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Category: Telemedicine

Healing Heros: Conversations About Veterans’ Healthcare Solutions and Telehealth

In the expansive realm of healthcare, Veterans grapple with a unique set of challenges that necessitate specialized attention. These challenges often stem from many factors, including the aftermath of military service, physical and mental health issues, and the complexities of transitioning back into civilian life.  

Many Veterans find themselves facing additional hurdles in accessing the care they urgently require. This impacts not only the individual Veterans but also their families and the broader community, as delayed healthcare could contribute to the worsening of existing conditions and, in some cases, escalate into crises. 

David Shulkin MD
David Shulkin, MD

Enter Dr. David Shulkin, the Ninth Secretary of the U.S. Department of Veterans Affairs, whose leadership style proved instrumental in addressing the complex problems afflicting Veterans’ healthcare. Dr. Shulkin, recognizing the urgent need for change, set a visionary goal: to achieve same-day appointments for Veterans nationwide. This audacious objective was not merely an incremental adjustment but a transformative vision that aimed to overhaul the existing healthcare system for Veterans.

As a new member of Caregility’s Board of Directors, Dr. Shulkin endeavors to leverage his expertise to advance the company’s mission of pioneering innovative methods for remote healthcare delivery.

His visionary leadership has left an indelible mark on the landscape of Veterans’ healthcare, and in this interview, we unravel the complexities and unveil the exceptional solutions he implemented. 

Military Doctor

Dr. Shulkin, can you share your approach to leadership and how you fostered a positive organizational culture during your tenure as Secretary? 

In my career, I’ve found that it’s easier to create bigger change than to do change through small increments. One of the issues when leaders try to make small changes is they get frustrated at how challenging it is to change the culture.  

Being able to clearly articulate where you want your organization to go, why you want to create this change, how it’s going to be accomplished, a timeline, and an accountability plan are all crucial to effect change. Make sure your organization understands all those factors, that you’re consistent in your messaging, and that you put the resources within the organization behind that change initiative. As Secretary, I ensured our initiatives were Veteran-centric and tapped into the strong commitment to mission within the workforce to foster positive culture and change.  

What strategies did you employ to improve the efficiency and effectiveness of the U.S. Department of Veterans Affairs? 

When I entered the Department of Veterans Affairs, we had a situation where Veterans were waiting long periods of time for appointments. The clarity I brought was making it our priority to get those wait times down. I was clear that we’d set same-day appointments before the end of that year and the specific ways we’d do that were listed; using telehealth technology was one way, and allowing VA professionals to go across state lines was also part of that. We also gave advanced practice nurses independent practice authority, creating additional staffing opportunities to do that.  

Efforts to make everyone accountable for that goal included actually publishing wait times publicly. Everyone could see what our goals were and whether we were achieving them. By the end of 2016, we had same-day appointments across the entire country at every VA facility. I believe we were able to accomplish that great change because there was clarity around what our objective was. 

How did you navigate budgetary challenges and allocate resources to ensure Veterans received the necessary care and support? 

The easiest answer when things are not performing the way anyone wants is, “Well, we don’t have enough money,” and I don’t think that is usually the answer. There are times that is true, but in my experience with the VA that was not the case. Congress would always allocate the money we needed to care for Veterans. The harder part is designing systems meant to get the results you want that are optimally performing, like finding ways to get your workforce to operate at their highest level of training or licensure and letting others field lower-level tasks or using technology to increase labor productivity but decrease the time to perform tasks to look for new, more cost-efficient ways to practice. That’s hard to do but it ultimately saves money if implemented well.  

As a new member of Caregility’s Board of Directors, what specific goals do you have in mind for the company’s role in pioneering innovative methods to deliver healthcare remotely? 

Healthcare has been one of the few industries in our economy that has not seen labor productivity improvements over the past decade. Instead, we continue to struggle with labor shortages and increasing costs. For a health system to get real value from technology it must be versatile and integrate into the current workflow. Caregility seeks to be the enterprise solution for health systems that seek to use technology to improve efficiency and outcomes.    

Looking ahead, what emerging trends or technologies do you foresee playing a significant role in shaping the future of telehealth, and how can Caregility position itself to stay at the forefront of these developments? 

Future strides in telehealth are going to be dependent upon the ability to integrate data sources, personalize care options, integrate care delivery among various disciplines, and use artificial intelligence and large language models to extract information from clinical and administrative data to better inform diagnosis and treatment options for patients. 

Homelessness among Veterans is a persistent issue. What strategies did you employ to address and reduce homelessness within the veteran population? 

We awarded grants to groups that operated in the communities. We also worked closely with HUD to expand the use of HUD-VASH vouchers for housing, including expanding benefits to Veterans beyond those who were honorably discharged. 

How did you ensure and measure the quality of healthcare provided to Veterans within the VA system? 

We measured quality using and comparing quality metrics in the private sector. We then published all our quality measures. When you look at the VA’s publicly reported outcomes compared to the private sector, the VA overall outperforms the private sector. This surprises many people. It demonstrates that an integrated system of care that can follow patients longitudinally and has a system based largely in primary care with strong integration with behavioral health does have better outcomes. 

That doesn’t mean the VA is best at everything. At the system level, it’s superior because private organizations often experience gaps in care. Care should still be an individual choice though. Sometimes you can get the best care for you within the community you live in. Or perhaps you need a heart transplant, and the best provider is a non-VA facility. You may need a treatment that the private hospital does better than the VA. You want to have a system of care that is transparent enough that you can actually look and see, “Is that the best care for me? Is it VA or a private system?” We need to be educated enough as consumers to make that call. 

During your tenure, the VA faced various challenges. Can you discuss a specific crisis or challenging situation and how you managed it effectively? 

The wait time crisis was our biggest challenge at the VA. We ultimately achieved same-day appointments for all urgent Veteran healthcare. 

There is a lot to be learned from the VA in terms of the integrated system of care, chronic care management, behavioral health integration, incorporating the social determinants of health into care planning, and decreasing access barriers like high copays and deductibles. 

Transparency is good for healthcare and it’s good for patients. If we can provide that information in an accurate way, we can improve the whole health system. That was my goal at the VA. Wherever you can shine light on issues, people will make better decisions. 

Rural Veterans often face unique challenges in accessing healthcare. What initiatives did you undertake to address healthcare disparities in rural areas? 

We had an office of rural health that addressed issues with home-based care, remote monitoring, and telehealth. 

Women Veterans have distinct healthcare needs. What steps were taken to ensure that the VA adequately addressed the healthcare and support requirements of women veterans? 

We created women’s health clinics in each of our medical centers and initiated new programs and policies and increased funding. 

Given the advancements in technology, how did you integrate telehealth services to improve accessibility for Veterans, especially those in remote or underserved areas? 

Tech needs to be a big part of a solution in accessing care where you don’t have physical facilities or the workforce distribution. There are other ways of addressing the access issue besides pure tech, but I primarily think that should be the essence of the solution – get people to care wherever the expertise exists.  

Other solutions include things like working with educational programs to do workforce training and to promote greater patient and family caregiver training to help people understand how they can be part of improving health in their communities, implementing preventative strategies, using tools like AI to help people get information on when they should access specialty care versus primary care versus urgent care, and the expansion of telehealth and remote monitoring care in the patient home and community. People want care where it’s most convenient for them. To me, that means either care on your phone where it’s mobile or care in your home.

Looking back on your tenure, what do you consider to be your most significant accomplishments, and what lessons did you learn that could benefit future leaders of the Department of Veterans Affairs [or health systems in general]? 

Creating a system of integrated VA and community-based care that served the Veteran is what I perceive to be our most significant accomplishment.  

My advice for others is that incremental change is overrated. Sometimes big goals, while risky, are the way to achieve great things. It’s important for every organization to ask, “What’s a goal that would make a big difference that would be wise for us to pursue?”  

Healthcare organizations have the responsibility to answer that question for their specific communities. Healthcare is geographic. Look at what clinical priorities there are for different patient populations in your community. Certain populations have a higher incidence of diabetes, for example. Look at not only the problems but how you’re trying to solve them. Be more proactive in outreach to solve problems.  

Many healthcare organizations still have a model where they wait until a patient has a problem and then schedule an appointment to bring them in. Organizations need to think about how we can reach out to people in the community to intervene and manage conditions better or prevent them from having to come to the hospital.  

In the Department of Veterans Affairs, when I became aware of drugs that can cure Hepatitis C, we looked at how many Veterans had Hepatitis. There were 176,000 patients documented in our database. We reached out to all of them to bring them in for the treatments that can cure that disease. By doing so, we were able to get it to less than 10,000 untreated Veterans. That proactive outreach model of intervention is extremely powerful. 

Read the Impaakt article where this interview was originally published here.

Five Tech Factors for Inpatient Telehealth

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.

Virtual nursing, virtual patient observation, and other provider-to-provider telehealth programs connecting internal and third-party specialists, nurses, and technicians are cropping up in hospitals across the U.S. As inpatient virtual care programs multiply, technology needs are shifting from siloed use cases to enterprise-wide enablement.

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

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:

Chart via Telehealth and Medicine Today

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:

Chart via

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:

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

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.

According to the Centers for Disease Control and Prevention, 90% of healthcare spending is on patients with chronic and mental health conditions. Moreover, chronic diseases such as cardiovascular disease, diabetes, and chronic obstructive pulmonary disease are responsible for more than seven out of 10 deaths in the United States and are the leading cause of disability.

Despite widespread awareness of this problem, the healthcare system has struggled to find an effective approach to chronic conditions in part because healthcare accounts for only 10 to 20% of populations’ health outcomes.

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.

In other words, the care model would enable a holistic approach to care that eliminates barriers to good health and even reverses chronic diseases.

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.

Augmented Intelligence

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.

Want to learn more? Check out our post on Augmented Intelligence in Telehealth.

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.

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:

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:

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

Ease of Use: What Does It Mean, Really?

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:

  1. Constraints facing clinicians
  2. Constraints facing patients
  3. 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.

For example:

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.

If you’re interested in reading more about how telehealth design choices facilitate ease of use and promote effective care, you can download our eBook What Ease of Use Really Means in Telehealth.