A HIMSS 2023 panel debated whether pharmacists could help beleaguered primary care doctors by taking on some non-acute care services.

Primary care providers are under a lot of stress these days. Pharmacists can help them.

That was the takeaway from an intriguing panel at last week's HIMSS 2023 conference and exhibition in Chicago. Hosted by Surescripts, the panelists maintained that pharmacists now have the technology and workflows at their disposal to support the PCP and improve the patient's healthcare journey.

"Pharmacies did step up" during the COVID-19 pandemic, noted Kevin Nicholson, vice president of policy, regulatory, and legal affairs for the National Association of Chain Drug Stores (NACDS), the Virginia-based advocate for traditional, supermarket-based and mass market pharmacies. "The proof is there that pharmacies can do it."

There were roughly 60,000 retail pharmacies in the US as of 2021, according to the Commonwealth Fund, roughly one-third of which are independent and rest located in retail chains, supermarkets, or mass retailers. Dominated by the likes of Walgreens, Rite-Aid, and CVS, the pharmacy has pushed its way into the spotlight as the neighborhood hub, offering not only prescriptions but health and beauty supplies, groceries, and other retail items.

Frank Harvey, CEO of Surescripts, the healthcare IT company that supports e-prescription and other health information exchange platforms, pointed out that many rural communities in the US have four or less PCPs per 1,500 residents, making primary care access at a distinct challenge. But most, if not all, have a pharmacy nearby.

And they have the technology to connect with care providers and access the patient record.

The idea, the panel said, is to have pharmacists take some of the duties traditionally reserved for PCPs, such as treatment for minor health concerns, thereby giving residents who can't easily access a doctor or who don’t want to go to the hospital or retail clinic an easy avenue to quick treatment. Most people, they said, would rather go to a pharmacy than a doctor's office or hospital for basic care services if they had the choice.

"We're not talking about complicated services," said Anita Patel, vice president of pharmacy services development for Walgreens. "We're talking low-acuity, very basic care."

The challenge? Pharmacists haven't traditionally been considered healthcare providers, and they're not recognized as providers in Medicare Part B plans. They weren't part of the meaningful use movement, and are often on the outside looking in when patient care is discussed.

The pandemic did prove that pharmacies could handle more care duties, and several states have since enacted legislation that allow pharmacists to be classified as providers, but federal officials haven't made that move.

Nicholson said NACDS has been working with states to redefine the pharmacist as a provider and has been talking to the Center for Medicare & Medicaid Innovation (CMMI) about developing a model program.

Eric Weidmann, chief medical officer for eMDs, a provider of ambulatory EHR and practice management software and revenue cycle management services, was hesitant to accept that change. He said pharmacists might be accepted as care providers in a team setting and for low-acuity health concerns, but there are too many exceptions to the rule that could affect the patient.

"It will be a rocky road," he said.

Weidmann also pointed out that pharmacies aren't as interoperable with other segments of the healthcare network as they can be, creating significant gaps in care. The challenges to integrating the pharmacy into the care network, he added, won’t be easy to overcome.

Patel said the pharmacy can be folded into a value-based care model, using infrastructure already in place for diagnostic testing and data-sharing. Nicholson pointed out that pharmacists were among the first to use technology, with e-prescribing platforms that in many cases pre-date the EHR.

Patel also noted that pharmacists don’t need to access the entire medical record to conduct basic care services.

"We don't need all of that data," she said. "How complicated are we going to make this? It's more like how simple can we make it."

And she emphasized that pharmacists wouldn't be competing with PCPs, but would help them. They could handle the low-acuity services, then send that data onto the PCP, reducing their workload and allowing them to focus more on care management. That, in turn, would benefit the patient.

"You actually have a care team for you," she said.

The health system has upgraded its clinical decision support technology to give care providers on-demand, FHIR-enabled access to important data at the point of care.

Intermountain Health has launched a new, FHIR-enabled tech platform aimed at giving its care providers instant access to clinical decision support (CDS) resources through digital health apps.

The platform highlights the Salt Lake City-based health system's efforts to create an interoperable platform that uses AI to give providers real-time information, including entering and pulling data from the EHR, events, and imaging and diagnostic services.

The EHR capabilities are important—and intriguing. By building on a Fast Healthcare Interoperability Resources (FHIR) framework and operating outside of any one EHR, users are able to securely read from and write into many different medical record platforms in real-time.

“This advanced approach to using data builds on the strong culture of innovation we foster at Intermountain Health," Craig Richardville, Intermountain's chief digital and information officer, said in a press release. "Patient care is often complex and very personal. This gives providers another tool to help them give patients the best, individualized care possible and helps ensure the right decision is being made at the right time."

“The platform has the capability to effectively perform and represent complex clinical processes and enables more rapid development of both clinical and business workflows," added Kathryn Kuttler, PhD, FAMIA, the health system's advanced decision support director. "This will help create a more seamless experience for patients."

The announcement touches on a number of themes at last week's Healthcare Information and Management Systems Society (HIMSS) annual conference and exhibition in Chicago: Interoperability, AI, and the development of healthcare services outside the hospital setting. With AI technology that sorts through and identifies relevant data to put at a provider's fingertips, the platform enables care teams at any location within the 33-hospital network to grab the information they need to support and improve patient care.

The health system is using this platform to support an updated version of its ePneumonia app, which was launched in 2011 and is now used in Intermountain Medical Center in Murray, Utah, to help emergency department personnel identify and treat patients dealing with pneumonia. Among other things, the app determines a patient's likelihood of having pneumonia and its severity and recommends appropriate clinical treatments, including whether the patient should be hospitalized.

Officials say the app has facilitated quicker diagnosis and treatment.

“In the studies, we demonstrated a 36% relative decrease in 30-day mortality for pneumonia patients, which is more than 100 lives saved annually," Nathan Dean, MD, section chief of pulmonary and critical care medicine at Intermountain Medical Center and principal investigator of the studies, said in the press release. "We observed [a] 17% increase in outpatient disposition from the emergency department and increased the use of antibiotic best practices."

“This ePneumonia app is one of the most complicated apps to build, as there are more than 50 data elements that go into diagnosis, assessment of illness severity, and decision making for patients with pneumonia,” he added. “Published pneumonia care guidelines have been historically difficult to follow at the bedside and have a complex workflow.”

Officials say they'll soon expand use of this app to other EDs within the health system, and they'll be launching other apps with these capabilities as well.

With HIMSS23 in the rear-view mirror, we look back and the challenges, solutions, and strategies that brought healthcare leaders to the Windy City.

HIMSS 2023 packed a punch this week in its hometown of Chicago, with large crowds, a busy agenda, and an exhibit hall that sought to take on the many challenges facing the healthcare industry. But the question remains: Are healthcare leaders ready to embrace change and, in effect, transform a struggling industry?

"Everyone is wondering what the next generation of healthcare is going to look like," said Yan Chow, MD, MBA, a former Kaiser Permanente executive who now serves as a global industry leader for Automation Anywhere, which develops intelligent automation software. "Are we ready to take that step?"

An Eye on Automation

Chow's company is part of an automation and AI wave that permeated almost every nook and cranny of McCormick Place, reflecting a desire by the industry to embrace technologies and strategies designed to make workflows easier and boost efficiency and outcomes. There were plenty of stories about health systems using AI to improve back-end business services or sort through available data to pull out the right information for the right task, either business or clinical.

Many see automation as a tool to addressing healthcare workforce shortages, clearly one of the biggest challenges facing the industry. With burnout and stress at record levels and clinicians, IT specialists, and other support staff retiring or quitting, health systems are looking to improve workflows to reduce stress and create virtual and hybrid care platforms that give employees more leeway (and, hopefully, satisfaction with their job). Key to that is automating repetitive tasks and processes that focus on data entry and analysis.

"What [clinicians] would like to do is practice medicine," noted Paul Brient, chief product officer at athenahealth. "What they don’t want to do is all that other crap."

Chow said C-level executives are now getting involved in the decision-making process because they see the value of innovation and technology, and they're mapping out enterprise-wide strategies. That was seen at ViVE as well, which attracted an impressive number of CIOs, CTOs, and even some CEOs.

The upshot: They're thinking of organizational change, not incremental steps forward.

"I can't bring in point solutions any more—I need platforms," said Eve Cunningham, MD, MBA, a vice president and chief of virtual care and digital health at Providence Health, who was there to scrutinize digital health products and unveil the health system's new Hospital at Home program.

Cunningham's thoughts are also reflective of a change in the healthcare innovation space, seen at HIMSS, ViVE, and other events. An industry that once focused on brand-new technology and tools is now more interested in how they're being used, and especially how they're showing value. Telehealth, of and by itself, isn't an innovation any more, but how it's used in different situations and how it's showing ROI are the attention-getters.

Cunningham noted Providence has a telestroke platform that allows two neurologists to cover more than 90 hospitals within the network, and a telemental health program that can treat patients in more than 40 hospitals from one clinic. That's what healthcare leaders want to see and talk about.

"There are a lot of health systems that have innovation fatigue," she said. Events like HIMSS, she added, allow health system leaders to "get the lay of the land and hear from thought leaders" on how to make their technologies work.

"It's all about evidence now," she said.

ChatGPT: The Shiny New Object

That doesn't mean HIMSS was devoid of shiny new ideas. One of the shiniest, of course, is ChatGPT.

"The reason ChatGPT became so big is that they gave wide access to it," Chow said of OpenAI's chatbot, one of the industry's fastest-growing tools and the focus of the HIMSS opening keynote. Both Epic and Microsoft have quickly embraced the technology, aiming to integrate it within the EHR platform.

Chow said a number of academic medical centers have approached him with requests to help develop an AI strategy that includes ChatGPT.

Sophy Lu, senior vice president and chief information officer at Northwell Health, said ChatGPT is certainly intriguing, with a variety of use cases that will be good for healthcare, but at the moment the hype is overshadowing the practicality. Health systems and vendors are jumping on the bandwagon without taking the time to wait for the technology to become more mature.

From Disruption to Transformation

ChatGPT might be considered disruptive because it's prompting healthcare executives to change how they look at healthcare delivery, but many are starting to think that "disruption" might be the wrong way to describe the forces of change within healthcare these days. Noted digital health influencer and radio host Gil Bashe said the attitude in Chicago was one of transformation, even enthusiasm.

"Just as the world is rebooting as the COVID cloud perceptually passes, HIMSS23 shows that the health IT community has returned with a passion for learning what’s just around the corner and a practical mindset for maximizing investments in infrastructure to improve care and reduce cost," he wrote in a recent analysis of the event.

Indeed, while the post-COVID economy edges toward a recession and healthcare organizations struggle to stay afloat, McCormick Place was busy. The two exhibit halls were crowded, the booths larger and more festive than last year's muted affair in Orlando, and the keynotes and sessions spread out across the sprawling complex were well-attended.

And HIMSS, facing spirited competition from the likes of HLTH and ViVE, was ready to put on a show, adding exhibit hall social events with drink carts, a puppy pavilion (now seemingly a standard at all events), and a 'Taste of HIMSS' food court.

"You come to HIMSS because it is HIMSS," athenahealth's Brient pointed out. "It really is a connecting event for us."

Making a Pitch For Partnership

Even the so-called disruptors were there, and looking to prove that the healthcare industry should be focused on collaboration rather than competition.

"We know they're getting pressure from new [participants in the healthcare space]," said Chris McGhee, co-founder and CEO of Current Health, the home-based care services platform acquired by Best Buy in 2021. "We give them a way to consumerize healthcare."

Best Buy made waves earlier this year when it announced a partnership with Atrium Health to support the North Carolina-based health system's Hospital at Home program. Hospital and Home and remote patient monitoring platforms are two of the fastest growing services in the industry, and they represent and effort by healthcare to expand the care platform away from the hospital, clinic, and doctor's office and into the patient's home.

“This is the coming together of technology and empathy,” Rasu Shrestha, executive vice president and chief innovation and commercialization officer for Advocate Health, part of Atrium Health, said in a press release announcing the partnership. “We're able to leverage the power of social workers, paramedics, nurses and physicians, but also technology to take care of the patients in their homes. We can bring forward things like remote patient monitoring and sophisticated wearable devices that capture their vital signs and combine it with the human touch – bringing it directly into our patients’ homes."

Hospital at Home and RPM were part of the playbook at HIMSS as well, and McGhee was on hand to explain how health systems should be pairing up with the retail industry to give both providers and patients access to the tools they need to enhance those pathways.

"We're fundamentally changing healthcare," he said, noting the Best Buy can pick and choose the technology needed to make the best and most reliable connections between a patient in the homes and his or her care team at a hospital. "Hospitals value that curation."

Indeed, with companies like Amazon, Google, Walmart, and Salesforce entering the space, the talk at HIMSS was not about how to counter those retail giants, but how to work with them.

Salesforce, which moved into the healthcare space roughly eight years ago with data products based in the cloud, is also trying to get hospitals interested in consumerism. The company's lavish, shrubbery-filled booth offered an attractive, oasis-like invitation to customer relationship management (CRM), from which it unveiled its new Customer 360 for Health platform.

"We're offering an engagement and relationship layer that healthcare definitely needs," said Amit Khanna, the company's senior vice president and general manager of health and life sciences. "Healthcare needs those relationship tools."

Khanna said healthcare organizations have been slow to embrace consumer-facing care, and they're facing a backlash from consumers and patients who have seen the retail, banking, travel, and entertainment industries meet their needs and want health systems to do the same.

"You can book an appointment with your banker easily, but you can't make an appointment to see a doctor," he pointed out.

All In For Interoperability?

Aside from the new ideas and entries in healthcare, HIMSS also highlighted a long-standing challenge in healthcare: Interoperability. Data sharing and interoperability are crucial to the expansion of value-based care. Intriguing examples were featured in the Interoperability Showcase, in various sessions and in booths across the exhibit halls, where attendees talked of sharing data from various sources, structured and unstructured, inside and outside the hospital walls, to create a complete patient record.

"We are at such an exciting time in the data interoperability journey," noted Steven Lane, MD, MPH, chief medical officer for Health Gorilla, one of six organizations recently selected by the US Health and Human Services Department to begin implementing the Trusted Exchange Framework and Common Agreement (TEFCA) standards, the first step toward becoming a designated Qualified Health Information Network (QHIN).

Lane said the TEFCA standards, QHIN announcement, recent information blocking rules, and expended revisions to the Health Insurance Portability and Accountability (HIPAA) guidelines to account for digital health technology have all been positive steps in the move toward a nationwide healthcare information exchange.

"It's getting a lot of people thinking about interoperability," he said. "And we need to be thinking about and talking about … expanding the participants. One of the challenges going forward will be how we actually put all the data to work."

"Data usability is certainly a key," added Rita Bowen, vice president of privacy, compliance and health information management policy for MRO, a clinical data exchange company, and a member of the board of director for the Sequoia Project, which was designated the TEFCA Recognized Coordinating Entity. "We think the industry is getting ready. The technology is certainly ready."

Lane admitted that interoperability isn't as sexy as ChatGPT or the Hospital at Home movement, so it might be overlooked in the HIMSS headlines and roundups, but it's a foundation to healthcare. Digital health and telehealth programs rely on the exchange of data between different platforms, and the ongoing national effort to address health equity and the social determinants of health (SDOH) will rely on the ability to pull information from a wide range of sources into the clinical record.

"Getting the data and actually working it into workflows is what matters," he said.

So as thousands of HIMSS attendees flood into O'Hare and Midway and make their way home at the end of the week, will strategies like RPM, patient engagement and activation, prior authorization, AI and automation, and digital health take hold? Will these strategies help healthcare organizations to bolster the workforce, reduce burnout and stress, boost clinical outcomes and keep the lights on in hospitals across the country?

If the attendance and activity at HIMSS—and at HLTH and ViVE prior—are any indication, the healthcare industry is shaking itself free of the COVID doldrums and looking to move forward. They're talked the talk and seen the options. It's time to walk the walk.

As the Healthcare Information and Management Systems Society's annual conference and exhibition opens in Chicago this week, attendees are looking for ideas and programs that have proven their value in addressing care gaps.

As HIMSS 2023 kicks off this week in Chicago, the topics of conversation are familiar to healthcare executives: Workforce shortages, using AI to automate back-end functions and improve workflows, and the growth of remote patient monitoring.

The annual conference and exhibition hosted by the Healthcare Information and Management Systems Society is the largest of its kind, though the pandemic and strategically placed competing events have had some effect on attendance. But the activity taking place in and around McCormick Plaza this week will still pack a punch.

Healthcare organizations know where their pain points are. They've listened to ideas around the redefining of healthcare at HLTH, caught a glimpse of some cool new toys at CES, learned about the expansion of telehealth at ATA, and seen how innovation and technology can be applied to those pain points at ViVE. Now, they want to see those ideas validated.

In the exhibit hall and in sessions over the next few days, the focus will be on how health systems have addressed stress and burnout in the workforce, how they've improved the prior authorization pathway, how they're using AI to smooth workflows, and how they're launching RPM or Hospital at Home programs to care for patients at home. Many press releases or announcements this week will likely focus on strategic partnerships to embed AI in administrative or care pathways, and new functions in products or platforms that reduce the burden on the provider and the patient.

All of these strategies are vital to a healthcare industry that's struggling to stay afloat and ahead of new competitors.

"Listen, respect, engage," Aaron Miri, senior vice president and chief digital and information officer at Jacksonville-based Baptist Health said during a pre-HIMSS presentation, noting that far more than half of their patients are expecting the same experience in healthcare that they're now getting at Amazon, Domino's and Dunkin. "If you do that, your patients will appreciate it."

Keynote speakers at HIMSS reflect the changing landscape of healthcare. They include executives from Amazon, Best Buy, VillageMD, and Microsoft, alongside HealthPartners CEO Andrea Walsh and Mayo Clinic CIO Christopher Ross.

The key to pushing value-based forward, these executives say, is to make the process more intuitive, and help both consumer/patient and provider/care team make the journey easier. Brad Reimer, CIO of the Sanford Health network, noted during a presentation that the most progressive virtual care and RPM programs won't work unless patients want them to work. And Shannon Crotwell, a clinical nurse navigator for Atrium Health, pointed out that health systems have to design programs that fit their patients, rather than trying to shoehorn a patient into an existing model.

In many cases, the conversations at HIMSS were started at HLTH, or ATA, or most likely at ViVE. They carry over to Chicago as more organizations get involved and new ideas are tested out. The strategies that work will have the data to support adoption—a key factor at a time when ROI is at the top of the list.

A state-funded effort to improve EMS services uses a virtual care platform to connect paramedics with emergency care specialists.

Fire and EMS departments across South Dakota are seeing positive results from an innovative program that gives paramedics on-demand access to emergency care specialists right in the ambulance.

The Telemedicine in Motion initiative was launched in late 2022 by the state in a partnership with Avel eCare, the telemedicine company spun out of Avera Health in 2021. The program, supported by a $20 million investment in EMS programs by the state legislature, equips ambulances with the telemedicine technology needed to enable a virtual connection with a hospital.

"We have a lot of patient care time in the back of an ambulance," says Randy Angermeier, director of the Clark Ambulance Service, which covers a significant swath of rural eastern South Dakota, not far from the Minnesota state line. The telemedicine platform "gives us another person back there [and] allows the medic in back to keep his or her eyes on what is going on."

Angermeier says a typical ambulance call can take 40 minutes for the vehicle to reach the patient, then another 45 minutes or longer to transport that patient to the nearest hospital. That's an eternity for a patient in serious condition and a paramedic trying to administer treatment.

Clark's ambulance is one of about 20 now equipped with audio-visual telemedicine technology supplied by Avel eCare, which connects the ambulance to emergency care specialists working in brick-and-mortar healthcare locations across the state. Rebecca VandeKieft, Avel's vice president and general manager of emergency and EMS services, says the program—one of the first of its kind in the country—offers triage and consulting services, including both basic life support (BLS) and advanced life support (ALS).

"It has a pretty historic monumental value," she says. "There's a lot of 'busyness' that we can take off these care providers in the back" during stressful times.

VendeKieft says the program was piloted at 11 sites in 2022 before going live this year, and she hopes to have 60 ambulances equipped with the technology (out of 122 identified by the state as eligible) by this summer.

Aside from a cabin-mounted tablet with audio-visual capabilities, the platform includes a router and cellular booster and a pair of antennas mounted to the roof to ensure a reliable connection to either Verizon's or AT&T's FirstNet first responder network.

While some larger organizations have been experimenting with digital health tools in EMS vehicles, ranging from ambulances to police units, to enable on-demand access to healthcare services at the site of an emergency, few have put a platform into an ambulance. But as the technology improves, the use cases are growing. Some larger health systems are experimenting with specially designed vehicles aimed at bringing on-site treatment to those suffering from a stroke or heart attack, while rural regions are most interested in adding services to EMS vehicles.

"Right now we can call them and boom—we're online," says Angermeier, who notes the platform gives his paramedics a sense of comfort knowing they have someone to back them up and offer support when needed.

"When you're 40 miles away from an ER, it's nice to have somebody else looking over your shoulder," he says. "You can't put a dollar value on that toolbox."

VandeKieft says more than 100 EMS companies have asked to join the program, and Avel eCare is getting interest from healthcare organizations, state agencies, and others around the country.

"We're hearing that cry for help," she says. "We've gained a lot of attention kind of being the first of its kind."

Telemedicine in Motion, she says, has been involved in more than 90 encounters so far, with positive clinical outcomes reported—even some lives saved. That data and much more will be collected as the program looks to move beyond the state grant and explore further scalability and sustainability.

"We will learn from our EMS partners" how to expand and fine-tune the program, she says, noting the platform could be used for more remote monitoring services outside the ambulance at accidents and emergency care at the scene. "The sky's the limit for that."

VandeKieft says the platform could also be used to not only train paramedics for more complex care such as moving from BLS to ALS), but to attract more paramedics and care providers, especially in rural areas where numbers are thin.

The Utah-based research firm's annual awards recognize 25 programs launched by health systems and payers that address key issues such as data integration and exchange and value-based care.

KLAS Research has unveiled its annual Points of Light awards, highlighting 25 innovative partnerships between healthcare organizations, payers, and vendors that have shown success addressing the nation's biggest healthcare challenges.

The announcement precedes by just a few days the Healthcare Information and Management Systems Society's (HIMSS) 2023 conference in Chicago, and tackles topics that will be front and center at the event, including workforce shortages; data interoperability, exchange and analysis; automating back-end functions; and valuer-based care initiatives.

Among the projects included in this year's awards is a deviceless remote patient monitoring (RPM) program launched by Illinois-based Carle Health and Health Alliance in a partnership with Lightbeam Health Solutions. The program has shown improved clinical outcomes and reduced monthly costs for a number of patients living at home with hypertension, COPD, and congestive heart failure.

Another project, launched by the Allegheny Health Network and Highmark Health in a partnership with Cedar, consists of a self-pay digital health platform and call center, giving patients real-time access to information including deductible progress, out-of-pocket maximums, and FSA/HAS balances, and a portal through which they can choose a payment plan, pay bills, or seek more information. That program, now being used by one-third of eligible patients, has boosted payments and improved patient engagement and satisfaction.

For each of the profiled programs, KLAS highlights outcomes achieved through collaboration, placing a high value on health systems and payers that work together and with vendors to solve problems.  Other key lessons learned included choosing the appropriate technology partners, creating groups and governance structures necessary for success, and using data to drive improved outcomes.

Last year's KLAS Points of Light winners included Vanderbilt University Medical Center, which launched a maternal health bundled payment program with the Metro Nashville Public Schools (MNPS) health plan and Cedar Gate Technologies that helped save more than $400,000 in its first year.

"People don't feel like their health systems are going with them on their journey," CJ Stimson, MD, JD, chief medical officer  at VUMC and Vanderbilt University Employee Health Plans and senior vice president of value transformation in VUMC's Office of Population Health, said in a HealthLeaders interview. "So we told them we'll take all the risk."

The study found that California FQHCs were still conducting 20% of primary care visits and 40% of behavioral care visits by telephone or audio-only computer platform.

Federally qualified health centers (FQHCs) in California are still delivering healthcare via the telephone, according to a new study from the RAND Corporation, raising the value of a modality only used since the pandemic to boost access.

The study of 30 FQHCs providing services to 1.3 million underserved residents found that, in August of 2022, audio-only telehealth was used for one out of every five primary care visits and two of every five behavioral healthcare visits.

Federal and state regulators relaxed the rules around telehealth access and coverage during the COVID-19 pandemic to enable more people to access care from their homes and help healthcare organizations reduce the spread of the virus. This included allowing providers to connect with patients by phone for some services.

Telehealth advocates say many underserved populations, especially in rural areas, can only access care by telephone, as they can't afford or don't have easy access to computers or reliable broadband. Critics say the platform isn't good enough for many healthcare services, and that a telehealth connection should at least have an audio-visual connection.

[See also: How Will the End of the PHE Affect Telehealth and Digital Health?]

While audio-only telehealth permissions will be scaled back with the end of the public health emergency in May and the two-year grace period included in the Consolidated Appropriations Act of 2023 passed by Congress, RAND researchers found that the platform still has considerable value. Some states, including California, have permanently allowed Medicare coverage for audio-only telehealth for some services, especially behavioral healthcare access.

“It is likely that these safety net clinics continued to deliver audio-only visits in high volume because of their role in improving access to health services,” Lori Uscher-Pines, lead author of the study and a senior policy researcher at the nonprofit research organization, said in a press release issued today. “Our study raises important questions about what kind of role we want audio-only visits playing in the care of disadvantaged populations and the public in general going forward.”

According to the study, which tracked the FQHCs' traffic over roughly two years, primary care visits increased by 8.5% from February 2020 to August 2022, while behavioral health visits jumped 23% during that same time. The proportion of audio-only visits, meanwhile, peaked during the height of the pandemic at 67% of primary care visits and 74% of behavioral care visits, and have since dropped back to 21% and 39%, respectively.

[See also: Audio-Only Telehealth Visits During Pandemic Draw GAO Scrutiny].

While telehealth use has declined in the wake of the pandemic as patients and providers return to in-person services, the platform still has considerable value in helping underserved populations access care and giving consumers more opportunities to connect with their care providers. Many health systems are looking to balance the two or create a hybrid approach to accessing care.

And while the argument over using a telephone or audio-only channel on a computer will continue, the RAND study indicates it's still a viable avenue for access for those who face barriers accessing care.

“It appears likely that audio only visits in these settings will remain widespread in coming years,” Uscher-Price said in the press release. “More research is needed on the effectiveness of audio-only visits to inform their use in safety net settings.”

The Medical University of South Carolina's chief innovation officer says innovation is part of the health system's culture, and something in which everyone takes part.

Jesse Goodwin sees innovation not as a technology issue, but as a mindset.

"Everyone in the organization has something that doesn't work ideally," she says. "We want them to use creative solutions to address those pain points. We're empowering them to take that next step and come up with innovative solutions."

Goodwin is the chief innovation officer at the Medical University of South Carolina (MUSC), helping to develop and guide innovation strategy for one of only two institutions in the country designated as a National Telehealth Center of Excellence. MUSC is an academic medical center, occupying that unique space between a stand-alone university and a health system, so her efforts and goals are both clinical and educational.

"Innovation is center to the MUSC enterprise," she says. "It's in our mission, vision, and values and the first goal of our strategic plan. Other health systems might play lip service to innovation, but we're all being charged here to be innovative."

"It's not a white-coat thing," she adds. "This is in our culture."

Goodwin, who was vice president of development for the Zucker Institute of Applied Neurosciences and director of the medical device practice of a Boston-based intellectual property consulting firm before taking on the CIO role at MUSC, knows a thing or two about technology. Her biography on the MUSC website notes that she's an engineer by training, and she designed a transcatheter aortic valve replacement device for her senior thesis in college.

Jesse Goodwin, chief innovation officer at the Medical University of South Carolina. Photo courtesy MUSC.

But while technology can, at times, be innovative, innovation isn't always about technology.

"Technology is often not the right route to take," she says. "We're not just looking for new apps [or devices]. We need to work harder to expand the definition."

Goodwin says she wants to separate innovation from technology so that people will think beyond just finding an app or tool to solve a problem. In doing so, she says, they'll take a closer look at workflows and other factors that either contribute to the problem or can be altered to solve it. They'll get a better feel of how innovation can lead to transformation.

"That brings more people into the conversation," she says.

That can also make an answer more complex. In her profile, Goodwin notes that research is a driving force in many healthcare advances, though not the only one. In an industry like healthcare, which is undergoing a transformation of its own to value-based care, the patient experience is taking on a much bigger role. Providers must pay more attention to the patients as a collaborator in healthcare and look at new ideas that include engagement and the use of data supplied from the patient.

Goodwin agrees that healthcare innovation took a leap forward during the pandemic, when healthcare organizations jumped at any opportunity to shift to virtual care, often taking leaps of faith with ideas and technology that would have taken years to plan out and prove. The pendulum is swinging back now, toward a better balance of virtual and in-person care, though the emphasis on consumer preference and opportunities to improve access to care and target social determinants of health remains.

"The opportunities [created by the pandemic] really did give us some new ideas," she says.

This includes new platforms for behavioral health treatment, a key pain point coming out of the pandemic, both in the number of people needing access to care and the shortage of providers offering it. Patient access to the health system's digital front door is also a popular topic, as is patient-friendly reporting (finding ways to integrate the patient voice and patient engagement with the medical record) and precision medicine.

A program of which Goodwin is especially proud is the STEM-Coaching and Resources for Entrepreneurial Women (STEM-CREW) program, established last year in a collaboration with the College of Charleston to boost the number of women entrepreneurs in the medical science field. The program is supported by the $2.4 million grant from the National Institute of General Medical Sciences.

"Studies have shown that women start companies with 50% less money and raise 66% less capital than their male counterparts," Goodwin said in a press release announcing the program's launch. "There are a lot of hypotheses as to why this divide exists, and it includes things like implicit bias as well as the willingness of women to seek funds within their own network of contacts. These are barriers to success for women who have already decided to pursue entrepreneurship. The CREW program hopes to address both through coaching, mentorship, and other programmatic support."

Goodwin says MUSC's culture of innovation will certainly help in this effort.

"Not surprisingly, there a big gender disparity at all stages of the process," she says, noting the MUSC was one of the first in the nation to track the gender representation. "But over the last four or five years, we've seen a strong culture of entrepreneurship taking off. This gives us a chance to flip the switch and really create some new opportunities."

That said, there are challenges. The sluggish economy is playing havoc with many healthcare organizations, forcing them to curb expenses and put their focus on workforce issues. Goodwin says the impact is felt everywhere, from nursing to the IT department. New ideas and platforms need to have a solid business case behind them, with a clear definition of value and a good ROI.

"It puts a lot of attention on the organization's efforts to support innovation," she says. "We don’t have the resources—or the access to resources—that we used to have."

And that's where transformation may be more important than technology. It forces creative minds to find ways to solve problems and improve operations and outcomes without sinking money into new technology.

"Innovation is central to the true MUSC enterprise, and it's never going to go away," Goodwin says. "We actually take it as a goal, just like we do with quality metrics."