The latest version of the ACC's three-year-old series of TRANSFORM studies, being conducted in Boston and Kansas City, will test whether underserved patients living with chronic cardiovascular concerns can be better managed through a digital health platform that includes wearables and AI tools.
The American College of Cardiology is studying whether digital health technology like wearables and AI can be used to improve care management for people with chronic cardiovascular conditions.
The ACC is partnering with Boston-based Biofourmis on the third and latest phase of its TRANSFORM study, which was launched in 2019 to “leverage EHR data, office-based interventions and partnerships to include the pharmaceutical and medical device industry, health plans, employers, clinicians, and patients.” The latest phase focuses on improving guideline-directed medication therapy (GDMT) in care management.
“TRANSFORM3 will provide real-world data on how cardiologists and other clinicians can more effectively and efficiently manage chronic cardiovascular conditions in underserved populations,” Megan Welch, MD, TRANSFORM3 investigator team member and cardiovascular disease fellow at Massachusetts General Hospital, said in a press release issued by Biofourmis. “Through technology-enabled approaches, we are hopeful that providers will have timely, meaningful awareness of their patients’ health status and adherence to guideline-recommended therapies. Ultimately, what we learn from TRANSFORM3 could lead to accelerated adoption of effective, evidence-based care plans that optimize outcomes and help patients lead longer, healthier lives.”
Researchers aim to study whether devices and platforms that monitor patients throughout the day can improve care outcomes, particularly in patients who can’t or won’t see a doctor on a regular basis. One of the primary benefits behind these remote patient monitoring platforms is that they can establish the baseline for a specific patient and raise an alarm when data indicates a concerning trend, allowing care providers to act quickly to avert a health crisis.
The “Evaluation of Implementation Strategies of Teaching, Technology, and Teams to Optimize Medical Therapy in Cardiovascular Disease (T3),” study will focus on patients living with heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF), atrial fibrillation, or cardiovascular risk with type 2 diabetes.
The latest study is broken into three branches. One will focus on patient education (Teach); a second will use digital health devices and AI tools, along with “frontline virtual health navigators” supplied by Biofourmis (Teams) to serve as the first line of resource and help patients manage their care; and the third will use digital health devices and AI tools to improve care management for local care providers (Technology).
The study will be lead by a team of Harvard Medical School clinicians based at Mass General, Brigham and Women’s Hospital, and St. Luke’s Health System in Kansas City.
Penn Medicine researchers have found that the health system's virtual care platform not only allowed Black patients to access care as easily as non-Black patients during the pandemic, but is keeping them coming back for more health services.
Penn Medicine researchers are reporting that a telehealth platform is helping the health system reduce barriers to access for Black patients.
In a study published in Telemedicine and e-Health, researchers from the Perelman School of Medicine at the University of Pennsylvania found that a virtual care program set up during the pandemic allowed Black patients to access care at the same rate as other populations. And that platform is continuing to erase “historic inequities” affecting those patients as the pandemic eases and the health system offers both in-person and virtual care.
“We looked through the entire year of 2020, not just the first half of the year when telemedicine was the only option for many people, and the appointment completion gap between Black and non-Black patients closed,” Krisda Chaiyachati, MD, an assistant professor of medicine at Penn Medicine and the study’s senior author, said in a press release. “Offering telemedicine, even though it was for a crisis, appears to have been a significant step forward toward addressing long-standing inequities in healthcare access.”
The study addresses the validation of telehealth in tackling barriers to healthcare access for underserved populations. Telehealth advocates say virtual care could be an important tool in connecting with people who have problems visiting the doctor’s office or hospital due to geographical, cultural or social issues. Some also worry that telehealth could compound that problem because some populations might not be able to afford, access or use the technology.
Chaiyachati, who oversees the Penn Medicine OnDemand virtual visit program, and his colleagues studied how Black patients in the Philadelphia area accessed their primary care providers in 2019 and 2020, and compared that to PCP access by non-Black patients. Looking at roughly 1 million appointments per year, they found that completed PCP visits by Black patients increased from about 60% in 2019 to more than 80% in 2020, while the completed PCP rate for non-Blacks rose from 70% to more than 80%.
In fact, the study showed that Blacks used telehealth more than non-Blacks, with one-third of the former’s visits conducted by telehealth in 2020 and a quarter of the latter’s visits via virtual care.
“The specific time periods where we saw significant gains made by Black patients came when telemedicine was well-established in our health system,” Chaiyachati said. “This does not appear to be a coincidence.”
Looking more closely at the numbers, Chaiyachati and his colleagues found that Black patients steered clear of healthcare during the height of the pandemic in 2020, when the nation was practically shut down, but those visits rose back up to and even above 2019 levels when the pandemic subsided.
“Telemedicine allowed patients to seek non-urgent primary care despite hesitancy for in-person visits pre-vaccine,” Corinne Rhodes, MD, an assistant professor of internal medicine and assistant medical director of quality in Penn Medicine’s primary care service line and the study’s co-author, said in the press release. “Providing chronic disease management and preventive care helped return primary care offices closer to pre-pandemic business as usual.”
The next step will be to ensure underserved patients continue to use telehealth when it’s available and convenient, allowing providers to address health concerns that extend beyond COVID-19 and which affect long-term clinical outcomes.
At the recent American Telemedicine Association conference, some heavy hitters in the telehealth world said the future will be guided by care providers who make virtual care their own.
Health system leaders looking for sustainability in telehealth should be focusing not on the latest technology, but on how providers are adapting virtual care to their own needs.
Roy Schoenberg, president and CEO of AmWell, says the industry is well past proving the value of the audio-visual telehealth encounter. And as the nation looks to move further away from the pandemic, virtual care will be defined by how it's now being used to improve clinical outcomes and clinician workloads.
"If we can always be next to the consumer … we can completely rewrite how we care for them," he said during a main stage appearance at ATA2022 earlier this month in Boston.
Schoenberg's comments were part of a busy three days in Boston for telehealth advocates as the ATA returned to a live event for the first time in more than two years. In a conference attended by healthcare providers and decision-makers, the theme of "Now What?" was seen as a challenge to the healthcare industry to go beyond validating telehealth and get to the job of using it.
A lot of the discussion was shaded by the understanding that the regulatory landscape around telehealth is still uncertain. The industry has been allowed to flourish under emergency federal and state measures enacted during the public health emergency (PHE) to expand access and coverage, but there's no clear idea yet what will remain and what will be lost when the PHE expires.
In that context, Schoenberg said, healthcare leaders need to step up and take the initiative.
"Telehealth is not static—it's changing," he told ATA CEO Ann Mond Johnson during a keynote. And healthcare must keep up.
More specifically, telehealth is allowing healthcare to broaden its horizons to the home and office and giving healthcare providers the freedom to shape more meaningful care management programs to patients' lives and habits.
"We've completely disrupted the old model of face-to-face service," James Mault, MD, the former Qualcomm Life executive and the founder and CEO of BioIntelliSense, a developer of wearable biosensor technology, said during a main stage panel. "Basically, healthcare has not changed fundamentally for somewhere in the realm of 2,000 years."
Mault, referencing a McKinsey report that states $265 billion in care costs will shift from the hospital to the home over the next three years, said the industry has to combine high tech and high touch to deliver care directly to the patient. That means embracing digital health tools that not only enrich the patient's medical record, but AI tools that sift through the data to give providers the information they need to improve clinical care.
Remote Patient Monitoring Picks Up Steam
One trend demonstrating that desire to get next to the consumer or patient is remote monitoring. Healthcare organizations are launching remote patient monitoring (RPM) programs at a quick pace, with the goal of extending care to the home and providing opportunities for real-time care management and population health. Vendors, meanwhile, see RPM as not only a means of partnering with health systems but a direct-to-consumer (DTC) channel to encourage consumers to monitor their health and engage with their care providers.
"This is more than just vital signs collection," said Carolyn Walsh, chief commercial officer for Florida-based BioIntelliSense, which announced RPM partnerships with UC Davis Health and Houston Methodist. "This is a comprehensive view of one's health status."
Withings Health Solutions debuted its RPM program, called Med Pro Care, two years ago with a line of connected devices directed at the health-conscious consumer. This year the French company introduced an updated platform, pairing devices with an app-based dashboard that aims, according to company vice president Antoine Robiliard, "to put the patient back in the center of healthcare."
Robiliard—who has moved to the U.S. to spearhead the company's efforts in advancing the platform in the Americas—said many RPM programs are too complicated and focus on what the provider wants rather than what the patient wants. More effective programs, he says, put the technology in the background and focus on integrating with the patient's lifestyle.
"Patients who are sick know they're sick," he said. "They don't need to be told this every day."
Consumers are also driving the trend toward DTC healthcare. An example of this is Ro, the start-up launched a few years ago to address erectile dysfunction, which has raised more than half a billion dollars in funding and now offers a wide range of services, including pharmacy interactions, virtual visits, and even in-home care.
"I think we all agree that patients are the ultimate stakeholders," Zachariah Reitano, chief executive officer of Ro that now rivals Teladoc and Amwell, said during a main stage presentation.
Reitano said the industry is shaping up to be a "competition over earning the right to take care of someone," a comment echoed a day earlier by digital health expert Joe Kvedar, who wondered who would "win the battle for primary care." Reitano said the battle might well be won by whoever figures out how to best control payment, reducing costs, marrying quality of care to value, and attracting the consumer's attention.
"This patient revolution, as cheesy as it sounds, is going to happen," he said.
Keeping Providers in the Loop
While interest in DTC telehealth tools and platforms is strong, Amwell's Schoenberg was quick to point out that telehealth won't achieve true value unless these services are linked to healthcare providers. That's why many telehealth companies are focusing their efforts now on new platforms and technology that integrate services into an enterprisewide network and improve the infrastructure behind virtual care.
"That's the ceiling for us as an industry right now," he said, likening efforts to "choreographing" the telehealth experience. "What that translates into is a laundry list of things we don't like" but that need to be done to improve the clinician experience.
Automation and AI will play a part in this. In a trend carried over from the HIMSS22 conference earlier this year in Orlando, several companies are pitching tools and platforms that do the back-end tasks that take up much of clinicians' time. And as Mault noted, others are marketing technology that sifts through the data coming in from various, unstructured sources, including wearables and smart devices, to give clinicians the data they need.
Several panelists and speakers said the innovation landscape will focus now on partnerships and mergers, as healthcare organizations look to expand their enterprise platform with certain tools and services. Some health systems have created their own innovation centers, and even set up venture capital funds, to serve as incubators for startups whose solutions can be field-tested in the health system before being marketed to the industry.
"The last couple of years have been a sandbox," Nathaniel Lacktman, a partner with the Foley & Lardner law firm, chair of its telemedicine and digital health industry team and a national expert on digital health law, said during one panel discussion focused on the future of virtual care. "Building upon that, we'll create programs that are more meaningful."
And that's where Schoenberg says the healthcare industry should focus. Healthcare providers now have the tools to improve patient care and the platforms to make healthcare a digital companion, always at the consumer's side.
And if providers really want to choregraph the care continuum, as Schoenberg said, they'll need to lead the dance.
Researchers at The Ohio State University are developing digital health technology that can track one's health through a small device worn on the ear or finger by measuring small amounts of gas emitted through the skin.
The next generation of digital health wearable might focus on body gases.
Fart and BO jokes aside, researchers at The Ohio State University are working on skin sensors that detect gaseous acetone leaving the skin. Those emissions could contain biomarkers for a wide range of health issues, including diabetes and heart disease.
“Discerning health issues through the skin is really the ultimate frontier,” Pelagia-Iren Gouma, a member of the research team and professor of materials science and engineering at OSU, said in a press release issued by the university. “The project still has a couple of years to go. But in six months, we should have proof of concept and in a year, we’d like to have it tested in people.”
The research, supported by the National Science Foundation and recently published in PLOS One, points to an increasing interest in wearable sensors for remote monitoring, and the wide variety of form factors in that field. While smartwatches and fitness bands have long been the most popular, digital health researchers and companies have used rings, smartglasses, hearing aids, patches, bandages, tattoos, and even sensor-embedded clothing to track one’s health.
Gourna and her team are working on a small device that would fit around the ear or on a fingernail and track acetone emissions. They’re using a film-like material made from derivatives of plant cellulose and electroactive polymers that reacts to the acetone.
“We found significant bias toward bending more upon exposure to certain chemicals over others,” Anthony Annerino, a graduate student in materials science and engineering and lead author of the study, said in the news release. Using AI and machine learning tools, the platform could enable the tracking of long-term changes to one’s metabolism, and it could be modified to track ethanol, which can signal liver disease.
“This is an area of research that hasn’t been nearly as well developed yet, because we’re just now producing the technology to measure lower concentrations of these gases with high selectivity,” he said.
Annerino also noted that many wearables track biomarkers through electrical signals applied to sweat, which means that a user has to sweat – sometimes profusely – to get enough data. And while tracking biomarkers through someone’s breath has been done through mHealth devices like a breathalyzer, that requires “active intent” and only gives a momentary glimpse of one’s health.
He and his team contend that detecting gases through the skin can be less intrusive.
“It is completely non-invasive, and completely passive on the behalf of the user,” he said.
Self-contained telehealth kiosks had a short-lived heyday about 10 years ago. Now they're getting a second chance, as healthcare organizations look at new ways to improve access and deliver care to remote populations.
The telehealth kiosk may be making a comeback.
Canada-based UniDoc Health Group unveiled its H3 Cube Virtual Care Solutions Model (VCSM) kiosk at the American Telemedicine Association conference this week in Boston, alongside news on a handful of projects around the world and proposed new uses.
The announcement raises the profile of a direct-to-consumer telehealth form factor that had enjoyed a heyday roughly a decade ago before sinking into obscurity. Now, with an emphasis on delivering care to populations in remote locations and helping people access care outside the hospital or doctor’s office, healthcare organizations are taking another look.
The H3 Cube is a self-contained room that can be dropped into a specified location to give people an on-demand and discrete virtual link to healthcare providers. It can include a chair and a bed and dozens of digital health devices, most of which are supplied by Boston-based AMD Global Telemedicine, and can be customized to meet a provider’s specifications.
“We can put these anywhere in the world,” company president and CEO Antonio Baldassarre said. “We are literally duplicating a clinic.”
Baldassarre said this kiosk first gained a foothold in Italy and Germany, where it was used to provide virtual care in remote Alpine communities. It’s now being deployed to Ghana and the Gambia in Africa, as well as in Ontario, where it’s being trialed in pharmacies and used to improve access to care for the Mohawk and Algonquin communities.
The H3 Cube, developed by the Canada-based UniDoc Health Group, was unveiled at the AMC Global Telemedicine booth during this week's American Telemedicine Association conference in Boston. Photo courtesy UniDoc.
Earlier this year the company signed a five-year, $6 million deal with Sirach Health and Wellness in Tucson, Arizona, to place at least 20 kiosks in locations around the city to serve low-income residents, veterans and the homeless. Other US deals are pending.
“Virtual care has come of age as the affordable and accessible alternative for providing front-line medical assessment for the underprivileged and underserved citizens of Arizona, America, and beyond,” Sirach COO Dr. Lynn P. Hall said in a press release. “This is a great opportunity to utilize technology effectively and compassionately.”
Baldassarre, who showed off the kiosk in the ATA exhibit hall and displayed a video of the H3 Cube being delivered to villagers in Ghana, said the kiosk allows healthcare providers to deliver care in hard-to-reach locations and to people who face barriers to accessing care. It can be placed in retail locations, community centers and other sites and equipped with as little or as much digital health technology as needed.
“We’re eliminating the burden of making an appointment” for a healthcare visit in a clinic or doctor’s office, he said.
The H3 Cube might remind more than a few people of the HealthSpot, the high-tech, high-gloss telehealth kiosk first unveiled at the CES show in Las Vegas in 2012. The company raised almost $50 million, built close to 200 kiosks and secured deals with the likes of Rite-Aid, the Mayo Clinic, the Cleveland Clinic and Kaiser Permanente before going bankrupt in 2016.
At that time, telehealth experts said the HealthSpot was too big and flashy, with a price point that made ROI impossible. Since then, kiosks have morphed into smaller units, like desktops or work-stations rather than rooms, capable of fitting into cubicles at libraries, clinics, malls, pharmacies, and even emergency departments at busy hospitals.
The form factor also took a hit during the pandemic. While the concept was a nice way of reducing in-person care and the risk of infection, healthcare providers had to spend lots of money and time cleaning and disinfecting the kiosks after every visit.
But the COVID-19 crisis has also helped. The pandemic forced many health systems to reimagine how care can be delivered outside the traditional hospital or office setting not only to boost access to care but to connect with populations who can’t or won’t go to care providers. They can also take advantage of better digital health technology and expanded wi-fi and cellular capabilities.
“They’re much more adaptable now,” Baldassarre said, noting the partnership with AMD Telemedicine gives them the opportunity to equip the cubes with more than 40 different tools capable of providing a wide range of primary and specialty care services. And through virtual care connections, he said, the cube can connect patients to payers, pharmacies and specialists at a moment’s notice.
In Arizona, he said, Sirach plans on deploying the kiosks to pull in homeless people, veterans and others who aren’t getting primary care services on a regular or reliable basis, and to use that platform as a bridge to more care services, even non-healthcare services that address the social determinants of health.
Baldassarre said he’s looking for partnerships with the Department of Veterans Affairs, as well as inner city clinics and Native American communities. And while the African deployments are subsidized by each country’s government, North American projects are hewing closer to a subscription-based model, with support from organizations like the VA, federal and state public health agencies and donations.
The success of these kiosks may very well hinge on how the company develops an ROI, which at this point isn’t clear. A press release issued this week further outlining the Sirach deal points out that more research is needed.
“The delivery of these initial VCSM kiosks and any additional kiosk locations are all subject to the commercialization of the VCSM kiosk by the Company, completion of successful site studies by both parties and other customary conditions,” the May 4 press release states. “As at the date of this news release, the VCSM remains under development by the Company and has not generated any revenues. There is no guarantee that any service fees will be paid to UniDoc under the Agreement or that the VCSM will generate any revenues at all.”
Magellan Federal is partnering with NeuroFlow to roll out the latter's digital health platform to US Military members and their families is select locations for on-demand access through a mobile device to behavioral health resources.
A managed care company working with the US Military is launching a digital health program aimed at giving military members and their families on-demand access to discreet and personalized mobile behavioral health services.
Magellan Federal, a subsidiary of Centene’s Magellan Health unit, is partnering with NeuroFlow to make the Philadelphia-based company’s platform available to military families on their smartphone or other mHealth device.
NeuroFlow is one of many companies targeting the behavioral health space with digital health platforms that prompt users to fill out surveys or questionnaires, then deliver reminders, symptom trackers, exercises and other personalized resources.
The strategy is popular in healthcare, which has seen a surge in stress, depression and burnout as a result of the pandemic. Late last year Philadelphia’s Thomas Jefferson University and Jefferson Health announced a partnership with NeuroFlow to make those resources available to health system staff as well as the university’s staff and students.
Magellan Federal, which handles managed care services for more than 300 US bases, installations and agencies around the world, is turning to the platform to help address high rates of stress among US service members and their families. The idea is to pair this platform with expanded health and wellness services offered by Magellan.
The first phase of the program, expected to take about 18 months, will see the NeuroFlow platform rolled out to families at three installations through the Military & Family Life Counseling (MFLC) program, which is supported by the Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy (MC&FP), Office of Military Community Support Programs (MCSP).
Along with giving military members and their families access to confidential resources, the program will also provide de-identified, population-level data to the US Military to help them track behavioral health trends across their network.
“We have the opportunity to proactively recognize and respond to the emotional highs and lows of the American military family,” Chris Molaro, NeuroFlow’s chief executive officer and former Army captain, said in a press release. “We want to pave an easier pathway for seeking support, if necessary, and this collaboration focuses on providing service members and their spouses with a secure, private resource to help close the gap between mental and physical health.”
As managing director of innovation at UnityPoint Health, Matt Warrens guides the health system through a crowded and complex landscape.
A recent survey of 100 health system executives found that only 6% have a "fully developed" digital health strategy. Iowa-based UnityPoint Health may well fit into that category, with a $100 million venture capital fund aimed at driving consumer-based digital transformation and a managing director of innovation who has a good idea of the path forward.
But that path isn't always clear.
"If this ever gets easy, then we're probably doing something wrong," says Matt Warrens.
Warrens, who spent roughly 20 years at OSF HealthCare, including time as the health system's vice president of innovation partnerships, joined UnityPoint in 2018, and within a year he'd helped to launch the venture fund to push innovation forward. It came at a crucial time for the 21-hospital network serving Iowa, Illinois, and Wisconsin, as the pandemic was just beginning to clamp down on healthcare and health systems were struggling to adopt—and adapt to—digital health.
"Health systems are notoriously slow" in embracing new ideas like digital care, he says. But in a changing world driven by new technologies and consumer demand, they have to be more nimble and accepting of platforms that improve care delivery outside the hospital.
Matt Warrens, managing director of innovation at UnityPoint Health. Photo courtesy of UnityPoint Health.
Flash forward two years, and COVID-19 is a nagging but fading concern. UnityHealth's program has made investments in 13 digital health companies, which Warrens is careful to say aren't necessarily start-ups but "scaling solutions." In fact, 12 of those 13 now have commercial contracts with the health system.
It's Warrens job to lead the team that filters through the potential candidates to find digital health solutions that are beyond the pilot phase. He estimates they looked at 650 companies in the past year, and average about one investment for every 100 companies.
"We have a dedicated team that manages the venture fund," he says. "They're recruited into our organization with the venture experience to do that. There are a lot of organizations that are trying to do venture investing, and if you don't have a dedicated team and people with experience to do the appropriate diligence, it's a hard thing to do because there are lots of opportunities."
"What's unique about what we're doing is on the strategic side," he adds. "We have a dedicated team, mostly of project managers and nurse informaticists, that work with our leaders in the organization once we've made a financial investment to help scale that solution across UnityPoint."
Warrens says it's important that he and his team knows what the various departments in the health system are doing and what they're looking for in new technologies or services. They'll ask department heads not only what they need but what they'd like to have.
"Innovation is a culture for our organization, and it's woven into all the strategic aspects of what we're doing," he says.
But he also needs to know, and to be able to tell those within the health system, about what's going on outside the network. In the rapidly changing healthcare ecosystem of today, that's a big sandbox with a lot of new players.
"The world doesn't work anymore like it used to, where things start on the coast and move to the middle," he says. "If Amazon is launching primary care, it's coming to Iowa. Walmart, Walgreens, United Healthcare, they all have innovation strategies, and it's important to know what they are doing as well so that we're helping our leaders understand those threats, and then bringing forward the innovation opportunities that we believe can compete with those. We're not competing with the hospital across the street anymore, right? It's a different world today."
Warrens says UnityPoint's innovation strategy primarily focuses on two types of technology: Tools or platforms that make the healthcare process more frictionless for patient-consumers, and solutions that make healthcare delivery easier for care providers.
"What we're seeing coming out of the pandemic is this staffing crisis is not going to go away, so what can we be doing to help there?" he says. "And that could be around recruiting, [or] it could be around retention, [or] it could be around more efficient scheduling. But also because the crisis isn't going to go away and we're going to continue to face this challenge, it's accelerated the opportunities around what things can we automate."
For example, UnityPoint is partnering with Baltimore-based b.well Connected Health to use the company's "digital transformation platform," which leverages FHIR-based APIs to collect data from various locations, such as the EMR, digital health devices, wearables, and other sites. Putting that data in one place enables patients to access everything on one platform, which gives providers the data analysis tools to identify gaps in care.
"Organizations like ours have to be putting things in place that are more open and adaptable to you the consumer, to the technology and the choices that you've made versus what a lot of health systems have done for decades, which is, 'Hey, patients, here's the way we want it done. Here's the one way that you have to do this,' " he says. "That's what we have to do better."
Warrens says the industry is shifting from endpoint solutions to enterprisewide products, with more of a focus on integration with other platforms to accommodate complex health concerns, such as multiple chronic conditions, behavioral health, and social determinants of health. And there's more interest in partnerships and collaborations, not only with vendors but with payers, pharmacists, and specialty care providers.
Those trends offer a hint to how healthcare should evolve, he says. The healthcare landscape is in turmoil, with a lot of ideas coming from non-healthcare sectors and a general feeling that providers are struggling to keep up with new competition.
Not so fast, Warrens says.
"For someone who's been in this industry for 25 years, when you see Amazon, or Berkshire Hathaway, or whatever, making an announcement like, 'Hey, we're going to get into healthcare,' I'm just, like, 'OK. Good luck.' It's really hard," he says.
"And what happens is they get in there, and they're like, 'Wow, this is really complicated, it's way overregulated, the margins are tiny.' They probably have to make a hard, quick decision like, 'Oh, OK. This was a mistake. I'm getting out of this.' "
The American Telemedicine Association kicked off ATA2022 this week with an examination of the challenges faced by care providers, and a plea that telehealth could be the avenue by which providers reconnect with their patients and understand the patient experience.
Telehealth, as everyone likes to say these days, is here to stay. But the really exciting thing is what it can do to bring humanity back to healthcare.
That was the big take-away from the first day of the American Telemedicine Association’s first in-person conference in three years, taking place this week in Boston. With a theme focused on “What now?”, the several hundred attendees milling about the convention center were told that empathy and connection are the keys to continuing virtual care in a post-pandemic world.
“It’s really about how we care for people,” said Adrienne Boissy, the former chief experience officer of the Cleveland Clinic who became chief medical officer of digital health company Qualtrics in 2021, in an opening keynote that focused on the idea of agility.
ATA CEO Ann Mond Johnson kicked off the three-day event Sunday morning with a call for attendees to recognize that the pandemic may have brought telehealth to the forefront and proven its value, but it also exposed long-standing challenges, ranging from policy and regulation to licensing and addressing social determinants of health.
“There is more than broadband and interactive access that we have to deal with,” she said.
This includes the idea that the business of healthcare has gotten away from the simple, basic act of helping people with their health. While the nation may be moving toward ideas like value-based and patient-centered care, much of what’s still taking place these days is episodic, centered on the healthcare provider or site, and plagued by a reliance on payment. That, compounded by the perils of COVID-19, is why so many healthcare providers are stressed out and either gone or ready to go.
And that’s where telehealth can and should help.
Joe Kvedar, the Harvard Medical School professor and longtime digital health expert, pointed out that consumers “have always been enthusiastic” about telehealth because it helps them access care when and where they want it, while payers are still ambivalent but leaning in the right direction. Providers, he said, “are our biggest challenge.”
Hospitals may lose revenue on telehealth, he said, and “there’s a lot of holding back” in embracing virtual care because of the uncertainty surrounding reimbursement and, in some cases, clinical value. But the healthcare industry has to understand that telehealth checks some of the boxes that in-person care can’t, and it’s what consumers want.
More importantly, said Boissy, it gives providers and consumers and opportunity to connect in ways they haven’t before.
“This should be a wake-up for us,” she said.
Boissy pointed out that we’ve gotten to the point where consumers are fed up with their healthcare options, and will seek out providers who give them what they want. And it’s up to healthcare to give them what they want. Telehealth gives them that opportunity to meet the consumer, and to establish a connection that goes beyond occasional office visits. It gives them an opportunity to collaborate with patients on their health and wellness.
Furthermore, Boissy said telehealth gives providers an opportunity to engage with patients and enrich the patient experience – to which she quickly added that the patient experience isn’t just “any question on a survey.”
“It starts with communication,” she said.
Boissy said the healthcare industry, for the most part, may have forgotten how to communicate with consumers, or it may not understand what communication means. Providers, she said, tend to say “I understand” too quickly, or far too often, driving a wedge between them and patients who don’t think their doctors are listening to them.
And one of the biggest issues that consumers have with healthcare is access. It may take days to schedule a visit to the doctor, and hours to travel to the doctor’s office, yet the doctor may spend only a few minutes with the patient for an issue that could have been handled with a simple video visit.
Healthcare providers are reluctant to embrace those video visits because they aren’t getting reimbursed for them as well as for the in-person visit, but consumers want that access, and they’re willing to switch providers – or even ditch the tradition primary care provider model for a platform supported by their health plan or a retail site like Amazon, Google or Walmart – to get what they want.
“Who’s going to win the battle for primary care?” Kvedar pointed out.
As he, Boissy and the other speakers on day one of the ATA conference emphasized, telehealth can be the platform by which healthcare providers re-engage with consumers and understand the value of the patient experience.
The state is one of 10 and Washington DC that allow patients with a terminal illness to request help in dying from a healthcare provider, but had been the only one that didn't specifically allow that request to be made via a video visit.
Vermont’s governor has signed into law a bill amending the state’s assisted suicide statute to include telemedicine.
S.74, passed by the state House and Senate after an almost two-year process and signed by Gov. Phil Scott on April 27, amends the state’s medical aid in dying law, which was passed in 2013, allows a patient who meets specific criteria to request a prescription to aid in dying through telemedicine, eliminating the need for two in-person consults and a 48-hour waiting period. The bill also establishes legal immunity for licensed healthcare providers, including pharmacists.
The bill defines telemedicine for these purposes as an interactive audio-video platform that complies with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
The argument follows a familiar path around the use of telemedicine for controversial healthcare services, such as abortion. Supporters say patients should be able to use virtual care to access the services they need but can’t get to in person, because of physical, geographical, or social barriers or a lack of available providers. Opponents argue that some healthcare services shouldn’t be allowed through virtual channels because a patient should be in front of a care provider, in the same room, to talk through what may be a difficult decision.
Ten states and the District of Columbia currently allow medical aid in dying, also called assisted suicide and death with dignity, with all but Vermont including the use of telemedicine in their guidelines.
Vermont’s bill was hotly debated, and included the rejection of an amendment in the House that would have mandated at least one in-person meeting between the patient and a healthcare provider during the process. Adding to the emotion surrounding the issue, the bill was supported by former Vermont House Majority Leader Willem Jewett, who gave an interview with the VTDigger online news service just a few days before dying in January.
“It’s the fundamental authority of the individual over the most fundamental decision they’ll make in their life,” Jewett, 58, who died of mucosal melanoma, said in the interview. “It becomes simple if you accept that premise.”
The original law, which Jewett helped to pass, enables patients with a terminal illness and a prognosis of six months or less to make two in-person requests, at least 15 days apart, to a prescribing physician for drugs to assist in one’s death. That patient must also see another consulting physician in person and make a written request, and wait at least 48 hours after receiving the prescription to use it.
State Senator Dick McCormack, who sponsored S.74, and others, including Patient Choices Vermont, said that process can take months, sometimes longer than the time the patient have left, robbing those patients of their choice in the matter.
“These improvements will really help alleviate suffering toward the end of life, and make the process of medical aid in dying more compassionate,” Betsy Walkerman, president of Patient Choices Vermont, told VTDigger on April 27, following Governor Scott’s signature making the bill a law.
As amended by the bill, Vermont’s law allows patients to request medications to assist in dying from a healthcare provider, either in person or via telemedicine if the physician determines that a video visit is clinically appropriate. The patient must make the request twice, at least 15 days apart, and the clinician must determine that the patient is suffering from a terminal illness, is capable of making that decision and has been informed about the process to access and use those drugs. It allows the physicians to prescribe and the pharmacist to fulfill that prescription and eliminates the 48-hour period between when the patient receives the drugs and uses them.
Finally, it states that “no physician, nurse, pharmacist or other person licensed, certified, or otherwise authorized by law to deliver health care services in this State shall be subject to civil or criminal liability or professional disciplinary action for acting in good faith compliance with the provisions of this chapter.”
A recent survey of 100 health system executives finds that most say a strong digital health strategy is essential, yet less than a quarter are confident in the one they have.
More than 90% of health systems surveyed recently say a strong digital health strategy is essential to improving clinical outcomes, boosting clinician satisfaction rates and increasing productivity, yet less than half actually have a strategy in place. And less than a quarter are “very confident” that they have the right strategy.
That’s the troubling take-away from a survey of 100 health system executives conducted this past February by Sage Growth Partners. The survey, contained in Panda Health’s Hospital Digital Health Technology Report: 2022, offers a glimpse of the chaotic digital health market that healthcare leaders are facing these days, and offers a few guidelines to establishing a path forward.
"This report shows that hospitals are struggling in their efforts to improve efficiency, patient care, and outcomes as a result of challenging and time-consuming technology procurements," David Harvey, CEO of Panda Health, a digital health marketplace launched in 2020 through a partnership of CentraCare, the Gunderson health System and ThedaCare, said in a press release. "It can take hospitals up to one year or longer to find and contract for new solutions, and even after implementing them, many question if they selected the best technology for their unique needs. Healthcare organizations need a more streamlined process, so they can confidently move faster and drive better outcomes."
Digital health was seen as a “nice to have” strategy just a few years ago, but the pandemic pushed things into overdrive. Many healthcare organizations embraced virtual care platforms and digital health tools and programs to reduce traffic at overcrowded hospitals and replace in-person treatment at a time when the risk for spreading the virus was high.
Now, with COVID-19 easing into the background and consumers expressing their desire to continue using digital health, health systems are looking to make those emergency measures more permanent and trying to develop long-term strategies.
Identifying the Path Forward
“Many organizations are turning to digital health solutions, which tend to integrate with and complement EHRs and other systems of record, to build patient loyalty, improve the bottom line, and support staff members and clinicians,” the Panda Health report says. “These technologies span a multitude of use cases and solution categories, including patient engagement platforms, financial clearance and price estimation tools, digital care navigators, and more.”
According to the survey:
68% want digital care coordination/care journey orchestration tools;
63% of the health systems are looking to implement digital reputation management tools within the next three years;
61% are looking for digital care navigators or website chatbots;
47% are looking for financial clearance and price explanation tools;
43% are looking for self-service patient scheduling solutions;
41% want patient engagement tools;
39% are interested in remote patient monitoring services; and
38% are eyeing self-service payments and estimates services.
(Interestingly, of the health systems surveyed, 91% say they already have a telemedicine platform in place, with the remaining 9% planning on adopting one within three years.)
But creating a strategy to address those needs is not that easy.
According to the survey, only 6% of the health systems surveyed have a “fully developed” digital health plan, while 46% feel their plan is “moderately developed.” Conversely, 16% said they haven’t developed any plan, and 31% say it’s “slightly developed.”
When asked to identify the biggest barrier to establishing a strategy, 38% citing the integration vetting process, 34% identified vetting solutions for functionality, 15% focused on cybersecurity vetting, and 10% identified technical standards vetting.
Part of the problem is tied to the crowded digital health market, fueled by a dramatic increase in venture funding from $14 billion in 2020 to $26.5 billion in 2021. According to the survey, 66% of health systems say it’s moderately or extremely challenging to find the right solutions to consider, while 71% say it’s moderately or extremely challenging to align internal stakeholders to a digital health strategy.
Alongside that, more than half of the health systems surveyed said they get more than 10 e-mails or phone calls every week from digital health vendors, with 3% saying they field more than 100 a week, yet 95% surveyed said those vendor contacts result in business deals less than 2% of the time.
To tackle these challenges, the report makes three recommendations:
Establish a deliberate and actionable strategy;
Find new ways to quickly narrow the field; and
Conduct a more efficient evaluation and contracting process.
That may include seeking outside help. Some 56% of the health systems surveyed said it would be very or extremely valuable to partner with another organization to evaluate and implement a digital health strategy.
The recommendation may seem simplistic, but the value of a good digital health plan is clear. Some 83% of the health systems surveyed say digital health adoption will increase over the next three years, and 65% say their budgets will increase as a result. In other words, if they’re spending money on the issue, they’d better know what they’re spending it on.
