With Emergency Department violence at record levels, administrators are turning to technology—and the EHR—to help clinicians identify and treat aggressive or stressed patients.

The Emergency Department is a hectic environment, requiring clinicians to be ready for almost anything. That shouldn't, however, include violence.

With roughly 85% of emergency physicians reporting in a recent survey that ED violence has increased over the past five years, health systems are taking action to protect both providers and patients. And while the most visible response is to increase security in the ED, some are using technology to take a more proactive approach.

At Sturdy Memorial Hospital in Attleboro, Massachusetts, administrators are tapping into the electronic health record platform to identify ED patients with a history of threatening behavior, which pushes out alerts to the care team. Those alerts not only give providers advance warning, but can help them call in behavioral healthcare specialists to help those patients.

"It's definitely led to a lot more awareness," says Brian Patel, MD, the hospital's senior vice president of medical affairs and chief medical officer. "There are a lot of different reasons [that lead to stressful or violent situations in the ED.] If we can improve communication and get ahead of this, we are creating opportunities to improve both safety and care."

To get the most out of its EHR, Sturdy Memorial is working with digital health company PointClickCare. The two began working together in 2017 on ED utilization, and integrated security and care guidelines in 2021.

Once considered more of a hindrance than a help in improving clinical care, EHR platforms are slowly becoming more valuable in the hospital as vendors fine-tune the complex technology and providers learn how to use them. Among the bigger benefits just now being realized is the EHR's ability, under the right circumstances, to capture the entire patient history, collecting not only clinical information but data on social determinants of health, or outside factors that affect healthcare access and outcomes.

That includes behavioral or societal clues that could indicate a combative patient, such as past run-ins with the law, treatment for stress or aggressive behavior, or other clues that could indicate the patient is confused or agitated. An ED doctor or nurse seeing those clues in the EHR could then not only alert the hospital's security personnel, but call in specially trained care providers or social workers to work with the patient.

"There's so much information out there that could be useful," Patel says, "but in the past a lot of it was fragmented." In many cases, ED care teams were forced to piece together past reports or self-reported data, then an educated guess as to whether to take precautions.

Aside from reducing violence in the ED, the platform also improves care coordination and management by bringing in behavioral health resources more quickly to treat a patient. This ensures that a patient is connected more quickly to the right care providers and isn't forced to wait for a long time in the ED—an additional source of stress and agitation.

"The impact of the ED case manager program and our work with PointClickCare for patients with behavioral health challenges has been substantial, even during the pandemic, when behavioral health needs have increased, and staff resources have been stretched thin," Patel said in a separate e-mail to HealthLeaders. "Today, unnecessary ED utilization by individuals with mental health challenges managed through this program remains 44% lower than the six-month period prior to entering the program. And, because of the social determinants of health component of patient assessment, individuals not only receive better care, but also connections with resources that help meet their whole health needs, from healthy food to transportation to appointments or safe shelter."

There are, of course, challenges to using the technology. Patel says the platform was initially intended to reduce bias by giving providers as much objective information as possible so that they didn't have to make a decision solely based on how a patient looks or acts. But technology can introduce bias as well, and providers are cautioned to not jump to conclusions.

"This has to be treated very carefully," he says. "We have to avoid labeling patients. And that comes with learning how to use the technology correctly. We're all getting much more [comfortable] with the technology, but we have to avoid asking too much of it. The system is only as good as what we put into it."

The Centers for Medicare & Medicaid Services has issued guidance changing Medicaid and CHIP coverage for eConsults, or provider-to-provider specialty consults conducted via digital health or telehealth. The  ruling could expand the service, which helps primary care providers keep more of their patients and boosts access to care for underserved patients.

Federal officials have expanded coverage for specialty consults between care providers via digital health for Medicaid and Children's Health Insurance Program (CHIP) members.

In guidance issued earlier this month, the Centers for Medicare & Medicaid Services (CMS) announced that interprofessional consultations, or instances when a care provider seeks the advice of a specialist for a patient's treatment, via eConsults can be covered by state Medicaid or CHIP programs even when the patient is not present, as long as the consult is focused on that patient.

eConsults are clinical consults usually conducted via telemedicine (including the telephone) or digital health. They enable primary care providers to expand care management options for their own patients without having to send those patients off to a specialist. And they improve access to care for patients who might not want to travel to see a specialist due to a variety of reasons, including distance and cost.

Alongside helping primary care providers retain more of their patients, the platform is popular with federally qualified health centers (FQHCs) and community health centers who treat underserved populations and in rural areas where access to specialists is scarce. It also helps specialists expand their reach and treat more patients in need of their services.

"Timely access to specialty providers can improve the quality of care and treatment outcomes for both physical and behavioral health," CMS wrote in its guidance. "While access to specialty care has been a challenge across a range of specialties, access to specialty care for mental health and substance use disorders has been a particular challenge."

The ruling changes the payment model so that the consulting provider, or the specialist, can bill for the treatment. Previously, CMS allowed the treating provider to bill Medicaid, which in many case forced the program to pay higher rates to the treating provider so that he/she could reimburse the specialist for consulting services.

To qualify eConsult coverage, both care providers must be enrolled in the Medicaid program in the state where the patient is located, though the consultant can be located in another state.

"Given the potential for improving access to specialty care, a number of states have obtained authority through state legislation for or expressed interest in covering eConsults," the Los Angeles-based Manatt, Phelps & Phelps law firm wrote in a recent blog. "States that choose to cover eConsult codes must submit a state plan amendment to CMS to add a payment methodology for the qualifying service, and should consider broadly communicating any related policy changes to their enrolled provider community."

The Chicago health system and CVS Health are partnering on an ACO that will be part of CMS' REACH direct contracting model, aimed at improving healthcare access for Chicago-area residents on Medicaid.

While some see retail healthcare services as competitors to traditional healthcare organizations, Chicago's Rush University System for Health (RUSH) is launching a partnership with CVS Health aimed at improving health equity for Medicaid patients.

RUSH, which comprises RUSH University, three hospitals, and a network of outpatient care sites, is joining a newly created accountable care organization (ACO) developed by CVS Health. The collaboration is based on the redesigned  ACO Realizing Equity, Access, and Community Health (REACH) direct contracting model developed by the Centers for Medicare & Medicaid Innovation (CMMI).

Through the program, RUSH and CVS Health aim to create a care management network for Chicago-area residents on Medicaid. It will enable members seeking care at MinuteClinic locations in Chicago and Evanston to access additional services, including specialty care, through RUSH.

“This provides another option for patients at a time when access to high-quality health care is more important than ever," RUSH President and CEO Omar Lateef said in a press release. "It will help strengthen care coordination for patients, while enabling them to receive services convenient to where they live and work.”

“As part of CVS Health’s care delivery strategy, we are engaging our assets on behalf of this ACO REACH population to help drive high-quality outcomes, promote health equity, and bring healthcare costs down,” added Mohamed Diab, CEO of the CVS ACO. “Our strategic alignment with RUSH has the potential to help improve longitudinal care for their Medicare population of 35,000 beneficiaries.”

The partnership offers not only an interesting example of collaboration in the competitive primary care space, but highlights the efforts of the healthcare industry to tackle barriers to access for underserved populations, including social determinants of health. The program will include access to virtual and home-based care, transportation support for annual wellness visits, cost-sharing options on co-pays, and other incentives and services.

“RUSH has a long-held commitment to improving the health of the communities we serve,” Lateef said in the press release. “This agreement reflects that strong commitment and a terrific opportunity to build upon that foundation of strong community-based programs and partnerships and have impact for patients on day one."

The number of hospitals improving their EHR platforms to enable data sharing, especially from outside sources, has more than doubled since 2017, according to a report from the HHS Office of the National Coordinator for Health IT (ONC).

The number of hospitals improving their technology base to promote interoperability has more than doubled in the past five years, according to a new data brief from the Health and Human Services Department's Office of the National Coordinator for Health IT.

The ONC brief, which details interoperability advances from 2017 through 2021, also found that hospitals have improved the availability and use of their electronic health record platforms to accept data from outside sources, and half of the nation's rural hospitals now have information electronically available at the point of care.

"Hospitals’ rapid improvements in interoperability could be attributed in part to the initial implementation of health IT provisions from the ONC Cures Act Final Rule (Cures Rule) and adoption of 2015 Edition certified technology," the ONC brief, prepared by Yuriy Pylypchuk and Jordan Everson, says. "The Cures Rule updated the Health IT Certification Program to include new and updated criteria and standards that will advance interoperability. Nearly 90% of hospitals have adopted 2015 Edition certified technology and are well positioned to adopt these new and updated criteria and standards."

"Other data show that a large majority of hospitals have already done so," it continues. "Additionally, 74% of hospitals adopted the bulk data export capability, as of 2021. The most common uses of bulk data export were for analytics and reporting (63%) and population and health management (35%), and, less so, for switching EHRs (12%)."

Among other findings in the report:

• Health information service providers (HISPs) and health information exchanges (HIEs) remain the most common methods used by hospitals for electronically sending and receiving summary of care records.
• More than 60 percent of hospitals have used an HIE to to electronically query or find patient information from external sources.
• Hospital participation in CommonWell Health and the Sequoia Project's Carequality increased significantly between 2018 and 2021.
• significantly between 2018 and 2021.

An appendix to the report listed the top barriers to exchanging health information. They include:

• One partner in the exchange doesn't have an EHR or other electronic system to receive data.
• Difficulty in matching or identifying the correct patient between systems.
• Challenges of exchanging data across different vendor platforms.
• Difficulty in finding a provider's Direct address.

"Policy activities that support cross-network exchange such as Trusted Exchange Framework and Common Agreement (TEFCA) will help reduce the number of different networks and methods that hospitals need to use to support exchange," the brief says. "Other provisions of the Cures Rule are being implemented now to help hospitals shift from simply establishing connectivity to optimizing and simplifying the use of multiple methods of exchanging information. However, some barriers to information exchange remain prevalent. For instance, 48% of hospitals reported one-sided sharing relationships in which they share patient data with other providers who do not in turn share patient data with the hospital."

"Given that a majority of hospitals (74%) reported the ability to integrate information into their EHRs, current policy efforts could increase the value of that integration," Pylypchuk and Jordan Everson conclude. "For instance, recent actions were taken to improve the quality of data from external sources by advancing the use of specific data elements, such as through the United States Core Data for Interoperability (USCDI), and through the required use of standardized application programming interface (API) technology using the HL7 Fast Healthcare Interoperability Resource (FHIR). Efforts such as these should help ensure that information is available, integrated into the EHR, and used at the point of care – all of which have further room for improvement and will ultimately drive improvements in care and secondary use of data, such as for research."

A new report says the proposed Amazon-One Medical deal will reshape the healthcare delivery landscape, and traditional providers will need to make changes to keep up. 

A new report from Forrester Research says the Amazon-One Medical partnership could strongly impact the healthcare delivery landscape in the near future, and offer a few tips for healthcare organizations interested in keeping up.

The report says the almost $4 billion proposed purchase of primary care company One Medical by retail giant Amazon, currently being reviewed by the Federal Trade Commission, marks an important stage in the integration of fee-for-service and consumer-facing healthcare.  And it places Amazon at the front of a wave of retail-based healthcare services announced or planned by Walgreens, CVS, Walmart, Google, and others.

"The rise of consumerism driven by the pandemic spurred soaring demand for personalization and digital disruption in healthcare," it notes. "Today’s traditional healthcare systems struggle with poor patient experiences, long wait times, lack of transparency, and legacy technology."

Healthcare organizations are paying close attention to the Amazon-One Medical deal, as well as others in this vein, as the marketplace heats up for on-demand primary care services, which can also serve as a platform to other services such as specialty care and chronic care management. Because traditional health systems have struggled to keep up with a tech-savvy consumer population that looks for ease of use and convenience, those consumers are looking to other providers for their healthcare needs. This includes not only retail care centers but self-insured business and health plans.

Aside from not addressing the consumer's wants and needs, much of the healthcare industry still focuses on reactive, episodic services at a time when many consumers—and a good deal of healthcare innovation—is turned toward preventive or proactive care. Forward thinking providers now talk about the patient's entire healthcare journey, which not only includes treating current health issues but collaborating to improve health and wellness and reduce the chance of more serious health issues later on in life.

In addition, the pandemic has shone a spotlight on the challenges of healthcare access for underserved populations, a problem that traditional healthcare organizations have struggled to address. New care pathways and programs are focused on integrating health equity, giving underserved populations more opportunities to access services.

According to the Forrester report, the Amazon-One Medical partnership could address many of the deficiencies in the current healthcare landscape. With a consumer-centric strategy, the platform could make use of an evolving pipeline of new technologies, including pre-built collaborative filtering engine (CFE) algorithms and cloud technologies. Amazon also features an evolving ecosystem of new products and services and a solid platform to introduce third-party products and services.

"Healthcare is moving toward orchestrating long-term loyalty and longitudinal relationships," the report points out. "The more information providers can gather about a specific patient, the easier it is to deliver seamless, proactive care. This is where Amazon and One Medical have not only unlimited opportunity but also a critical responsibility. One Medical’s 767,000 members’ patient data combined with Amazon’s own robust consumer profiles and various healthcare and retail experiences put Amazon in the driver’s seat to transform the patient experience."

To compete in this new landscape, the Forrester report offers three recommendation for traditional providers:

1. Highlight and adhere to transparency. Healthcare organizations have to invest in technology resources or partner with technology vendors to comply with new price and data transparency requirements—something that only about 6% of hospitals now do.
2. Make interoperability "the cornerstone of the patient experience." Healthcare organizations need to either pare down the various platforms and products that keep patient data in silos and lead to incomplete medical records and subpar care. "Healthcare data interoperability is the key to creating holistic records, but it is still not commonplace for healthcare organizations," the report says. "To overcome this hurdle, technology executives must leverage vendors and partners with deep expertise in HL7 FHIR and ensure that new technology investments comply with the latest regulations promulgated by the CMS and ONC Cures Act final rules."
3. Empower patient accountability through education and communication. Many patients are still confused about their healthcare journey, and they aren't taking advantage of new digital health and virtual care tools and services designed to make that journey easier. Providers need to pay more attention to talking with patients, educating them about to use these new tools and giving them the resources they need to improve the journey.

Fairbaugh, who rose through the ranks as a paramedic and nurse before getting a Master's in nursing informatics, has been named chief clinical information officer for the Pittsburgh-based 40-hospital health system.

UPMC recently named John Fairbaugh, MSN, RN-BC, to a new role as chief clinical information officer (CCIO).

Fairbaugh had been director of clinical and operational informatics and emergency services at UPMC Magee-Women's Hospital prior to the promotion, and now supports clinical operations across the Pittsburgh-based health system's 40 hospitals and 800 outpatient sites. A former paramedic, he has more than 21 years of experience in nursing, emergency medicine and informatics, joining UPMC as a nurse in 2002 and completing his Master's in nursing informatics in 2013.

HealthLeaders recently spoke to Fairbaugh—virtually—about his role and his priorities.

Q. What are the responsibilities of a Chief Clinical Information Officer?

Fairbaugh: As the chief clinical information officer, I oversee the safe, secure implementation of technology in the healthcare workplace. My teams are familiar with current medical systems, and continually seek opportunities to integrate technology to a greater extent within these systems to improve the quality and effectiveness of care.

John Fairbaugh, MSN, RN-BC, chief clinical information officer, UPMC. Photo courtesy UPMC.

In this complex field, as informaticists, we need to consider the combination of healthcare practices with IT resources and analytics to measure and improve outcomes, drive healthcare decisions, and to provide a high-quality experience for both our patients and providers.

Q. Your healthcare career began as a paramedic, then transitioned to nursing before moving into informatics. How has that career path shaped your view of clinical informatics?

Fairbaugh: This career path has allowed me to see many different aspects of healthcare, both in the ambulatory and the inpatient setting. As the healthcare landscape shifts from a traditional inpatient to more of an ambulatory outpatient approach, having the knowledge of both will help me lead my teams to implement technology that will communicate across all venues.

Digital technology is rapidly changing the way we live, and healthcare is not immune to this. The way providers deliver care will continue to be challenged as more consumers want increased access and convenience to manage their care. This shift will require organizations to implement technology that allows for improved communications and tools that enhance both the clinician and patient experience.

Q. What are your goals for 2023 and beyond in this role?

Fairbaugh: Over the years as our $24 billion heath system has grown, our IT systems have become increasingly large and complex. This has led to a deterioration in usability and created alert fatigue and documentation burdens, while exacerbating some disruptive workflows.

The plan for my team is to work collaboratively with both our IT and clinical leadership to implement standardized technology that supports the mission, vision, and values of UPMC. We will concentrate on taking an enterprise approach that enhances quality and safety, user and patient experience, and financial stewardship. Our people must remain our priority during this time to promote efficiency, usability, reliability, and connectivity for all users and patients. 

Q. How has the pandemic affected clinical informatics, and what have you learned from the pandemic that you'll be applying to your job?

Fairbaugh: COVID has allowed healthcare leaders to see how vulnerable we are as healthcare organizations and has escalated the need for technology transformation and the growth of healthcare informatics. As we face today’s financial and staffing demands, we must radically improve our technology to adapt and support clinical workflows. As a leader in technology adoption and innovation, UPMC is well-positioned to drive this change.  

Q. How do you define and approach healthcare innovation? What new technologies would you like to use?

Fairbaugh: Healthcare innovation will mean providing patients and providers with technology options that harness opportunity to manage complex health issues. It will be necessary for organizations to provide access to digital tools, apps, and health trackers with embedded artificial intelligence (AI). When providers and patients have this access, it will improve their ability to prevent disease and manage care, while also improving our patients’ ability to make the best medical decisions for themselves.

Q. How has the value and usefulness of the EHR evolved over the past few years? How do you or your department use the EHR? And how could that platform be improved?

Fairbaugh: Technology has become the new normal for our healthcare industry. Although many remember the days of paper charting, we all know the power of data to drive high-quality decisions.

Providers also depend on technology to collaborate and manage care.

Healthcare consumers also want to utilize technology to manage their care to enhance convenience and ensure they are getting the best value possible along with quality outcomes.

We as healthcare organizations will need to look at our technology over the next few years and implement systems that help improve communications and decision-making while providing patients with quick access to their records to collaborate with their providers. For this reason, it will be necessary for organizations to implement systems with standardized technology and interoperability to share information quickly with many different applications and tools to make the technology meaningful for every user.

Q. How do you see the role of CCIO evolving? What more would you like to do in this position in the future?

Fairbaugh: The chief clinical information officer role has evolved from handling day-to-day clinical technology operations to being a key leader in strategic decision-making. Today's technology is changing at an ever-rapid pace and requires more critical thinking about interoperability, security, and usability to ensure our providers have the necessary tools to support clinical practice and to limit disruption that may affect patient outcomes. Our non-IT clinical leaders depend on our expertise to ensure technology supports clinical workflows, evidence-based care, and the best outcomes for our patients and the entire organization.

This position and healthcare informatics in general require that informaticists have a formal knowledge of both clinical and IT models and workflows. We need to be the change agents that mediate the collaboration between clinicians and IT which requires us to have experience in both. Until recently, there has been an abundance of siloed work which has increased our vulnerability as organizations. As we move forward, we need to develop and form a concrete governance structure that improves the collaboration and decision making as an organization to meet our goals.

Q. How does the CCIO impact the evolution of healthcare as we move from episodic to value-based care?

Fairbaugh: As payers prioritize value-based care, hospitals will be charged with aligning their processes and workflows to support this new healthcare delivery model. As a leading integrated healthcare insurer and provider, UPMC understands the need to improve our technology to support consistent medical practice with standardized workflows and to identify and support patients who are most at risk for adverse outcomes.

CCIOs will be challenged by their organizations to improve communication among many different healthcare providers so the care can be shared among many specialists. Placing meaningful data in the hands of physicians and other care providers will give them more control over patient outcomes. This will help drive high quality care and provide benchmarking of value-based metrics, like length of stay and readmission rates, to drive results.

With stress and burnout rampant within the healthcare industry, health systems are looking for new ways to use surveys and social media to boost morale and highlight positive news.

In today's social media-saturated landscape, healthcare organizations need to stay on top of their brand to ensure a positive public image and address any negative publicity quickly. But health systems can also use that platform to improve patient engagement and, more importantly, tackle clinician stress and burnout.

Several health systems from across the country have joined a Clinician Retention Workgroup launched by Feedtrail, a North Carolina-based company focused on experience management technology. The goal of the workgroup is to study how patient experience data, coming from surveys and social media channels, can be used to combat burnout and disengagement, and boost clinician engagement and morale.

"We've been focused for so long on patient satisfaction," says Dennis Lamb, chief experience officer for Texas Tech Physicians, the medical practice network for the Texas Tech University Health Sciences Center School of Medicine, based in Lubbock. "It's time we started looking at our physicians and focusing on them. They want to hear how they're doing, too."

Paul Jaglowski, co-founder and chief strategy officer for Feedtrail, says health systems have typically focused on a generic post-discharge survey to keep track of how they're doing. But with the growth of social media and consumer-centric care, alongside increased competition in the primary care space, savvy healthcare executives are developing better programs that allow patients to rate and comment on every aspect of their healthcare journey.

"Engagement shouldn't end with surveys," he says. "There are many more opportunities now to engage with [consumers and patients], and healthcare organizations can choose their own thresholds. They can get visibility into what is being said and even guide [commenters] to the right person or department."

Aside from monitoring a hospital's or health system's public image, the technology enables administrators to address critical or negative comments by communicating with the commenters and connecting them to resources to resolve complaints. Administrators can also address those issues within the organization, identifying areas where improvement is needed.

These strategies aren't entirely new. Organizations in many industries have used surveys and social platforms to both highlight the positives and address the negatives. The same is true in healthcare, with platforms such as Google, HealthGrades, and Yelp all offering opportunities to rate and offer comments on a healthcare provider.

But with the pandemic and a sour economy causing a wave of stress and burnout and pushing doctors and nurses to their breaking point, health systems are turning the technology around to focus on provider and staff engagement.

"Looking across our patient experience data, 80% of patient comments are positive and complimentary in nature, and this feedback can be an essential component to a healthcare organization's culture of gratitude," Jaglowski said in a December 2022 press release announcing the launch of the Clinician Retention Workgroup, which includes, alongside Texas Tech Physicians, Cedars Sinai, First Health of the Carolinas, and Huntington Hospital in Pasadena, California.

"Best in class organizations are connecting clinicians back to their purpose and battling burnout through the sharing of patient gratitude and we want to help them measure and operationalize this beneficial practice," he said. "Based on demand, we will continue to bring providers in to participate on a rolling basis as the industry continues to build a new blueprint for employee engagement and retention.”

At Texas Tech Physicians, Lamb says his doctors and nurses need this positive reinforcement.

"Physicians want to hear these things, too," he says. "Too often they only hear the negative things. We have to be better at communicating the positive things."

Lamb says the health system has protocols in place to address any negative or critical comments within five days, so that patients know their concerns are being addressed, but there's nothing on the books to pass along good comments. In fact, in one previous survey, more than half of the providers who responded said the health system doesn't do enough to emphasize good news.

"They're the ones on the front lines," he says. "Patients don't schedule an appointment to see your front desk people."

While health systems can gather this information through surveys and online comment portals, many don't know how to use the data. Efforts like the Clinician Retention Workgroup will give them a chance to share innovative ideas on new programs and resources aimed at not only passing along the good news, but boosting engagement and retention.

"Working in the emergency department is stressful, now more than ever, so as a staff member, hearing how you made a positive impact in the life of a patient or family can really give a needed morale boost," Claude Stang, executive director of emergency services at Cedars Sinai, said in the Feedtrail press release. "It is also an opportunity to thank the employee for upholding the values of the profession and the organization. We're looking forward to sharing more patient gratitude, learning from our colleagues in other organizations across the country, and, ideally, replicating this best practice across the organization.”

"It's going to be positive and it's going to mean more," says Lamb. "It's going to make a huge difference in how we can support [staff] because we'll be doing more than just relying on surveys."

The Techquity for Health Coalition aims to emphasize the integration of health equity into healthcare technology innovation and data practices.

The HLTH Foundation has announced the launch of a coalition and national survey aimed at making sure that health equity is embedded in technology innovation and data practices. And they've coined a new word to describe the process.

The foundation, a non-profit offshoot of HLTH, has unveiled the Techquity for Health Coalition, and has defined techquity as "the strategic design, development, and deployment of technology to advance health equity, and encompasses the notion that technology can inhibit advancements in health equity if not implemented intentionally and inclusively."

The organization has also produced a national survey aimed at understanding how the healthcare industry is approaching techquity. The survey results will be announced at the ViVE 2023 conference on March 26-29 in Nashville.

"Technology and data analytics offer enormous promise to improve care access and quality, but also add new layers of consideration for health equity," Janna Guinen, executive director of the HLTH Foundation, said in a press release. "We urge healthcare leaders to participate in the techquity survey. With the continued digitization of healthcare, action is needed now to avoid further entrenchment of systemic inequities and outcomes disparities."

"Techquity engages us in thinking and acting in a way where no person is left behind," added Andrea Werner, chief population health officer at Bellin Health and Gunderson Health System, which are part of the coalition. "Leveraging the collective knowledge, diverse perspectives, and experiences of the [coalition] will help us go further [and] faster to level the playing field and optimize technology for the people we serve."

Health equity is a popular topic these days, as healthcare organizations look to identify and understand the barriers to healthcare access that plague underserved populations. Some can be attributed to social determinants of health, or non-clinical factors that affect healthcare delivery and outcomes, including geography, work and family factors, education, race, and culture.

The coalition is supported by Ipsos Healthcare, a strategic research partner, and guided by an advisory committee that includes Werner; Ricky Y. Choi, MD, MPH, of the Stanford University School of Medicine; Grace Cordovano, PhD, BCPA, of Enlightening Results; Burgess Harrison, MBA, of the National Minority Health Association; Tanisha D. Hill, MPH, of the Digital Health for Equitable Health Alliance; Pooja Mittal, DO, of Health Net; Lorren Pettit, MS, MBA, of the College of Healthcare Information Management Executives (CHIME), a co-coordinator of the ViVE event; and Kyu Rhee, MD, MPP, of Aetna/CVS Health.

The group's efforts are also supported by the American Medical Association, Amazon Web Services, EmpiRx Health, Epistemix, Hopelab, NTT DATA, Outcomes4Me, ResMed, Tegria, and the VSP Vision Global Innovation Center.

"Techquity is not an individual- or consumer-level problem, but rather will require collaboration, transparency, inclusivity, and a commitment to organizational and systemic transformation," Alexis Anderson, a principal with Ipsos Healthcare, said in the press release. "Our research over the next year, in addition to fielding a second survey, will include working with the coalition to gather case studies and expert opinions in order to establish guidelines for a techquity practice healthcare."

The study found that virtual visits have the same value as in-person visits for communication and shared decision-making. And they're more convenient.

A new study out of Vanderbilt University finds that a telehealth platform is as effective as an in-person meeting for patients who are checking in with their care teams prior to surgery.

The study, published in the Journal of the American College of Surgeons (JACS) and presented at the Southern Surgical Association's Annual Meeting in December 2022, reinforces the notion that a virtual platform can replace an in-person meeting for shared decision-making and communication, as long as no hands-on services are required.

These virtual visits soared during the pandemic, when health systems shifted as many non-crucial services as possible from in-person meetings to telehealth. They've also become popular with patients who would have to take time off from work or travel to those appointments and providers who could better fit virtual meetings into their workflows.

According to the study of 387 patients participating in first-time pre-surgery visits between May 2021 and June 2022 at Vanderbilt University Medical Center clinics in Nashville, those who used telehealth and those who visited the clinic reported high levels of quality communication with their care teams. Those using telehealth cited convenience and usefulness as benefits, while negative comments were focused on technical difficulties and an inability to be in the same room with the doctor.

“We see patients that live hours away. When the COVID-19 pandemic hit, it threw fuel on the fire of our telehealth program,” Alexander T. Hawkins, MD, MPH, FACS, an associate professor of surgery at VUMC and co-author of the study, said in a press release. “Across the entire healthcare system, we now do about 20,000 telehealth visits a month. Previously, there had been concerns about whether we could effectively communicate with patients remotely, but we found that patients are just as satisfied with telehealth visits as in-person appointments.”

“We believe these results suggest that either method, in-person or telehealth, is appropriate," he added. "Ultimately, it very much depends upon what the surgeon and the patient think is the best way to communicate. Going forward, we need to determine what is most appropriate for telehealth, and what is most appropriate for in-person visits. The data we generated in this study do give folks support, so that if they prefer telehealth appointments, they can be confident that they will not be sacrificing quality of communication or shared decision-making.”

Some surgeons involved in the study said telehealth should not be used for first-time visits, when patient and provider are establishing a relationship, but would be appropriate for follow-up visits that do not involve hands-on care. Telehealth advocates have long argued that point, saying and audio-visual platform can be just as effective in establishing a provider-patient relationship as an in-person meeting.

The next step, researchers said, would be to create protocols for when telehealth is appropriate for pre-surgery consults, and when an in-person visit is recommended.