The New Orleans-based health system is seeing improved clinical outcomes in a pilot Medicaid program targeted at patients living with hypertension and type 2 diabetes.
Ochsner Health is reporting strong results from a pilot remote patient monitoring program targeting Medicaid patients living with type 2 diabetes and hypertension.
Billed as one of the first in the country, the program, coordinated by Ochsner Digital Medicine, saw nearly half of participating patients dealing with uncontrolled hypertension bring their blood pressure under control within 90 days, a 23% improvement over traditional care management. And almost 60% of those with poorly controlled diabetes were able to improve their blood-glucose readings and A1c levels.
“So meaningfully moving the needle among Medicaid patients with type 2 diabetes and hypertension is unprecedented," Denise Basow, MD, the New Orleans-based health system's first and current chief digital officer, said in a press release. “We are confident this program can be scaled to improve the lives of others across the state and around the country to mitigate the impacts of chronic disease.”
The RPM program was launched in June 2020 at Ochsner LSU Health Shreveport, and has enrolled more than 4,400 patients. Health system officials noted the program addresses a serious gap in chronic care management in Louisiana, where roughly 40% live with hypertension and 14% lives with diabetes.
RPM programs hold great potential in bringing care management out of the hospital, clinic and doctor's office and into the home, where providers can monitor a patient's daily health and habits and adjust care (including medication) accordingly. With digital health technology, they can capture relevant data to identify trends and support treatment plans.
Ochsner is one of the top health systems in the country with regard to digital health strategy, and has been gradually building out several programs on a national platform. Data from the RPM program could be used to support arguments to the Centers for Medicare & Medicaid Services (CMS) to improve Medicare and Medicaid reimbursement.
“As clinicians, we are always working to improve patient outcomes and the overall patient experience, and this program shows that we can use home-based technologies to accomplish both," Lauren Beal, MD, Ochsner's medical director of primary care and community clinics for northwest Louisiana, said in the press release.
One of the keys to a sustainable RPM program is sustainable clinical outcomes, and Ochsner officials noted that those living with hypertension continued to show positive results after 18 months. In addition, the program was well-received by patients, with a net promoter score greater than 91.
Ochsner officials said they'll continue to work with payers and employers to improve reimbursement, which would allow the health system to expand the program to other parts of the state and, eventually, other parts of the country.
“Over 30,000 patients have benefited from Ochsner’s Digital Medicine chronic disease programs,” Richard Milani, MD, Ochsner's chief clinical transformation officer and vice-chairman of the Department of Cardiology, said in the press release. “We're offering patients compassionate human care combined with the power of technology, and we’ll continue to expand these programs to help more patient populations.”
Jennifer Bollinger says healthcare organizations are paying too much attention to technology and not enough on the people and processes that make virtual care work.
To Jennifer Bollinger, the patient experience shouldn't be defined by technology, but by the value of interactions with the care team. For that reason, she's ditching the term "digital health" in favor of "connected health."
"Digital really isn't our strategy," says the senior vice president and chief consumer officer at Ochsner Health. "It is one of the key levers for transformative care, but it's just one part of [an equation] that includes people and processes. Connecting them and making those connections seamless and personal is our goal."
Bollinger's work in digital consumerism with the New Orleans-based health system highlights another underlying challenge as well: connecting with the consumer, rather than the patient. As healthcare organizations move toward value-based care, they need to look beyond the idea of connecting with patients of the health system and focus more on connecting with consumers of healthcare services.
That ecosystem is much larger and more complex, encompassing not only the individual moments that require healthcare interactions but the whole journey.
Jennifer Bollinger, senior vice president and chief consumer officer at Ochsner Health. Photo courtesy Ochsner Health.
"Consumers really don't know how to figure out that they don't want a lot of choices," she points out. "They want ease and guidance. They want someone to guide them."
In the midst of this shift from periodic to value-based care, healthcare providers have been undergoing a change of perspective as well. The emergence of telehealth and digital health tools and strategies has given the consumer more control over healthcare choices, which in turn has flooded the market with new healthcare locations and opportunities. Healthcare organizations can no longer sit back and expect the consumer to come to them; they need to reach out and market their capabilities, competing with other hospitals and health systems, health plans and telehealth vendors with their own providers, retail health clinics, and large companies like Amazon.
In this atmosphere, health systems have to see the consumer, or everyone within reach of their healthcare services, rather than the patient, or someone who has used their services. And the strategy is shifting from 'You're going to need healthcare services and here we are,' to 'We're better at this than the others.'
And part of being better is using technology to make healthcare more intuitive.
"The pandemic was certainly an enforcing factor" in identifying the value of virtual care, says Bollinger, noting the nationwide shift to telehealth and digital health tools to facilitate easier healthcare access at a time when in-person care was risky. And now that the pandemic is waning, she says, health systems are asking themselves, "Are we going to be able to cash the check that we wrote?"
At Ochsner, which has forged a path in digital health that goes back long before the pandemic, the key isn't highlighting these new tools and platforms, but showing their value. An RPM program works if it improves medication adherence and reduces trips to the doctor's office; a messaging program works if it boosts scheduled wellness visits or vaccinations or reduces no-shows for appointments; and a patient portal is effective if it channels patients to the right place without the need for extra clicks or a phone call.
On some of those occasions, "if I have to pick up the phone and talk to someone, something has broken down," Bollinger says. "Now there are times when talking to someone is a positive, but not when you're just trying to do something quickly."
In many cases, consumers already know about patient portals, messaging platforms, and virtual care, Bollinger notes, but they haven't seen how it can help them. The health system has to connect the dots.
"We've done a lot of 'one-size-fits-all solutions," she says. "Now it has to be made personal."
Bollinger points out that consumers have seen how technology improves the experience in other businesses, like banking, travel, and shopping. But how does that translate to healthcare? Making a bank deposit, planning a vacation, or buying a jacket isn't the same as conferring with a doctor about a health concern.
"It's sometimes hard to get them to articulate their expectations for healthcare," she says.
That's where connected health comes in, and where consumer strategy is important. Health systems need to focus not on the technology but on the people and processes that make it work. Instead of talking about the digital ecosystem of consumer tools, talk about the connections that these services offer with providers and care teams, and the opportunities those connections offer to improve health and wellness.
"We aren't paying enough attention to the up-and-coming generations," Bollinger says. "The pandemic offered them a lot of choices, and they’re taking advantage of that."
The Delaware-based health system's Helen F. Graham Cancer Center & Research Institute has received an award from the Association of Community Cancer Centers (ACCC) for a program that integrates cancer care with primary care.
ChristianaCare's cancer care program has earned national recognition for a unique program that integrates primary and cancer care.
It also addresses a gap in cancer care management spotted by the health system.
"We conducted an informal survey that found as many as 15% of our patients did not have their own primary care provider,” Cancer Program Clinical Director Cindy Waddington, MSN, RN, AOCN, said in a press release, which includes a link to a recent podcast on the program. “Having a primary care provider onsite working closely with the entire cancer care team helps ensure that essential patient care beyond cancer treatment is not delayed."
The health system pointed out that patients undergoing cancer treatment are often dealing with other health concerns, especially chronic issues like diabetes, heart problems, COPD, and high blood pressure, and that cancer treatment can exacerbate those issues. To facilitate comprehensive care, the program enables oncologists to refer their patients to primary care services for any non-cancer concerns.
"Primary care in oncology has been a long-standing challenge for cancer patients and cancer programs,” Family Nurse Practitioner Debra Delaney, RN, MSN, ACNS-BC, FNP-BC, who provides primary care services at the Graham Cancer Center, said in the press release. “Thankfully, we’ve been able to solve that challenge by addressing the whole person and promoting healthy living for the long-term.”
As part of the process, Delaney helps patients who finish their cancer treatments transition to a primary care provider for ongoing care management.
"Earning the prestigious ACCC Innovator Award for our primary care practice is an accomplishment that belongs to our entire cancer care team, which has worked long and hard to develop this unique program designed to improve our patients’ long-term health,” Nicholas Petrelli, MD, the Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute, said in the press release.
The Center for Connected Medicine has released a new report identifying the 15 health systems who are investing in biotech and therapeutic startups and spinning out their own companies.
Large health systems are fueling healthcare innovation by making their own investments in biotech and therapeutics startups and supporting intriguing new startups.
A new report from the Center for Connected Medicine has turned the spotlight on this little-known and often secretive trend. Titled "A New Player in Biotech Investing," it highlights a growing movement in healthcare to support companies and technologies that could someday change the way clinical care is delivered.
“There’s a notion across the industry that we’re just seeing the tip of the iceberg when it comes to what medicine is capable of achieving to treat disease,” Matthias Kleinz, senior vice president of UPMC Enterprises, the innovation and venture capital division of UPMC and one of the 15 organizations included in the report, said in a press release. “Organizations like ours bring unique resources and expertise to efforts that seek to turn groundbreaking scientific research into life-changing therapies for patients around the world.”
According to the study, the increase in health systems support mirrors the increased activity that has been seen in digital health and telehealth in general, some of its sparked by the surge in telehealth use during the pandemic.
The study identifies four characteristics of a health system that's investing in new biotech and therapeutic startups:
They're large enough to dedicate resources to venture startups;
They have relationships with academic researchers;
They include dedicated venture capital organizations; and
They focus on internal spinouts.
"There is also near-term benefit to health systems beyond the potential return on their investments," the report notes. "By working to ensure more personalized and custom therapies, such as stem cells, CAR-T, and others, are accelerated from laboratory to patient bedside, health systems not only greatly improve patient care but also have the potential to capture commercial upside through new service revenue."
At the same time, investments don't guarantee success, and a successful investment includes support from the top down, significant guidance and coaching from healthcare experts, and an understanding that risk is involved.
“Can you build the support within your organization and invest for the long term?" Kleinz noted in the report. "It’s hard to take a long view when you have more immediate short-term needs.”
The health systems included in the report are:
Cleveland Clinic Ventures;
Intermountain Ventures;
Jefferson Innovation;
Johns Hopkins Technology Ventures;
Kaiser Permanente Ventures;
Mass General Brigham Ventures;
Mayo Clinic Ventures;
Michigan Biomedical Venture Fund;
Mount Sinai Innovation Partners;
NYU Langone Health Technology Opportunities and Ventures;
With the end of the COVID-19 public health emergency on the horizon, some healthcare organizations are struggling to come to grips with the impending loss of telehealth freedoms.
For healthcare providers treating some of the most underserved populations and communities, the end of the COVID-19 public health emergency is pretty bleak. Federal waivers expanding access to and coverage of telehealth will end with the PHE, forcing them to curtail or even end programs that had seen quite a bit of success over the past few years.
"It's going to be a challenge," said Chris Grasso, MPH, chief information officer for Fenway Health, a Boston-based federally qualified health center (FQHC) serving more than 35,000 patients annually, many of them part of the LGBTQ+ community. "It's a lot to untangle and figure out."
Grasso, who keynoted a recent telehealth summit in Massachusetts hosted by the Northeast Regional Telehealth Resource Center (NETRC), said these all-in-one healthcare centers serve patients who fall through the cracks because of those barriers.
"Now that the COVID restrictions are coming back, it's going to be harder to do our work," she says. "But we need to keep the lights on and the doors open."
NETRC is one of 12 regional and two national resource centers in the federally funded National Consortium of Telehealth Resource Centers. Based in Augusta, Maine, it serves as the clearinghouse for telehealth policy and information for all of New England and New York.
Healthcare organizations of all sizes across the country often rely on the consortium and individual TRCs for the latest news in telehealth policy and regulations, and these regional summits serve as focal points for catching up on the latest.
At the NETRC event in Southbridge, Massachusetts, Christina Quinlan, an executive consultant and advisor to the NETRC who'd previously worked as the chief operations officer for an FQHC on an island off the Maine coast, noted FQHCs and RHCs have long balanced the need to use new technology to reach patients with ROI.
"Telehealth and innovative technology wasn't anything new to us," she pointed out. "We just never got paid for it."
That changed with the pandemic, which thrust these types of healthcare providers into the spotlight as an important resource for both primary and specialty healthcare services at a time when hospitals were overcrowded and people were avoiding them and the doctor's office for fear of infection. Among the federal and state waivers to expand telehealth adoption were measures specifically focused on FQHCs and RHCs.
Quinlan noted that despite the positive results seen from the increased use of telehealth, CMS has only made permanent six CPT codes for telehealth services related to behavioral healthcare.
"It's primarily for psychotherapy," she said. "What they've expanded isn't nearly enough."
Grasso said Fenway Health, which sees more than 2,000 patients seeking HIV care, embraced virtual visits early on during the pandemic to provide a safe means of accessing care for those at heightened risk. As time has passed, they've seen patients from more than 40 states and 1,000 zip codes, as well as transgender patients from states who've taken action to restrict healthcare services.
"There have been lots of opportunities for us to be innovative," she said.
And they have to. According to Grasso, a 2015 study indicated one-third of all LGBTQ+ patients have reported a negative healthcare experience, and 23% have avoided seeking healthcare because of fears of mistreatment. This puts the pressure on providers to find new methods for providing discreet care, such as through digital health messages and virtual visits.
"Our patients are some of the biggest disruptors in healthcare right now," she pointed out.
FQHCs and RHCs are also facing stiff competition, she noted—not only from hospitals and health systems ramping up their efforts to address social determinants of health and connect with underserved patients, but from free-standing and retail health clinics offered by the likes of CVS and Walgreens, telehealth providers and health plans with their own provider resources, and direct care platforms launched by Amazon, Google and others.
"We have to continue to be creative to compete in this market," she says, mentioning a plan to explore the use of kiosks in locations around Boston and surrounding cities.
Part of the problem may be that FQHCs and RHCs haven't been vocal enough about the lack of permanent telehealth coverage.
"For them [CMS], it's like, if we're not complaining about it enough, it's not an issue," said Quinlan, who's urging advocates to give federal officials an earful so that CMS might address the issue in its proposed 2024 Physician Fee Schedule, which is slated to come out next July.
They're also hoping that Congress may step in and enact new legislation making those telehealth waivers permanent. Danielle Louder, the NETRC's program director for technology-based initiatives, noted there are more than 100 telehealth-related bills now before Congress, alongside lobbying efforts from a broad range of stakeholders to take action.
For now, FQHCs like Fenway Health are continuing to look for new ways to reach and deliver care to underserved communities—Grasso said they've "had to do a lot of MacGyvering" along the way—and keeping an eye on the end of the PHE, which is still a moving target. The latest news puts that date in 2023, and Congress has ensured that the CMS waivers will remain in effect six months after that.
"It's their job to continue doing what they're doing," Quinlan says. "But it will be much harder."
The money is being issued by the US Department of Agriculture to 208 healthcare organizations in 43 states and Guam to improve rural health outreach and programs.
The Biden Administration has designated $110 million in American Rescue Plan funding to allow rural healthcare providers in 43 states and Guam expand their footprint through telehealth and other platforms.
Some 208 rural healthcare organizations will receive grants through the Emergency Rural Health Care Grants Program. The money will be used to help rural hospitals and healthcare providers implement telehealth and nutrition assistance programs, increase staffing to administer COVID-19 vaccines and testing, build or renovate facilities, and purchase medical supplies.
For example, New Hampshire-based Families Flourish Northeast is getting a $1 million grant to renovate a residential treatment center that has seen an increasing number of mothers with substance abuse issues during the pandemic. And in Minnesota, Kittson Memorial Hospital will use a $51,700 grant to upgrade the clinic exam room and nurse's station and add an isolation room for patients with infectious illnesses or those who are susceptible to infections.
Some $9 million of that funding will go toward 12 rural healthcare organizations to help almost 200,000 people living in designated energy communities, which are areas with high concentrations of coal-dependent jobs, as the nation seeks to transition to clean energy.
“Access to modern and sustainable healthcare infrastructure is critical to the health, well-being and prosperity for the millions of people who live in rural and Tribal communities,” Xochitl Torres Small, the US Department of Agriculture's undersecretary for rural development, said in a press release. “That’s why the Biden-Harris Administration remains committed to making sure that people who need it most, no matter where they live, have access to high-quality and reliable health care services like urgent care, primary care and dental care."
Stanford Health Care's Alpa Vyas is part of a new wave of healthcare executives looking to forge more meaningful and lasting connections between patients and their care teams.
For Alpa Vyas, the concept of patient experience has changed significantly in healthcare. Once considered a luxury to the C-suite, it's now an important part of clinical care delivery and a key to measuring the value of the organization.
"It's really become about the whole journey that a patient experiences with a [care provider] or an organization," says the vice president and chief patient experience offices for Stanford Health Care. "How care is delivered … has fundamentally changed due to the pandemic."
Patient experience is an integral part of patient-centered care, an idea that's been gaining steam for at least two decades, as healthcare organizations look to shift from episodic to value-based care and make the patient the center of the equation rather than a peripheral. And it means a lot more than simply handing out a survey or asking patient to rate their healthcare experience.
"It's a connected experience now," says Vyas, who's been with Stanford Health Care since 2015 and previously worked with the Medical University of South Carolina (MUSC) and Deloitte Consulting. "And the care team has to understand the value and need [for that connection]."
Alpa Vyas, vice president and chief patient experience officer at Stanford Halth Care. Photo courtesy Stanford Health Care.
Stanford Health Care is one of many organizations to elevate the role of chief patient experience officer, part of a "patient experience journey" that Vyas says has been ongoing for several years. With health systems dependent on publicly reported data and benchmarks, Joint Commission reviews and HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, leadership has to know how to connect with patients (both current and future), meet their needs, and address concerns before they become complaints.
Due in part to COVID-19 and the elevation of virtual care, the patient experience space is also seeing a good deal of innovation. Healthcare organizations are using a wide array of digital health technology, from online portals to self-scheduling platforms to telehealth and remote patient monitoring tools, that are designed to improve the patient experience.
"We've moved to the next generation [of] omni-channel communication," says Vyas. "Patients can now choose [how they want to connect with their care providers.] When that ability to choose is there, it's up to us to create differentiators."
That means, to use a phrase repeated quite often these days, connecting with patients when, where, and how they want to connect, be it through e-mails, text messages, phone calls, or snail mail. And it's not only about how to connect with them, but how often.
"We're about to connect with and collect data from a patient in new ways, but how do we actually bring this data together in a meaningful way … that personalizes the connection but isn't intrusive?" Vyas asks. "The information that the patient provides has to lead to a broader, more complete picture."
Vyas says she and her team at Stanford Health Care conduct a lot of research, on topics that include human-centered design and empathy, to understand how the healthcare experience from the patient's point of view. They include family and other caregivers in the equation, with the understanding that patient care doesn't begin when the patient enters the hospital or end when he/she is discharged.
There is also an understanding that the benefits of new technology go both ways. While patients can enjoy the luxury of communicating with their care providers on a variety of channels, those providers also have new opportunities to reach their patients with important messages, information, and links to resources, and they can use that technology to measure how those messages are received and acted upon.
"The value is only demonstrated when we can actually do something with it," says Vyas. That might mean an uptick in cancer screenings brought about by an e-mail or text message campaign, or an improvement in patient discharge times caused by a digital platform that smooths out the rough edges of scheduling and provider check-offs, or maybe a single message to a grumpy teenager that leads him or her to improve their diabetes care management routines.
That's the gist of the connected experience, she says: The use of clinical, operational, and interventional data so that the patient experience is completely intertwined with the experience of the care team and physicians.
As the healthcare industry continues its journey toward value-based care, chief patient experience officers like Vyas will be crucial in establishing and maintaining that connection with the patient. And hospitals and health systems will rely on that expertise as they face stiff competition from telehealth companies, health plans and retail giants like Amazon for those healthcare dollars.
"There's still a lot of healthy skepticism about measuring the patient experience," she says. "Over time, we want to use that to design better connections not only for the patient, but also the provider."
Healthcare organizations are using a digital health platform to help care teams monitor wounds in real time and reduce the chance of hospital-acquired pressure injuries.
Healthcare organizations are embracing new technologies to improve wound care, which can lead to serious complications, including death, if not managed properly.
Digital health tools such as smart bandages and sensors and reporting tools within the EHR that include images can help care teams keep close tabs on wounds and avoid hospital-acquired pressure injuries (HAPIs), which are listed by the Centers for Medicare & Medicaid Services as "never events." The agency has estimated that HAPIs can add more than $43,000 in costs to a hospital stay, with severe cases running into the hundreds of thousands of dollars.
One such health system facing that challenge is New York's Northwell Health system.
“We were taking ruler measurements, and it was extremely inaccurate because I might be off by a millimeter or two,” Alisha Oropallo, MD, FACS, FSVS, FAPWCA, FABWMS, director of the Department of Vascular and Endovascular Surgery's Comprehensive Wound Care Center in Lake Success, said in a recent e-mail. “Then the nurse might measure the next week and have a slightly different measurement; sometimes, the depth would not be taken; and rulers don’t provide an accurate square surface area, so if you wanted it, you had to manually calculate it.”
Northwell Health has partnered with Pittsburgh-based digital health company Net Health to deploy its Tissue Analytics (TA) software for wound care management. The technology is integrated into the health system's EHR platform to give clinicians more accurate wound data and allow for real-time monitoring.
HealthLeaders recently spoke, virtually, with Roxanne Elling, RN, BA, BSN, CWOCN, a wound care specialist at Good Samaritan Hospital Medical Center in West Islip on New York's Long Island, part of the Catholic Health system, about how the technology improves the wound care process at her hospital.
Q. What impact does wound care have on your organization?
Elling: Wound care has a great impact on all healthcare organizations. With the implementation of the EMR, the demands for all clinical documentation have increased, which of course includes a complete wound assessment. With time constraints, staffing challenges, competing priorities, and thorough documentation needs, these can be difficult to complete during one’s shift.
Q. What challenges are you facing with wound care? (e.g., number of patients with wounds increasing, impact of COVID, HAPI penalties, compliance, MIPS, etc.)
Elling: Health disparities within our population have given rise to untreated chronic conditions and loss of optimal health. Pressure injuries are caused by poor nutrition, limited mobility, and chronic conditions. When these conditions are left untreated or poorly managed, a sicker, more vulnerable patient is admitted. This is especially a concern among the elderly, and was also more common during COVID. Like most hospitals, GSH is challenged by pressure injuries, and their impact on our reimbursement and overall ratings.
Q. How was wound care handled prior to the adoption of technology?
Elling: Prior to the use of Tissue Analytics (TA) technology, the clinician spent a large amount of their time carefully measuring and documenting each of the patient’s skin related challenges, including but not limited to Incontinence Associated Dermatitis, pressure injuries, skin fold challenges, and traumatic wounds. This documentation was often significantly subjective. Despite the overwhelming amount of education given to both physicians and nurses, there was a consistent challenge with documentation accuracy among various clinical groups.
Q. How has new technology improved wound care?
Elling: With the use of TA technology we have the ability to see what the clinician saw at the time of admission through pictures. This allows the Certified Wound Ostomy and Continence Nurse (CWOCN) to review and expertly evaluate without actually being at the patient’s bedside at the time of admission.
This is especially helpful for challenging documentation. With the adoption of the technology, accurate and/or progressing wounds that are in question can be better monitored.
We were fortunate to have adopted TA in our facility over two years ago. While change is generally a challenge, TA has now become part of the culture and part of our practice as clinicians. As EHRs and technology evolve, such as documenting on smartphones, the need for a HIPAA-protected environment is a necessity for sharing information for evaluation. TA gives all clinicians involved in patient care the ability to see what is going on “below the blankets.” It is essential that all team members are able to visualize, acknowledge and update the plan of care regularly. Tissue analytics allows our physicians to review pictures at their fingertips in real time and within a protected environment.
For our facility, and throughout our hospital system, TA is being used as an inpatient tool. It allows the CWOCN to see what challenges each patient has, and it enables us to structure our days, prioritize our patient load and maximize time management strategies. For our physicians, TA has greatly improved the ability to collaborate by allowing the patient’s photos to be included in their assessment and ongoing evaluation. Keeping physicians continuously updated with photographs of skin conditions has become an essential communication tool used in patients’ ongoing treatment plans.
As a society we expect immediate results. With the capability of virtual visits and remote chats online with physicians, the need for more real time evaluation in acute care is required. With TA, staff at the bedside has the ability to enter a photo into the chart that can be viewed by physicians elsewhere in real time. Ongoing and progressive photographs within the EMR can demonstrate effective improvement in wound condition and character and assist us in driving successful management.
Q. What are the challenges or barriers to using these new techniques?
Elling: Similarly with any technology, the challenges are generally related to user education and usability as well as the reliability of hardware and connectivity.
Q. How do patients feel about these services?
Elling: Prior to taking any pictures, patients and family members are educated and understand the need for us to photograph their skin to validate treatment and monitor healing over time.
Hospitalizations are always stressful. In using TA technology, the care team has been able to demonstrate wound healing to family members while participating in the patient’s plan of care. This allows open communication of challenges with the patients’ clinical status, in an ongoing effort to help everyone collaborate for better goals of care for each patient.
Q. How do you measure success with this technology?
Elling: We have data to suggest that between 6% and 10% of pressure injuries were incorrectly staged on arrival to our facility. We believe that without the use of TA, the appropriate prevention and treatment interventions could be overlooked as well as the risk of potential financial penalties as a result of incorrect documentation.
Researchers have found that telehealth performed better than in-person care in 11 of 16 HEDIS quality performance measures, but that doesn't mean virtual care is superior to the office visit.
New research published in the Journal of the American Medical Association (JAMA) finds that telehealth was superior to in-person care in 11 of 16 quality performance measures for primary care.
The study, conducted by researchers at the Robert Graham Center in Washington DC and Pennsylvania-based Wellspan Health, focused on more than 526,000 patients receiving healthcare services at roughly 200 Wellspan Health outpatient sites between March 1, 2020, and November 30, 2021, and used HEDIS (Healthcare Effectiveness Data and Information Set) measurements.
The researchers, led by Derek Baughman, MD, of the Robert Graham Center and Wellspan Good Samaritan Hospital in Lebanon, Pennsylvania, and Yalda Jabbarpour, MD, and John Westfall, MD, MPH, both of the Robert Graham Center, said the results don't mean that health systems should close their clinics and focus on virtual care. Rather, they should offer telehealth as a part of the overall care plan, particularly for those who face barriers to accessing in-person care.
The study noted that in-person care showed better results for all medication-based measures, while telehealth offered better results in testing and counselling measures, such as vaccinations, chronic disease testing, and cancer and depression screenings.
"Notwithstanding the statistical significance, the clinical relevance of these findings is perhaps more meaningful at the population health level for evaluating the outcomes of adding telemedicine as a care venue," Baughman and his colleagues noted. "Moreover, telemedicine exposure (especially blended office and telemedicine care) likely simulates a likely real-life scenario for the health consumer."
"Practically, these findings provide reassurance for health entities seeking to add telemedicine to their care capacity without reducing quality of care," they added. "And as we found, embracing telemedicine for enhancing certain aspects of care might be an avenue for enhancing quality performance in primary care."
Baughman and his team said it wasn't clear why telehealth outperformed in-person care, though they noted that a telehealth platform offers better opportunities for care providers to reach out multiple times to patients to "engage in quality measure-promoting intervention." They also noted that some treatments, such as the initiation of a lifelong or life-changing medication program, are best begun in person, and perhaps shifted to virtual platforms for follow-up.
"Future studies could provide more granularity on optimizing the specific role of telemedicine in clinical scenarios, eg, understanding whether there is an association between stages of hypertension and effect modification attributable to the management venue or an association between venue and number of blood pressure medications," they wrote. "This would provide insight on where to invest in health care infrastructure and what clinical venue would be most valuable. This could also guide venue selection for patients initiating antihypertensive therapy vs patients requiring a third antihypertensive. Such insight would promote win-win environments to increase value: improved health outcomes for patients and incentive for clinicians and health systems operating in value-based care models."
The Jacksonville health system is deploying two life-sized (and selfie-capable) robots designed to perform tasks for staff and care providers that would otherwise take them away from the bedside.
Jacksonville, Florida-based Baptist Health is using a robot to improve clinical workflows and give patients and visitors 'someone' to snap selfies with.
Baptist Medical Center Jacksonville and Wolfson Children's Hospital have deployed Moxi, developed by Austin, Texas-based Diligent Robotics, to help staff and care providers with tasks that might otherwise take up time away from patients, such as transporting equipment and lab samples and even picking up items left for patients at the front desk.
“Today, our team members spend time retrieving and gathering supplies, medicine and patient items,” Tammy Daniel, DNP, Baptist Health's senior vice president and chief nursing officer, said in a press release. “Moxi’s support will allow them to focus on people as opposed to tasks, and on what they do best: patient care.”
The adult-sized robot, equipped with a gripper at the end of an arm, uses AI technology and an array of sensors to navigate busy hallways without bumping into objects or people, can maneuver through doors and elevators, and learns as it goes. Hospital officials also describe it as "intelligent, dedicated to its job, has expressive eyes, and is happy to pose for selfies."
“We are continually looking for innovative ways to support our team in caring for our patients, which is why I am so pleased to see this project begin,” Michael A. Mayo, DHA, FACHE, the health system's president and CEO, said in the release. “Artificial intelligence combined with robotic process automation in a tool like Moxi provides a way to improve hospital functions – giving our team members time back in their day to work where they are most needed.”
Once called COWs (Computers On Wheels), robots have been used for years for various functions within the hospital setting, ranging from manual pickup and delivery to providing audio-visual communication between patients and care providers in other locations. As the form factor and technology have improved, they've been assigned other duties, and are even being used in remote locations like health clinics, assisted living communities and homes.
Baptist Health is using two Moxi robots, one in Wolfson Children's Hospital and the second in the adjoining J. Wayne and Delores Barr Weaver Tower at Baptist Jacksonville, and officials expect to evaluation their performance in six to eight months. The project is supported by the Reid Endowment for Technology at Baptist Health, established in 2008, and the Miller Electric Technology Endowment at Baptist Health, established in 2014.