other relevant physiological data — all of these gathered from hospital at home products.
Meanwhile, telehealth home care will provide the connective platform to leverage that data through the patient’s entire care journey.
Using these health records and the information gathered during the initial consultation, providers will be able to create a personalized care plan for the patient, automatically generate customized workflows, and schedule video check-ins that correspond to the care plan.
Meanwhile, with the patient at home, remote telehealth devices or hospital-at-home equipment will be able to collect new patient data and automatically transmit it through the platform.
A combined hospital-at-home and telehealth program will allow providers to conduct video appointments via the telehealth platform and then use those appointments to gather information about the patient’s social and environmental circumstances, such as the patient’s transportation options, proximity to grocery stores selling healthy food, and the safety of the local neighborhood.
The patients would also get an easy-to-understand overview of their health via a patient dashboard. If the patient for any reason was beginning to deteriorate, that would set off an alarm or notification, and the provider could initiate a video call with the patient to investigate further and get the patient back on track.
In short: a robust telehealth hospital-at-home program would facilitate preventive care that nips problems in the bud.
Telehealth home health care for chronic conditions would be efficient and effective
Another advantage of care-at-home models is that providers could check on more patients via video per day than they would be able to see if traveling to different nursing homes and assisted-living facilities.
In addition, a platform that incorporates social determinants of health data would enable providers to more effectively guide patients toward better health. Specifically, the social determinants data would reveal factors that were impeding patient compliance with the care plan.
For example, if the patient wasn’t following a recommendation to eat a plant-based diet, environmental data might reveal that the patient lived in a so-called food desert, where access to healthy food is limited. To address this problem, the care team could identify a program or service that delivers healthy food to the patient’s home.
Or, if the patient lacked transportation to a pharmacy, the care team could arrange for low-expense mail-order prescriptions.
Learn more about how we’re building the future of care for chronic diseases
If you’re interested in learning more about this new hospital-at-home model, please contact us.
As McLain explained, “The paradigm of care for chronic conditions has shifted to a telehealth model, and this new frontier is wide open for innovation.”
Combining the Future of Telehealth into a Virtual Care Platform
2020 brought the crucial nature of virtual care to the forefront of healthcare delivery. From mitigating the spread of the coronavirus to connecting isolated patients and providing care for non-COVID patients, we have seen validation of telehealth under the most extreme circumstances as healthcare organizations grapple with the COVID-19 pandemic. Telehealth is now a critical component of care delivery, not just a “nice-to-have.”
How Telehealth is Shaping the Future of Healthcare
As we look ahead to the future of telehealth medicine, virtual care will continue to lay the fundamental foundation needed to enable agile and effective care with the right clinician, at the right time, and in the right location for patients. Inpatient care will increasingly be imbued with virtual components that improve productivity, patient outcomes, and provider experience.
A wide range of patient engagements will employ a digital-first strategy designed to bring costs down, improve patient satisfaction, and make the entire experience more convenient for the patient and caregiver alike. Telehealth will be reinforced with a new era of predictive tools and applications that augment the information available to improve overall outcomes.
In 2021, the blending of artificial or augmented intelligence (AI), wearables, and two-way video will advance virtual patient care. The combination of these technologies into a comprehensive virtual platform will help providers improve population health and outcomes across more patients as they extend the hospital room outside of the physical facility and into patients’ homes.
First and foremost, virtual care will continue to drive efficiency in inpatient care. AI will play a tremendous role in enhancing clinical insight and enabling care for more patients, in spite of challenges related to limited staff resources. Although artificial intelligence gets the lion’s share of attention in the world of healthcare innovation, it is essential that we do not underestimate the importance of the human element in the marriage of healthcare technology and care delivery. Rather than refer to it as artificial intelligence we prefer to focus on the concept that, in reality, it is augmented information.
Investments in augmented information are equally important as a steppingstone in complementing and enhancing the existing workflows of clinicians. Nothing can replace a knowledgeable, experienced caregiver, but how much more effective can they be if we augment the information they have at their fingertips? Continuous virtual monitoring of patients, data capture through wearables, and access to predictive algorithms that can help providers anticipate conditions affecting the patient’s outcome can combine to improve care.
Hospital at Home
The acceleration of telehealth and virtual care to address how to provide services to patients unable to visit their doctors during the pandemic has proven virtual care is not only viable but often the preferred option. As a result, hospitals are looking for ways to extend the healthcare engagement experience into the patient home. While this has largely been pursued out of necessity in order to reach patients isolating at home during the ongoing COVID-19 pandemic, it is also fueled by evolving patient expectations around easier access to care.
Virtual care models represent the modern-day equivalent of the home visit or house call of the past. Technology platforms and an array of connected devices will become permanent fixtures in our homes, as common as connected thermostats or doorbells. These virtual care solutions offer a cost-effective means for reducing some of the overhead commonly associated with hospital stays, as well as increased convenience and comfort for patients. Home-based care has the added advantage of minimizing exposure to infected patients by the healthcare staff.
Wearables in Healthcare
The proliferation of Internet of Things (IoT) devices and wearables as a growing trend will have an impact on virtual care an telehealth in coming years. Wearables such as smart watches, fitness trackers, biosensors, ECGs, and blood pressure monitors represent some of the first home-health devices to approach ubiquity. Remote technologies that consistently measure and monitor patient vitals can accelerate provider insight into patient risk factors.
By proactively alerting care providers to warning signs, clinicians are able to intervene earlier to prevent adverse or catastrophic events—again offering patients the right care at the right time. These interactive devices can also encourage patients to make better health decisions in real-time. The rise of these “digital medicine cabinet” technologies will unearth previously untapped avenues for healthcare providers to advance the shift from responsive or reactive care to more proactive and preventive medical interventions. Management of access to and the security of these devices will be paramount.
What is the Future of Telehealth?
Each of these components have had varied success to date in individual use cases, but the real power and benefit will come from combining them into a comprehensive virtual care platform. Over the course of the past year, utilization of telehealth has clearly reached incredible levels and has established a new normal which is anticipated to remain even after the pandemic is over. Now is the time to optimize these technologies and prepare for growth.
Not only has virtual care helped us deal more effectively with the pandemic, but we have been given a glimpse of what the future of telehealth and telemedicine can be. The digital revolution in healthcare has begun and leveraging two-way video, wearables, and augmented information will enable us to create a better patient experience, improve outcomes, and be more prepared for the next challenge that might come.
The benefits of virtual care have been on full display in 2020 and as we move into 2021 and beyond it is clear that there is no limit to the ways telehealth can positively impact the overall experience and outcomes across the entire healthcare continuum.
This post was originally published on Population Health
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.
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.
Every telehealth vendor will claim their telehealth solution is easy to use — but how many have truly designed their platform for both patients and providers? And how many telehealth vendors have recognized the myriad constraints of different clinical environments, including during the pandemic, and chosen designs that address these challenges?
We recently created an eBook that provides a deep dive on ease of use in telehealth, including concrete examples of how a well-designed user experience in telehealth technology can address clinical challenges.
Below we share a few of the eBook’s critical concepts and insights:
The pandemic introduced three principal constraints in using telehealth technology
During the pandemic, hospitals and providers have faced three principal challenges in implementing and scaling up telehealth technologies:
Constraints facing clinicians
Constraints facing patients
Constraints inherent in clinical facilities themselves
To achieve true ease of use, telehealth solutions must address all of the above categories.
For example, an effective telehealth solution must address the challenge that clinicians have to continually monitor patients with COVID-19.
Similarly, a telehealth solution must consider that patients with COVID-19 often have very limited energy (or are completely incapacitated) and thus need a very simple telehealth interface that, when necessary, can function without the patient having to do anything.
In addition, given that patients with COVID-19 are often isolated from family and friends, it’s critical to patients’ morale that they have an easy means of communicating and connecting with loved ones.
Ease of use is also critical in responding to a facilities challenge that has arisen during the pandemic: specifically, many hospitals have had to repurpose existing spaces, such as gift shops and conference rooms, into patient rooms.
A telehealth technology that requires a time-consuming installation would not be ideal when trying to quickly set up these converted spaces.
What user-friendly telehealth looks like from the perspective of patients
Given the fatigue many patients experience, the interface on telehealth technology must be intuitive and clear.
In this example of an easy-to-use mobile telehealth interface, there is one large red button for help, and one large green button to reach family and friends.
With just that one button, the interface automatically routes the call to the correct pre-programmed party. There’s no need for the exhausted patient to remember phone numbers, punch in numbers, or go through several screens.
Another design choice that contributes to ease of use for telehealth technology is not requiring a patient’s family to download a specialized app to interact with the patient. Instead, the patient’s family can receive a video call from the patient simply by clicking a link in a text.
Practical examples of telehealth that is easy to use for providers
Just as user-friendly telehealth technology must anticipate a patient’s constraints, so must it address a provider’s needs.
For example, providers sometimes need to communicate with a patient who is too weak to pick up a video call request from a provider. That’s why a feature like auto-answer at the patient’s bedside is key.
Or consider a provider who needs to remotely monitor a patient at night when the lights in the patient’s room are dimmed or off. A telehealth solution that shows the provider only a darkened room wouldn’t be of much use. But a camera with night-vision will enable the provider to watch the patient, while enabling the patient to properly rest in the dark.
Overcoming facility challenges
With so many hospitals having to repurpose spaces as hospital rooms, imagine if a telehealth technology required drilling through drywall to mount specialized cameras and monitors. That would not be an easy-to-use system.
Instead, ease-of-use means that the telehealth technology is device agnostic. It can work on smartphones and tablets, or simple carts with small cameras and screens can be rolled into a room.
The telehealth technology should also be reliable but able to reduce its wi-fi use when feasible to preserve bandwidth for other critical network-connected devices.
Ease of use in telehealth saves time
When a telehealth solution takes into account all of these real-world issues and others, its ease of use facilitates quick care, and fast, efficient care in a hospital setting can often be the difference between life and death.
Augmented Intelligence in Telehealth Holds Promise for Health Systems
If 2020 was the year that health systems embraced telehealth out of necessity and then discovered its many benefits, what might 2021 and beyond hold?
For health systems looking to further improve the cost savings and other advantages of telehealth, the new horizon is augmented intelligence: or, the use of artificial intelligence (AI) tools, such as machine learning, to assist and augment the capabilities of medical teams.
These tools can help with both routine administrative tasks and higher-level work, such as diagnosis, treatment, and patient monitoring.
Below we look at just a few of the helpful augmented intelligence tools that already exist in telehealth, preview potential future applications of augmented intelligence, and advise health systems on how best to take advantage of this new era in medical innovation.
Examples of augmented intelligence tools in telehealth and remote patient monitoring devices
The last few years have brought to market many remote patient monitoring devices that utilize augmented intelligence, enabling both hospital care staff and physicians to focus on other tasks while knowing that their patients are being continuously evaluated.
For example, EarlySense offers a sensor that is placed under a patient’s mattress and tracks multiple data points, including heart and respiratory rates. The sensor uses AI to analyze this continuous data stream and to detect early signs of deterioration, which the care team can then correct.
Similarly, Myia collects data from at-home patients with chronic conditions and uses machine learning to surface patients needing a clinical intervention.
Somatix offers the SafeBeing system, which is a remote patient monitoring device that relies on a wearable that uses AI to monitor gestures and passively collect biofeedback data. Somatix’s cloud-based system analyzes this data in real time to provide insights and alerts, such as an increased fall risk, for the care team. Somatix’s system works well for nursing homes and long-term care facilities.
Other companies are using AI to develop a more holistic portrait of patients’ health. Recognizing that clinical care accounts for only a small percentage of a patient’s health, with social determinants of health and behavior being major factors contributing to wellness, Innovaccer developed an AI-driven social vulnerability index that helps health systems see a fuller picture of both individual and population health.
We have also seen this type of technology being used to help with administrative tasks throughout various AI healthcare workflows.
For example, natural language processing, augmented by AI, can be used not only to transcribe patient-provider conversations during phone or video visits, but to assess which were the most salient points of the interaction and worthy of further attention. The resulting notes inform the provider’s care plan and also remind the patient of what was discussed.
In addition, as the Advisory Board wrote last year, at Providence St. Joseph Health in Washington and other health systems, system administrators have deployed chatbots to screen patients and direct them to the right resources, thereby discouraging the so-called worried well from unnecessarily coming into hospitals.
Future possibilities for augmented intelligence in healthcare
The possible future applications of augmented intelligence or AI in healthcare workflows are limited only by our collective imagination.
A Government Accountability Office Report envisioned that dermatology video visits may one day involve augmented intelligent patient care that assesses the patient’s skin for lesions and assists dermatologists in detecting precancerous and cancerous growths.
In this Becker’s Health IT article, a technology and data specialist with the University of California, Irvine, predicts that in the future individuals will have a digital health “twin” made up of all the data about an individual’s health. This twin’s data will continually be updated, and augmented intelligence tools will reveal health trends and trajectories for the individual as well as suggest personalized steps to better health.
Here, at Caregility, we predict that combining augmented intelligence with wearables and two-way video will be a game changer for virtual care, specifically when it comes to remote patient monitoring. Each of these components has had varied success to date in individual use cases, but when they are combined into a comprehensive virtual platform, providers will see the greatest benefit in improving care and reducing costs.
Taking advantage of the augmented intelligence revolution in telehealth systems
So, how can your health system benefit from all the latest applications in augmented intelligence in telehealth and be ready when new innovations reach the market?
To build a foundation for telehealth-enabled augmented intelligence technologies, the most critical step is adopting a flexible telehealth platform, capable of integrating with third-party apps and systems. Those who don’t start planning for the coming augmented intelligence healthcare transformation now may find themselves suddenly out-smarted and out-maneuvered: not by a human competitor, but by a learning machine.