TELEHEALTH | PRECISECAREMEDICAL.COM

 A comprehensive service blueprint should directly compare and contrast in-person and virtual care contexts, which can differ substantially according to the reason for a patient’s visit. This side-by-side presentation can help uncover process complexities that may arise unexpectedly when health systems transition from in-person to virtual care. This will allow a health system to identify those elements of a care encounter that should be reproduced, removed, or enhanced in the virtual environment. The blueprint should categorize care-related activities temporally (i.e., before, during, and after the visit) and guide the technical assistance process for patients who have specific visual, auditory, language, technology literacy, or technology infrastructure needs.

 At a nuts-and-bolts level, the blueprint should describe each element of the care infrastructure, such as technology for remote patient monitoring, software for patient scheduling, screening tools for assessing patients’ needs, and educational materials for patients and caregivers. It also should identify the billing and reimbursement mechanisms that may differ for virtual care visits, if any. A well-developed service blueprint can facilitate implementation by naming accountable departments and individuals within them and anticipating potential barriers to and facilitators of adoption. To monitor the trajectory and success of virtual care, leaders should develop key performance indicators (KPIs).

 MDACC, for example, implemented a remote monitoring program for patients undergoing immunotherapy. The program was associated with significant reductions in emergency room (ER) visits and improvements in patient satisfaction.

 The dissemination and scale of this initiative was guided by KPIs that reflected three areas of strategic focus: stakeholder buy-in (“traction”), operational efficiency, and improvements in health-resource utilization. Measures of traction included utilization by eligible clinicians, percentage of approached patients who consent to participate, and patient-satisfaction scores. Operational efficiency was quantified by volume of patient calls on the platform, rates of patient adoption, and clinical satisfaction with workflow. Health resource utilization focused on patients’ rates of avoidable emergency room (ER) visits and length of hospital stays. Year-end performance, relative to preintervention baseline measures, guided decisions about scale and program iteration.

 Optimizing the virtual visit means making the overall patient-clinician experience as seamless as possible by integrating its component parts. Start by preparing patients and clinicians to use the required technology. Specifically, educate them on how to look at the camera during conversations, choose appropriate lighting and audio equipment, identify a secluded space with minimal distractions, and select a virtual background (if desired). These features, while seemingly minor, can greatly influence the overall experience of this relatively new way to deliver service.

 Integration also means streamlining all ancillary logistics that complement a virtual visit, including but not limited to making future appointments, facilitating prescription refills, and incorporating personal health information captured on in-home devices (vital signs, medication administration history, and patient reported outcomes). Health systems also should design a suite of services that can be combined, as needed, for a given patient (in-person, remote monitoring, hospital-at-home, video visits). The entire service continuum should be modular, when feasible and appropriate, so that patients get care from the right person at the right time in the right modality.

 For example, the University of Pittsburgh Medical Center (UPMC) encourages virtual care use among health plan members by offering $0 copays for virtual visits, compared with a higher cost share for an in-person encounter. The health plan app also facilitates digital onboarding for a broad range of integrated virtual services, including virtual primary care, behavioral health, wellness checks, and urgent care.

 Continuity of care is key. Prepare patients and their home caregivers for self-monitoring and self-care with educational materials (tip sheets, links to training videos) on the proper use of in-home devices (blood pressure cuffs, pulse oximeters, tablets). To gain trust and buy-in, ensure that all communication is culturally and linguistically competent and clear.

 Clinicians and support staff should also be taught how to use broad-based communication platforms (“omnichannel”) to engage patients (e.g., correspondence via online patient portals, text messaging, phone calls) to proactively initiate contact (to remind, inform, and encourage), not merely to react to patient-initiated messages. Ideally, this platform should be unified such that all communications are integrated and visible across the different modalities to optimize patients’ and clinicians’ experiences.

 Ensure that virtual care visits and systems make full use of prevailing best practices for in-person care, sound principles of clinical engagement, and sensible goals for organizational alignment. First and foremost, use evidence-based decision criteria to guide the appropriate use of remote care — for example, lower-complexity and lower-emotion visits. Virtual care is simply not appropriate for all visits.

 Best practices for executing the visit itself are essential. Encourage clinicians to become familiar with patients and their health records before virtual encounters — and ensure, to the degree possible, that records and notes from other treating clinicians are available before and during the visit.

 In addition, like a health system does for in-person visits, it should involve the whole care team (e.g., nurses, medical assistants) in preparing for the virtual visit (gathering records, prepping the “virtual room”), connecting during the visit, and closing at its end (e.g., scheduling next appointments). This step minimizes the additional work (“friction”) associated with virtual care that can be time-consuming and frustrating for physicians and below their level of training; it also enhances team coordination and cohesion.

 Jefferson Health established the National Center for Telehealth Education and Research (NCTER) to “advance the use of virtual health services.” Clinicians can receive certificate-level training on all aspects of optimizing a virtual care encounter, including an overview of the technical, clinical, and operational aspects of common telehealth technologies, instruction on how to conduct a telehealth physical exam, coaching on how to serve as a telemedicine facilitator within the context of an inter-professional team, and general trouble shooting tips.

 Prioritize best practices that enable clinicians to adopt and sustain virtual care. Ideally, virtual care should substitute for, not add to, in-person encounters on clinicians’ schedules. Benefits to clinicians may include greater efficiency, improved outcomes and patient experience scores, and an intrinsic sense of mastery or autonomy. To preserve these benefits, codify virtual care workflows, when feasible, and refine them as new service-line-specific needs emerge.

 Systemwide best practices also matter. Use clear institutional and professional society standards to inform infrastructure and technology design, expectations for patient and provider conduct, and clinical workflows. The American Society of Clinical Oncology has issued practical guidance on integrating virtual care into clinical practice such as outlining appropriate care encounters where telehealth can substitute for an in-person visit, specifying the supporting documentation that is necessary for a virtual visit, and advocating for the use of standard operating procedures to guide a care team’s response to symptoms and side effects reported by patients virtually.

 Health systems should establish a governance and reporting structure for virtual care, tailored to the organization’s size and needs. This structure must include 1) a data integrity group focused on reducing hacking risks while optimizing privacy protections and patient access to their data and 2) appropriate oversight committees with representation from legal, regulatory, clinical operations, quality and safety, research, patient advocacy, and physician education.

 The structure also might have a vice president of digital health or connected care, tasked with overseeing the broader transition to virtual care, who works alongside an administrative director who provides operational support. This vice president should report to a chief operating officer or a chief medical officer to ensure the necessary C-suite support. Prominent health systems that use such an approach include Washington University in Saint Louis, Highmark Health, Mass General Brigham, and CommonSpirit Health.

 Real-time and other timely support for virtual care visits and the surrounding infrastructure are essential for serving all stakeholders’ needs effectively. That starts with investing in ready-to-serve technical assistance for patients, clinicians, and clinical teams. Ensuring adequate supply-chain redundancy to solve potential device or connectivity glitches (e.g., backup charging stations, replacement devices, mobile Wi-Fi hotspots) strengthens trust in the service.

 Think more broadly about support systems for patients. Involve in the virtual visit others who can help the patient (such as family members and caregivers) or contribute to the diagnosis or treatment plan (such as other physician specialists, with attention to the reimbursement structure for such visits). Leverage self-monitoring technologies and digital platforms to engage and empower patients with respect to self-care. (MDACC’s remote monitoring platforms contain short, easy-to-follow educational modules on the recognition and early intervention for chemotherapy-related side-effects.) Explore using artificial intelligence (chat bots, virtual nursing assistants, clinical decision support algorithms) to aid both patients and clinicians as they seek evidence-based guidance. For example, Houston Methodist health system implemented CareSense, a digital platform for surgical patients that offers guidance throughout all phases of a surgical journey in a format (text, email, phone calls) tailored to a patient’s preferences and level of health literacy.

Virtual Urgent Care

 Minimize the digital divide and disparities in access to care by, for instance, installing a telehealth center with private cubicles in low-income housing complexes, community centers, or other locations (with onsite technical help as needed). Equip low-income patients with chronic medical conditions (who require frequent care) with a dedicated device (such as an inexpensive tablet) that becomes a one-stop interface for their virtual care.

 Texas A&M Health Science Center, in collaboration with the telehealth company OnMed, has deployed kiosks in Milam County, a rural community in Texas. These booths comprehensively measure patients’ vital signs (blood pressure, heart rate, oxygen saturation, and temperature), contain a dispensary with common medications, and can facilitate on-demand video visits with a nurse practitioner.

 As a complementary feature to the support network, consider creating new facilitative roles such as a digital health navigator. Responsibilities might include assessing patients’ digital health literacy, tracking patient satisfaction with virtual care, maintaining documentation for regulatory compliance, providing patient and caregiver education, and troubleshooting technical issues.

 Patient care preference, dictated by necessary safety measures, has obligated hospital leaders to completely recalibrate how they approach healthcare visits, pushing mobile-based solutions such as Telehealth, Home Monitoring, Virtual Waiting Rooms and Virtual Visits; the list goes on and on. We here at Access wish to help by providing useful information that can guide healthcare strategies and efforts in this new era.

 1. Comprehensive Analysis | With a hospital approach, this guide provides in depth analysis of launching a virtual care program to equip you with the knowledge to decide if telemedicine is a good fit. Backed by research from top critics and advocates, we’ll provide answers to questions like, “Why should hospitals invest in telehealth NOW?” and, “How are Medicare, Medicaid and government regulations changing to increase telemedicine options for hospitals?”

 2. Resource Guidance | We’ll present research based, best practice guidance honed from the best telehealth resources available including the American Telemedicine Association, Telemedicine Journal and e-Health studies, Telehealth Resource Centers and many others. We will include and array of answers to question such as, “Which specific teleconference cameras meet ATA’s requirements?” and, “What are the Top 5 EHR Compatible, HIPAA Compliant Teleconference Software Solutions?” We’ll provide structured outlines to help build your telehealth business case, form your virtual care teams and set up the best telehealth room design for your clinicians.

 As the health care industry faces historic financial losses and a recession due to the COVID-19 pandemic, hospital leaders must quickly identify value-focused initiatives and seek out the financial resources to fund them.

 As the health care industry faces historic financial losses and a recession due to the COVID-19 pandemic, hospital leaders must quickly identify value-focused initiatives and seek out the financial resources to fund them.

 Looking back at the recession of 2007, shrinking household incomes were a key factor that contributed greatly to the strain on the healthcare system. Data suggests that many patients did not seek medically necessary care due to financial hardship. With a 13% unemployment rate and COVID-19, patients are not only affected financially, but also fearful of seeking care in the current hospital environment. The answer is increased access to care, and virtual care has proven to be the solution patients and hospitals are looking for.

  Since its inception in 1897, “tele” health has been considered an avenue to offer care to avoid unnecessary office visits. In the early 1970s, NASA in partnership with the Papago Indians, further laid the foundation by developing remote healthcare techniques that are still used today. Since then, telehealth has found its stronghold primarily in rural settings to increase health and mental health access for patients.Telehealth_Start_Early_Days

 Now, due to the pandemic, the barriers to telehealth have all but collapsed. CMS temporarily expanded Medicare reimbursement and applicable services to broaden telemedicine options for all Americans. This expansion now allows for Medicare to pay for visits regardless of location, including within a patient’s home, and allows for a wider range of providers to offer virtual visits. Congress also appropriated $200 million in funding to healthcare providers to rapidly develop and implement virtual care programs within their hospitals.

 Telehealth, virtual care, and virtual waiting rooms have quickly become a win-win for both patients and hospitals due to the low cost for patients and increased market for hospitals. Hospitals have seen incredible transformations around virtual visits, with reports of over 1,000% growth. Carrot Health’s white paper Combating COVID-19 with Virtual Care and Predictive Analytics documents a leading telehealth platform that experienced a 3,600% increase in use over the first 11 days of the COVID-19 pandemic and over 400K total visits in March 2020 alone.

 As telehealth proves to be a cost-effective and safe beacon of hope for the patient that would otherwise not receive care, it is also a solution for hospitals to deliver care amidst overwhelming public concern due to the COVID-19 pandemic. Increasing access to care through telehealth seems to be a promising option for hospitals, according to an analysis from Advisory Board,

 “as many as 20 percent of virtual care patients would theoretically convert to being full-service patients of a hospital or health system at an estimated annual revenue increase of approximately $3,000 per patient.”

 Despite this benefit, however, there are still several concerns with the efficacy and implementation of a hospital telehealth or virtual care program.

 A common myth among critics is the concern of an impersonal patient experience due to the virtual environment of a telehealth visit. It is often assumed that because patients and providers are communicating through a video screen and that visits are briefer than your traditional in-person visit, a virtual visit will lack a feeling of human connection and cause issues with patient satisfaction. This is a myth; patients often have lesser feelings of human connection during an in-person visit than during a telehealth visit.

 According to GlobalMed’s Virtual Care vs. In-Person Visits: Which is Higher Quality?, during an in-person visit, 64% of primary care physicians did not ask why a patient came in, and when they did, patients were interrupted within 11 seconds. American Telemedicine Association CEO Ann Mond Johnson in ATA’s Johnson Looks to Dispel The 7 Myths of Telehealth Adoption, explains a different perspective “virtual visits – especially those used in telamental health – often compel patient and provider to look each other in the eye. As well, the telemedicine platform can improve interactions for patients who aren’t comfortable seeing a doctor in person.”