Researchers at the University of Missouri have found that health systems who meet CMS meaningful use guidelines for EHRs are improving clinical care and reducing patient mortality rates.
A new study has found that health systems meeting meaningful use requirements established by the Centers for Medicare & Medicaid Services for electronic health records have been able to improve clinical care and reduce patient mortality rates.
The study, conducted by researchers at the University of Missouri, published in the Journal for Healthcare Quality, and focused on more than 5 million patient experiences in 300 US hospitals, reinforces the idea that hospitals should be making the effort to integrate EHRs into clinician workflows – and that the government should promote programs that support interoperability.
It also highlights the challenges that many healthcare organizations have faced in installing EHRs and getting them to work as expected. To date, the federal government has invested more than $30 billion in programs aimed to support EHR adoption, and yet few healthcare leaders will agree that the process has been smooth or fruitful.
EHRs "have the potential to be very helpful, but in practice they tend to be very disruptive because it's time-consuming to train personnel how to use them," Kate Trout, an assistant professor in the MU School of Health Professions and lead author of the study, said in a press release. "They're expensive, and there's always new complicated updates and new forms that come out, and there is often a lack of interoperability for the data to be shared among different healthcare organizations."
Using data from EHRs, the American Hospital Association, and CMS, Trout and her colleagues grouped health systems into three categories: Those who successfully met CMS meaningful use guidelines, those who are using EHRs but not in a way the meets meaningful use guidelines, and those who haven't yet implemented EHRs or who are still integrating the platform.
They found that health systems in the first category were more successful in providing quality care and reducing patient mortality than those in the other two categories.
"This research highlights the importance of using electronic health records in a way that promotes interoperability to streamline processes, speed up decision-making, reduce wasted time, and ultimately improve patient health outcomes," Trout said in the press release. "Ideally the United States could implement one standardized electronic health records system for everyone to ensure compatibility so policy makers can hopefully benefit from this research."
She also pointed to the value of innovation in EHR adoption and use.
"Are there alerts we can put in after a surgery to ensure we follow up at critical points in time?" she asked. "Are there certain patient populations that we can use the data to catch them earlier and make sure we give them extra care and not just put them through the same routine protocols as everyone else? That is how we move away from focusing on implementing the technology and progress toward encouraging innovative ideas that ultimately improve patient health outcomes."
Chris Belmont, vice president and chief information officer for Mississippi's Memorial Health System, says any new program should begin small and focus on the patient.
To Chris Belmont, innovation isn't just a strategy. It's a commitment to improving patient care.
"It's not something you have, but actually something you do," says the veteran healthcare executive who now serves as vice president and chief information officer for the Memorial Health System, a two-hospital network based in Gulfport, Mississippi.
And for innovation to really work, he says, it has to lead back to the patient.
"We're great at creating things, and technology, and processes … but are we really paying as much attention to the patient as we should?" he says.
Belmont has more than 35 years of experience in executive leadership, business development, and consulting, the last two of which have been spent at Memorial Hospital at Gulfport. In the past he's served as vice president and CIO at the University of Texas MD Anderson Cancer Center in Houston and system vice president and CIO for the Ochsner Health System in New Orleans, leading EMR transformation projects at both health systems while helping to revamp their Information Services departments.
At Memorial Health, his strategy for trying out new programs and technologies is to start small, with very specific outcomes, goals, and participants.
"Don't launch these big initiatives," he says. "If we had done that, we would have slowed things down and missed some opportunities."
Chris Belmont, vice president and chief information officer of the Memorial Health System in Gulfport, Mississippi. Photo courtesy Memorial Health System.
In some cases, that might mean starting in a clinical department, rather than IT, to give a program a chance to establish roots before marrying it to a specific technology. Once that base is established, data is gathered, and results are proven, he says. Then, a health system can scale a program out, adding more departments and serving more populations.
"We start with an idea, and we put a program together than can be part of our portfolio," Belmont says. "Once it's in our portfolio, we have the opportunity to put it onto a platform and ask, what can this platform do?"
By taking a tiered approach to innovation, he says, a health system can focus on patient interactions and care. A large project tends to overlook small details, but those details may be what the patient looks at or experiences. As a result, a big program might look good and meet the goals set forth by the health system, but it doesn't necessarily address what the patient wants.
"Don't let the bureaucracy get in the way," he says.
As an example, Memorial Hospital has been working with Emmi digital health technology developed by Wolters Kluwer for patient engagement efforts, with a goal of reducing avoidable ED visits and hospitalizations and improving follow-ups. The hospital had launched a handful of small, concentrated programs and wanted to combine them on one digital health platform.
"It was at a time when we were all distracted by COVID," Belmont says. "Our nurses were busy with screenings and vaccinations, and we wanted to help them. This wasn't a robocall project; we wanted comfortable interactive technology that could improve the experience."
Using interactive voice response calling and multimedia videos to reinforce discharge or care instructions, monitor adherence to care management plans, and remind patients about follow-up appointments, Memorial Health developed a rapport with patients, encouraging them to take a more active role in their care.
"A lot of times [patients] don’t remember what was said [in visits with their doctor]," Belmont says. "We created a more effective messaging platform that engaged with them. It was more comfortable for them than the traditional automated reminders. I was surprised at how quickly patients reacted to the new platform."
According to data supplied by Wolters Kluwer, the program reduced unnecessary ED visits by 26%, which, in turn, reduced ED costs by about $89,000 over 1,000 patient discharges. The 30-day readmission rate also dropped between 27% and 65%, depending on patient adherence to prescribed programs. In addition, patients were 50% more likely to attend follow-up care appointments with their provider within 21 days of discharge.
"This was so much more effective than anything we'd done before in getting patients to [follow their care plan]," Belmont says.
The key to establishing that relationship, he says, is in listening to and understanding what the patient wants, rather than creating some shiny new toy or program and asking the patient to accept it.
"We have to look at this from the patient's point of view," he says. "Just think what would happen if we did too much of this. Would the patient be overwhelmed if we communicate too much? How do we make sure that we're not contacting them [to the point that] they're turning away?"
Belmont calls this a conundrum that every health system will face as it adopts more technology and programs that create more connections with patients outside the health system. All these channels will be great for collaborating on care management and passing information back and forth, but when will it be too much? How do healthcare providers create a conversation with the patient that meets the demands and expectations of both parties?
"Feedback is vital," he says, "both direct and indirect." Aside from asking patients how they want to interact with their care teams, providers need to gather data on how often patients communicate, on what channels, and whether those communications make an impact.
"My metric is if they keep coming back for more," Belmont says. "My role in this is the platform manager. I'm here to connect all the points, to make sure they're secure, and especially to make sure that they are reliable, and that the data we're getting is making a difference."
As Belmont looks to broaden those platforms with new programs and technology, he's focused on creating services that continue, rather than one-time interactions. He wants patients to look at this platform as an ongoing relationship with their care team, as well as a library of resources that they can access whenever they need help.
"We as a health system have to make sure we're taking advantage of all the tools in the toolbox," he says.
Researchers from Stanford, USC, Georgia Tech, and the University of Tokyo have developed a battery-powered digital health wearable that attaches to the skin and can measure tumor size continuously and in real time, offering hope for advancements in both cancer research and treatment.
Researchers has developed a wearable digital health sensors that can track the size of a tumor, a vital factor in determining the effectiveness of cancer drugs.
The Flexible Autonomous Sensor measuring Tumors (FAST) device, a battery-powered patch that adheres to the skin, measures the strain on the membrane surrounding the tumor in real-time and transmits the data to a smartphone app. It has the potential to replace the traditional method of tracking tumors via caliper and bioluminescence, allowing care providers to understand a drug's effectiveness in days instead of weeks.
“This work is a prime example of how wearable electronics can further precision health technologies — we can monitor the growth of a tumor with tens of micron resolution using just a sensor and a cell phone app," Yasser Khan, an assistant professor of electrical and computer engineering at the University of Southern California, said in a press release. "We can observe the progression 24/7, unlike any of the existing imaging techniques, and precisely tell if a drug is working on not in treating the tumor."
Researchers from Stanford University, USC's Viterbi School of Engineering, Georgia Tech, and the University of Tokyo teamed up to develop the wearable, which could significantly improve cancer research and treatment.
“It is a deceptively simple design,” Alex Abramson, an assistant professor of chemical and biomolecular engineering at Georgia Tech and first author of the study, said in the press release. “But these inherent advantages should be very interesting to the pharmaceutical and oncological communities. FAST could significantly expedite, automate and lower the cost of the process of screening cancer therapies.”
Armed with newer, more refined technology, researchers across the globe have been developing digital health wearables for clinical treatment and research. Some have redesigned commercial smartwatches and fitness bands or added technology, while others have worked with smartglasses, jewelry, hearing aids, and clothing. Still others are developing ingestibles, bandages, patches, and tattoos that can track and gather data from the body and transmit that information through digital health apps to care teams or researchers.
In this case, researchers say the FAST device has three advantages over traditional care:
It provides continuous, real-time monitoring;
The sensor attached to the patch is sensitive to one-hundredth of a millimeter, enabling researchers to track miniscule changes to a tumor that might not be detected by other methods; and
The device is non-invasive, attaching to the skin like a bandage, and reusable.
The health plan is one of several healthcare organizations to develop a list of curated digital health apps and programs that can be prescribed for members or integrated into connected care treatments.
Digital health apps give healthcare organizations an opportunity to direct resources to patients in need of specialty care, but matching the right resources to the right patient is difficult when the marketplace features hundreds of thousands of apps.
To tackle that dilemma, health systems like Kaiser Permanente, UC Davis, Froedtert, and Banner Health and health plans like Cigna, Optum, and Express Scripts are developing formularies, or platforms that contain vetted apps and digital health programs. Healthcare providers are then able to prescribe apps that meet the requirements for efficacy and privacy.
Evernorth, the health services business of Cigna, recently added five new digital health platforms to its Digital Health Formulary, giving members access to care management resources to address sleeping issues, inflammatory conditions, anxiety, and substance abuse.
The company has also launched four pilot programs aimed at evaluating new digital health programs for clinical impact and user experience.
“Evernorth continues to expand our Digital Health Formulary to address unmet health care needs of patients with chronic and complex medical conditions,” Glen Stettin, the company's chief innovation officer, said in a press release. “The latest additions give patients access to new and affordable options to improve and maintain their health while making it easier and cost effective for our clients to include these solutions in their benefit plans."
Health plans can offer these apps to their members as a prescribed treatment or integrate them into a connected care program that includes the collection and analysis of biometric data with medical, lab and pharmacy services.
The five programs added to the Digital Health Formulary are:
Big Health's Sleepio app, designed to help patients dealing with insomnia;
Big Health's Daylight app, which addresses anxiety;
The Quit Genius app, which helps users dealing with alcohol and opioid use disorder; and
HealthBeacon's Injectable Care Management System, aimed at assisting people living with inflammatory conditions.
The four pilot programs, meanwhile, will test the efficacy of the following apps:
Jasper, which addresses oncology issues;
Zerigo, designed to help people dealing with psoriasis and eczema;
Hinge Health for women's pelvic health, and add-on to Hinge Health's Digital Musculoskeletal Clinic, which was added to the formulary in in 2021; and
Lid Sync, which addresses medication treatment adherence.
"The Digital Health Formulary is one of the ways we can connect employers, insurers, and patients with innovative, affordable, and evidence-based care that meet their broader healthcare needs," Stettin said in the press release.
Evernorth officials say the digital health apps now in the formulary, which are offered in benefit plans covering more than 20 million US members, have helped the organization save more than $120,000 per solution.
The latest digital health survey from the American Medical Association finds that physicians are rapidly embracing digital health for a variety of reasons, with the largest numbers using the technology for virtual visits and considering tools to monitor patients at home.
Adoption of digital health tools is growing rapidly among physicians, according to new research from the American Medical Association, with the biggest growth in technology that aid in remote patient monitoring.
Since the AMA began surveying physicians in 2016, the rate of adoption for digital health has increased from 85% to 93% this year, with increases reported regardless of age, gender, or specialty. And those physicians are expanding their toolkit: the average number of digital health tools used per physician has grown from 2.2 in 2016 to 3.8 this year.
“The physician adoption rate of digital health tools has accelerated as physicians grow increasingly optimistic about the advantages that properly designed digital health tools can have for patient care if key requirements are met,” AMA President Jack Resneck Jr., MD, said in a press release.
According to the survey of some 1,300 physicians, the platforms drawing the most interest from physicians are virtual visits (57%) and remote patient monitoring devices (53%), two categories that have seen tremendous growth during the pandemic. The number of physicians using virtual visits jumped from 14% in 2016 to 80% in 2022, while those using RPM jumped from 12% in 2016 to 30% in 2022.
Among other uses, 47% of physicians are now employing digital health tools for clinical decision support, up from 28% in 2016, while 43% are using tools to improve patient engagement (up from 26% in 2016), 58% are using digital health for point of care/workflow enhancement (up from 42% in 2016) and 68% are using the technology to improve consumer access to clinical data (up from 53% in 2016).
RPM still has the least usage among the listed digital health tools, a sign that the concept isn't yet fully supported by policy or reimbursement, but 38% of physicians surveyed said they plan to use it within the year and another 23% said they'll take a little longer to embrace the technology.
Among the reasons for jumping on the digital health bandwagon, improved clinical outcomes and work efficiency topped the list, while the ability to reduce stress and prevent burnout are gaining ground. The most important requirement for digital health adoption is liability coverage, followed by integration with the electronic health record platform and assurances of data privacy.
As for newer technologies entering the healthcare space, the survey indicated physicians are interested but haven't yet tried them out.
According to the survey, 20% of physicians are now using AI and 40% plan to try out the technology in the coming year. The same goes for digital therapeutics, biometrics authentication, and precision and personalized medicine, with low usage but lots of interest in adopting the technology in the near future.
Finally, 60% of physicians surveyed say digital health will have the biggest impact in chronic disease management, while 59% see the technology supporting preventive care, 57% say it will address and automate administrative burdens, 50% say it will augment physician capacity by supporting care for less acute patients as appropriate, and 46% say the technology will improve access to care in underserved areas.
“The AMA survey illustrates the importance physicians place on validated digital health tools that improve health while streamlining the technological and administrative burdens faced each day in medicine. These technologies also must be designed and deployed in ways that advance health equity,” Resneck said in the press release.
The 2022 Medicaid Innovation Awards, issued by the Robert Wood Johnson Foundation and National Academy for State Health Policy, honor states that have developed innovative programs or approaches that address challenges to accessing care.
Six states are being recognized for innovative Medicaid programs aims at reducing barriers to healthcare access.
The Medicaid program, administered by states and the Centers for Medicare & Medicaid Services (CMS), cover roughly one in every five Americans, including seniors, those with disabilities and about 40% of all children. Consulting with CMS, states can modify their Medicaid programs to address unique challenges or populations.
The award winners are:
Kentucky, which earned the Enrollment Innovation Award for launching measures during the COVID-19 pandemic that simplify Medicaid enrollment "and increase access to coverage including targeted, data-driven marketing and outreach; a simplified application; and coordination with other state agencies."
North Carolina, which earned the Improving Access to Care Award for a maternal/perinatal telehealth policy developed during the COVID-19 pandemic that features telehealth and home healthcare for patients, reimbursement to perinatal care providers for remote blood pressure monitoring, physiological monitoring, and lactation services, and postpartum depression screenings by video, phone, and online portal messaging.
Arizona, which received the Initiatives to Address Social Determinants of Health Award for its Whole Person Care Initiative, which offers support services that include transitional housing, transportation to community-based services for help with employment, food assistance and other issues, and long-term care services to reduce social isolation.
West Virginia, which earned the Care Coordination Initiatives for Vulnerable Populations Award for a new program aimed at helping children in foster care access needed healthcare services.
Minnesota, which received the Addressing Health Disparities Award for a program that engages community members in making recommendations on how to address racial equity for Black Minnesotans.
California, which earned the Promising or Emerging Initiatives Award for a program aimed at addressing challenges like homelessness, lack of access to behavioral healthcare services, caring for children with complex medical conditions, and healthcare services for individuals in legal trouble and seniors.
“The federal-state Medicaid partnership enables states to develop tailored, creative solutions to local challenges, and when faced with an unprecedented pandemic, Medicaid leaders dug deep to develop innovative approaches to care,” Tara Oakman, interim managing director at the Robert Wood Johnson Foundation, said in a press release. “While it remains a difficult period for Medicaid programs, all states can learn from successes in other states in improving Medicaid access, care delivery, and equity.”
Researchers at the Ohio State University College of Medicine have found that hospitalized patients who are given hands-on training on how to use the patient portal are much more likely to use that portal frequently and properly than patients who use videos for their education.
Online patient portals may offer huge benefits for hospitalized patients seeking to access healthcare resources, but they won’t work unless patients know how to use them.
New research conducted at the Ohio State University College of Medicine and published in JAMA Network Open finds that patients who are trained by their healthcare providers in person will have a better grasp on how to use digital tools than those who use videos for their education. This means that healthcare organizations should emphasize and invest in hands-on training if they want to see the full benefits from patient portals.
The study conducted by OSU researchers compared in-person training with video tutorials on both patients with a full understanding of digital health and those with limited knowledge. Testing took place between December 2016 and August 2019 at six hospitals in the health system and involved more than 2,800 patients.
For those with a full understanding of how to use the technology, the study focused on 10 functions including the ability to order food on demand, tutorials, patient education resources, care schedules, messaging with care providers and the outpatient portal. Those with a limited understanding of the technology were tested on three functions: the ability to order food on demand, tutorials and patient education resources.
According to the study, in-person training "was found to significantly increase inpatient portal use" and "had significantly higher odds of being comprehensive portal users" than those using video tutorials. Those receiving hands-on training also had higher odds of being satisfied with their experiences in the online portal in a survey conducted six months later.
“We found that patients who received personalized training accessed the portal more often and were more likely to be classified as comprehensive users than patients who only watched training videos,” McAlearney said in the press release. “Similarly, patients who had access to all functions in the inpatient portal used the devices more than patients with limited function access.”
Health system officials said they'll use the results of this study to improve strategies for gathering health data through patient portals, including the upcoming Better Birth Outcomes Through Technology, Education and Reporting project, which aims to improve maternal and infant outcomes and health equity by collecting data on social determinants of health.
The hospital is partnering with digital health company Limbix to test its SparkRx digital therapeutic app on adolescents who have an increased risk of depression.
CHLA is partnering with digital health company Limbix on the project, which will test the company's SparkRx app on roughly 40 people between the ages of 13 and 22 with elevated depressive symptoms who are being treated in the hospital's cardiology and gastroenterology programs. The app uses cognitive behavioral therapy (CBT) concepts to guide users through an interactive program on their smartphones to identify the relationship between mood and behavior.
"We’re excited about this opportunity to offer our patients a new resource for adolescent depression via a digital therapeutic that could help minimize barriers and increase access to mental health treatment," Heather Bemis, PhD, a licensed clinical psychologist in the Division of Comfort and Palliative Care at CHLA's Department of Anesthesiology Critical Care Medicine at CHLA and principal investigator of the study, said in a press release.
The five-week program is divided into five segments, which are intended to be completed each week. Patients are guided through the program by a character called Limbot, who provides examples of how they have undertaken behavioral activation therapy as they pas through each stage. Patients complete a patient health questionnaire and participant symptom check each week, and have access to online resources and in-app crises services if needed.
Participants will earn a gift car for as much as $100 for completing the study, as well as $125 if they take part in weekly calls about their experience.
Hospital officials say the mHealth app is designed to "help teens understand their depression and learn coping skills to manage their symptoms." It's being piloted on adolescents with chronic medical issues like cardiovascular and gastrointestinal diseases because they're often at a higher risk for depression.
With the Cardiac LIFT Clinic, Akron Children's Hospital is giving single-ventricle patients and their families an opportunity to 'survive and thrive' at home, rather than in a hospital or clinic.
Young children with acute care needs don't necessarily have to be in a hospital to get them. Healthcare organizations are now using virtual care platforms and digital health tools to give these patients and their families the care they need at home.
Akron Children's Hospital has gone all-virtual with the Cardiac LIFT (Lifelong Interventions Focused on Thriving) Clinic, reportedly the first program in the country to offer completely virtual care for young single-ventricle patients from prenatal early diagnosis through early adulthood. The program enables families to transition from an NICU to the home and stay there.
"We want [these patients] to survive and thrive," says Kathyrn Wheller, MSN, APRN-CNP, a pediatric nurse practitioner and the clinical lead for the Cardiac LIFT Clinic. "The single-ventricle population is a complex population for cardiology patients in general. This program gives them … that freedom."
Single-ventricle patients are born with one lower chamber of the heart that is smaller, underdeveloped, or missing a valve, and occur roughly in five out of every 100,000 newborns. Three of the most common diagnoses are Hypoplastic Left Heart Syndrome, Pulmonary Atresia/Intact Ventricular Septum, or Tricuspid Atresia.
They start their lives in a neonatal intensive care unit (NICU), and require open-heart surgery at 2-6 weeks, 4-6 months, and 3-5 years to reconstruct their hearts as they grow. These surgeries are called Fontan procedures, and for that reason the patients are often called Fontan patients.
Kathyrn Wheller, MSN, APRN-CNP, clinical lead for the Cardiac LIFT Clinic at Akron Children's Hospital. Photo courtesy Akron Children's Hospital.
The survival rate for all three surgeries used to be low, but improvements in surgical techniques and clinical care have pushed that rate upwards, so that many children can now expect to live into their 40s, if not longer.
Because of the complex nature of these surgeries and care management, single-ventricle patients and their families spend a lot of time in the hospital, clinics, and doctor's offices, meeting with a care team that often consists of several specialists. At Akron Children's, executives had been mapping out a full, multi-disciplinary clinic for these patients.
"Then COVID hit," says Wheller. "We skipped right over the planning and launched our program [on a virtual platform], focusing on the first few months. It's not that easy to do in the cardiac world, but we had to do it."
Wheller said the hospital made plans to go to a hybrid setup once the pandemic waned, "but the virtual visits went great. We didn't need to see them in person when we could do everything we'd need to do with a virtual visit."
The Cardiac LIFT clinic opened in January 2021, and has conducted more than 130 unique visits for about 70 of the estimated 140 patients within Akron Children's Hospital's coverage area (another 35 patients are adults, who receive care separately). Wheller says those numbers will grow in time, because the hospital will be able to serve patients and their families for a broader geographic area.
Wheller says the platform not only allows the patient and family to meet with the care team and specialists from the comfort of their own home, but it gives that care team an opportunity to see more of that patient's home life and environment, which could factor into care management plans. And in a less formal setting than a doctor's office, patients, family members, and the care team could talk about diet and exercise, behavioral health issues, and other factors that affect that patient's health and wellness.
"When you see them in their home environment, you understand better the challenges they face, and just as importantly, the challenges their family faces," Wheller points out. "You can then make more reasonable plans for care."
The platform also helps the care team. Specialists can be brought in virtually, no matter where they're located, and scheduled to meet individually with the patient or as a team. Through an audio-visual link they can arrange to meet weekly or bi-weekly, especially during the first few months, then monthly or as needed.
Wheller says the program is also incorporating remote patient monitoring tools, which allow the care team to keep a daily eye on cardiac function and other vital signs, tracking the trajectory of the heart and the patient in between necessary in-person appointments.
Sara Rush, MD, Akron Children's Hospital's chief medical information officer, says the platform allows the care team to be creative in how it develops a care management plan. They can include physical therapists, nutritionists, behavioral healthcare providers, teachers, and social workers as the need arises.
"This is not the way we learned to practice medicine, so it takes a little time to get used to things," she says. "Then you start to realize that reaching out and pulling in all these resources makes so much sense. You can even bring in community resources."
While the platform is designed with the patient at its center, there are clear benefits for parents and other caregivers as well. Virtual care can help to reduce the stresses on parents and caregivers who struggle with their own health and wellness, cutting down on travel time to and from the doctor's office and missed work, and offering resources for coping with the burden of being a caregiver. Many health systems, in fact, are integrating family and caregiver services and resources into their virtual care programs, with the understanding that a patient's health is directly affected by the health and wellness of those around him or her.
"This is one of those things that can make us better at what we do," says Wheller.
A study conducted by researchers from the CDC, CMS, and NIH found that the use of telehealth and digital health tools to provide medication to people with substance abuse issues and monitor treatment during the pandemic helped improve adherence and lower the risk of a medically treated overdose.
A new study led by the Centers for Disease Control and Prevention finds that telehealth services used during the pandemic to help people dealing with substance abuse improved treatment adherence and lowered the odds of a medically treated overdose.
The study, conducted by researchers from the CDC, Centers for Medicare & Medicaid Services (CMS), and National Institutes of Health (NIH) and published in JAMA Psychiatry, focused on how healthcare providers used medications for opioid use disorder (MOUD) during the pandemic to treat some 175,000 Medicare beneficiaries.
Providers took advantage of waivers enacted during the pandemic to prescribe three medications – methadone, buprenorphine, and extended-release naltrexone - via telehealth and manage care for their patients through a variety of channels, including virtual care and audio-only telehealth (often via a telephone). These waivers are currently scheduled to end when the national public health emergency (PHE) is lifted sometime next year.
According to the study, which examined telehealth use between September 2018 and February 2021, the use of telehealth and digital health tools and platforms to treat people dealing with opioid use disorder (OUD) increased 35-fold during the pandemic. Among those using medication assisted treatment (MAT), the study found that treatment retention was the same or higher than those treated prior to the pandemic, often in in-person programs. And the percentage experiencing a medically treated overdose was the same as pre-pandemic levels, even though overdose deaths increased 30% between 2019 and 2020.
On a less-promising note, the study found that only a small portion of both cohorts – pandemic and pre-pandemic – received their medications on at least 80% of eligible days, highlighting the challenges in engaging with patients dealing with substance abuse and keeping them engaged and underscoring the value of digital health tools and platforms that can reach patient when they most need help.
"Our results highlight the continued need for a well-coordinated and comprehensive health system that integrates physical and behavioral health care," researchers concluded in the study. "Beneficiaries in both cohorts had many challenging health conditions—co-occurring SUDs, mental health diagnoses, and chronic medical conditions, including a large majority with chronic pain. Our observations align with the goals specified in the CMS Behavioral Health Strategy and identify opportunities for focused and coordinated actions across clinical settings and healthcare practitioners, including advancing integrated care for co-occurring physical and behavioral health conditions, which is a core component of the 2021 HHS overdose prevention strategy."
The study's results drew the attention of the American Telemedicine Association, one of several organizations lobbying federal officials and Congress to permanently extend waivers for telehealth use and coverage for substance abuse treatment.
"We were heartened to read the significant results from this important study, demonstrating the positive impact telehealth can have on treating individuals with substance abuse disorder,” Kyle Zebley, the ATA's senior vice president of public policy and executive director of ATA Action, said in a press release. “It is important to note that the study reported that telehealth services helped to lower the odds of overdose and increased the use of medications for opioid use disorder (MOUD)."
“We hope this sends a strong signal to policymakers that telehealth can and should be a permanent part of healthcare delivery, to effectively and safely address critical needs of patients and individuals whenever and wherever they need it most,” he added. “This study is further proof that President Biden’s administration should work with Congress to make permanent the current Ryan Haight in-person waiver for the remote prescription of clinically appropriate controlled substances.”