The mission of the Northwell Population Health Informatics team is to improve population health and community outcomes through informatics and underlying technology. The COVID-19 pandemic expedited the need for some of this technology such as digital remote care and drew more focus to population health initiatives. While it shouldn’t take a pandemic to raise the importance of population health in the minds of the general public, that is exactly what happened in these last two years. The pandemic has allowed this focus on population health to be consistent for a significant amount of time, widening a pathway for us to learn through numerous areas of concentration Including the increase in utilization of video-based technology, the CMS Hospital at Home waiver, and Remote Therapeutic Monitoring.

One such area of focus for us was the rapid expansion of telehealth services at Northwell. While telehealth became a commodity during the COVID-19 Public Health Emergency, we have been looking into it for many years. Northwell went from having 200 clinicians on its telehealth platform prior to the outbreak, to more than 8,000 clinicians, nurses, and office managers in 2020. From April 1, 2020 to April 1, 2021, the health system performed nearly 500,000 telehealth visits. With this expansion of telehealth services, we are now looking to grow video-based telehealth into remote monitoring-based telehealth. There is no doubt the pandemic assisted in speeding up this process.

The COVID-19 pandemic expedited the planning, implementation, and adoption of numerous digital initiatives including the expansion of video-based telehealth, the proliferation of the Hospital at Home program, and the establishment of remote therapeutic monitoring.

This brings us to another area of focus:  remote care. Our areas of study around remote care include the preferences of our patients, consumer reasons for certain visits, and the needs of specific populations. One example of these needs would be the social issues impacting the use of remote care and how remote care may potentially assist vulnerable populations who cannot afford to travel to seek the healthcare they need. Prior to the pandemic, remote care was sparsely used. Some populations preferred remote care, and some required it due to barriers to mobility. However, most patients would by default go in for an in-person visit. With COVID-19, this idea was flipped on its head. Now, if it is an emergency, then you can come into the office. Otherwise, to avoid contact during the pandemic, remote care would be the default option for all. We expect patients to be driven by individual preferences regarding the type of visits they wish to have moving forward.

The pandemic also helped raise the need for more comprehensive remote care options for non-COVID related ailments. At the height of the COVID-19 Public Health Emergency in 2020, patients had to be turned away from hospitals due to a lack of available beds. Some normally hospitalized cases couldn’t even make it through the hospital door. At the same time, other patients who sought care were too afraid to even set foot outside their homes. We needed to break the walls of these inpatient facilities and figure out a way to expand access to high-quality inpatient care out to the community. CMS first provided the opportunity by establishing the Hospitals Without Walls program in March 2020, and then the Acute Hospital Care at Home program in November 2020.These changes coupled with the success of hospital at home initiatives at other large health systems gave us an opportunity to align a population health benefit to the financial incentives in current inpatient contracts. Now, we have the opportunity to provide the same level of care and receive the same level of reimbursement. At the same time, eligible patients normally admitted into an inpatient ward could be treated in a remote hospital unit in the comfort of their own homes.

Another area of focus for us related to remote care that was elevated by the pandemic would be the expansion and availability of remote therapeutic monitoring. While CMS had previously established reimbursement rules for remote patient monitoring (RPM), it has now introduced reimbursement rules for 2022 related to remote therapeutic monitoring. Where RPM allowed reimbursement for the monitoring of physiologic data only, remote therapeutic monitoring allows for the use of medical devices that collect non-physiologic data such as medication adherence and pain level. In addition, where RPM has a limited subset of clinicians that can bill for the service, the intention of remote therapeutic monitoring is to expand this service to a larger swath of clinicians such as nurse practitioners and physical therapists. Finally, where RPM requires the medical device to automatically record and upload patient physiologic data, remote therapeutic monitoring allows for self-reported data to be part of the non-physiologic data collected.

One final area of focus for our team that was spotlighted by the pandemic has been social determinants of health. While a person’s environment has always affected their health outcomes and risks, it was the pandemic that showed how truly urgent a priority it is to incorporate social data with clinical data to support care decisions and address social justice. During the pandemic, Northwell won a Phase 1 award in the Administration for Community Living’s Social Care Referrals Challenge competition by working with CBOs to aggregate referral data from multiple care settings and eliminate duplicative workflows by streamlining the referral process for Northwell Health’s care teams to create referrals, CBOs to receive the referrals, and for the referral results to be shared back with Northwell Health.

The COVID-19 pandemic expedited the planning, implementation, and adoption of numerous digital initiatives including the expansion of video-based telehealth, the proliferation of the Hospital at Home program, and the establishment of remote therapeutic monitoring. We are looking forward to learning how these technologies and others move the needle with respect to improving population health outcomes and reporting on a successful digital transformation. We also look forward to creating blueprints for scalability and sustainability of these initiatives and understanding the opportunities for improvements to move the needle even faster with a higher value for our populations in the future.

The post Healthcare innovations augmented by a pandemic appeared first on HealthTech Magazines.

One can imagine early uses of the telephone involving discussions about patient care between hospitals or a small town contacting a doctor in the city about a patient.

Today, we view telemedicine as the digital exchange of medical information from one site to another with the intended purpose to improve patient care and access. This is achieved through a wide variety of applications, devices, and services. These include things like two-way video, smartphones, email, tablets, peripheral exam devices, and many other mobile tools. All of these tools create a continuum of telemedicine technology complexity.

By leveraging the appropriate telemedicine technology based upon the use case, all of these groups can potentially converge to achieve the quadruple aim by providing better outcomes at lower cost, while, at the same time, improving both the patient and clinician experience.

Telemedicine helps to improve access to care in a way that has the potential to revolutionize the healthcare industry. This is more important than ever as healthcare systems continue to expand their footprint. Enacting telemedicine programs makes location of both patient and facility less important, and allows healthcare providers to expand their reach in ways never previously thought possible. In this article, we will review various telemedicine technologies with regard to complexity and appropriate use in specific cases.

Show patients and providers the benefit these technologies can afford them

In assessing the appropriate technology for a specific telemedicine use case, one must consider budget, use case requirements, and workflow. For basic interactions between provider and patient, mobile devices such as smartphones or tablets work extremely well and are commonplace among both providers and healthcare consumers. These devices allow for secure real-time audiovisual communication from any location with an Internet connection (Wi-Fi, 4G, LTE, etc.). There are multiple mobile-based, HIPAA compliant telemedicine platforms for use on mobile devices that can meet the needs of solo practitioners all the way up to regional healthcare organizations. Secure mobile video carts can also be used in conjunction with mobile devices to allow for similar communications from a health care facility to external locations using stable Wi-Fi or Ethernet connection. These carts provide better quality video than mobile devices as they function over stable internet connections and have a mounted camera that helps to steady the video feed.

The next level of complexity in telemedicine technology is the addition of connected peripheral devices to the audio-visual stream to provide more information for the clinician on the receiving end. The most high-yield and commonly used connected device is the stethoscope, which allows for real-time or store and forward transmission of heart and lung sounds. There are many different types of connected stethoscopes that vary in terms of form, function, and obviously price. Despite variations in price, the costs to implement such a program are not prohibitive to smaller practices or even individual providers. These types of systems can provide large amounts of useful information for a relatively low overall cost. Other connected peripherals include spirometers, otoscopes, ophthalmoscopes, high-resolution cameras, real-time ultrasound probes, EEGs, and various other real-time scopes. Usage of these types of peripherals is dependent upon the needs of the use case.

Also in the category of low complexity telemedicine technology are home monitoring solutions, which includes devices such as blood pressure monitors, scales, glucometers, pulse oximeters, vital sign monitors, wearable fitness devices, and medication dispensers. These devices can provide instant feedback for patients, and allow them to feel more in control of their health while at the same time allowing clinicians to remotely monitor them. Data from these devices can be synched to software platforms with algorithms to alert for certain events or findings. This information can then be sent along to the native electronic health record to allow clinicians to view this information in-line with the comprehensive medical record. Included in home monitoring devices are also cardiac telemetry devices that allow for remote intermittent or continuous monitoring of cardiac status. Aside for providing comfort to the patient, these devices can reduce the need for in-hospital monitoring in stable cardiac patients. With the emergence of new mobile solutions within this market, cardiac telemetry devices are more accessible than ever as they have cut down on previously cumbersome remote options.

As we approach higher complexity telemedicine technology, we start to see more of an “all in one” approach with devices that have enhanced mobility and can perform multiple aspects of a physical exam via telepresence technology and connected peripheral devices. Peripheral integrated carts are often used in hospital settings as they offer reliable video quality and a robust suite of peripherals and add-ons. Some models can even be driven remotely so that providers can “round” from a remote location. On the other hand, mobile integrated telemedicine kits allow either patients or health care providers to perform remote physical exams using mobile devices that have a variety of add-on attachments that allow for capture of various physical exam elements. These units are becoming more commonly used as they are affordable, allow for flexibility, and are relatively easy to use. There are various offerings of these kits that are targeted to different use cases: rugged for field use (disasters, EMS, etc.), small and compact for consumers, and those with increased durability and higher quality parts for healthcare professionals.

Atop the mountain of telemedicine technology complexity are the emerging technologies of AR and VR. VR platforms allow for creation of a completely immersive auditory and visual environment to create a world that can be based in reality or devoid of physical laws governing space, time, mechanics, etc. VR’s ability to manipulate the user world can be helpful in post-stroke/rehab care, various psychiatric treatments, and simulative learning. It also holds promise for telemedicine application in surgical procedures, radiology, and neuropsychological assessments/rehab. AR functions differently in that it augments the real world with virtual computer-generated objects that appear to the user to coexist in the same space as the real world. This allows for natural movement in the physical world and interaction in the augmented world through gaze, gesture, and voice commands. While the applications of AR are similar to those of VR, it differs significantly in that it is a more natural fit for the clinical workflow as users can still interact with their surroundings.

In order to decide what technology is most appropriate, providers and organizations need to first assess the requirements of the specific use case and then work within their budgeted funds to find the best overall fit to meet the workflow. In doing so, it is vital to do the following when implementing telemedicine technologies:

1. Listen to your staff!
2. Focus on need first, and not simply what is available or cutting edge.
3. Don’t force technology.
4. Adapt to current workflows as closely as possible.
5. Involve staff early and often.

And perhaps most important is to minimize the pain of implementation, while maximizing the gain. Show patients and providers the benefit these technologies can afford them by meeting them somewhere within their comfort zone so that you can then take them out of it.

The post Technology and Telemedicine appeared first on HealthTech Magazines.