Telehealth and Medicine Today

Telehealth for Limiting Readmission Rates of COPD Patients: An Assessment Based on Medicare Data

2020-10-13T16:29:41-07:00

Objective: Telemedicine has developed as an innovative way to remotely view and treat patients without necessitating for patients to physically come into a physicians’ office or healthcare facility. This study aims to provide insights into the effectiveness of integrating telemedicine in medical facilities, where patients have high hierarchical condition category (HCC) risk scores.

Design: This study utilized two raw datasets: (1) a Centers for Medicare & Medicaid Services (CMS) dataset created from the 2017 Medicare Physician and Other Supplier National Provider Identity Aggregate Report and (2) a National Center for Education Statistics (NCES) dataset created from the NCES table on the number and percentage of households in each state with computer and internet access. A regression analysis was carried out on the CMS dataset to determine the correlation between HCC risk scores and the reimbursement lost by healthcare facilities, where over 50% of their patients are diagnosed with chronic obstructive pulmonary disease (COPD). A second analysis was conducted with the NCES dataset to show which states had a high proportion of both households with internet access and COPD patients. A final regression analysis was run and translated into an interactive map in order to determine which regions of the United States could most benefit from telemedicine adoption.

Results: This study discovered a number of physicians and healthcare facilities in the eastern region of the United States that could benefit significantly from telemedicine applications. These findings were supported by the locations and data abstracted from facilities with high numbers of COPD patients, which were found to have poor HCC risk scores and thus high reimbursement losses.

Conclusions: This study confirmed the association between HCC risk scores and reimbursement losses. In order to alleviate those losses, this study identified states across the United States that should choose to incorporate telemedicine into how they diagnose and treat patients based on the needs of healthcare facilities and the internet capabilities of households in those states, because telemedicine integration presents the potential to improve patient HCC risk scores and reimbursement amounts by lowering readmission rates while also promoting higher patient and physician satisfaction. Future efforts should develop specific strategies to assist with telemedicine implementation and should track the observed effects of its adoption on reimbursements and quality of care.

Surgical Patient Experience with a Novel Telemedicine Program in the COVID-19 Era

2020-11-18T07:53:42-08:00

Background: During the COVID-19 pandemic, measures were taken to decrease viral spread by transitioning health care appointments to virtual mediums. This study evaluates the use of telemedicine within the Divisions of Colon and Rectal Surgery and Otolaryngology-Neurotology at a single academic institution during the COVID-19 pandemic.

Study Design: An online survey modeled after the TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) was administered to gauge patient’s experience with Electronic Medical Record-based telemedicine visits.

Results: Participants noticed several advantages of telemedicine visits over traditional in-office visits: shorter visits, saving money, and avoiding potential exposure during the pandemic. A total of 36% at least somewhat agreed that the quality of care was hindered by the lack of a physical examination;61.7% participants at least somewhat agreed that they prefer a face-to-face visit rather than telemedicine consultation. Most patients were satisfied with the care they received via telemedicine (Likert 6.19/7) and 95.8% would use telemedicine again. Participants self-reported an average saving of $108.70 when using telemedicine. When comparing the telemedicine cohort with the in-office control, the telemedicine patients noticed an improved ability to communicate with their physician in five out of eight domains of the MCCS.

Conclusion: Surgical preoperative consultation, postoperative follow-up, and routine visits were conducted via telemedicine during the COVID-19 pandemic, representing a new direction for surgical appointments and consultations. This study shows that telehealth can provide satisfactory care and increases access to surgical care for patients when external factors prevent the traditional physician–patient interaction. With better-perceived communication via telemedicine appointments, patients may subjectively feel that they can express their symptoms and gather information from the doctor regarding their diagnosis more efficiently.

Predictions for Telehealth in 2021: We Can’t Wait for It!

2020-12-15T15:00:07-08:00

Telehealth in Latin America: Progress, Challenges, and Opportunities in the Face of COVID-19

2020-11-23T11:30:35-08:00

The COVID-19 pandemic has accelerated the use and importance of telehealth and telemedicine globally. In industrialized countries, stay-at-home measures and changes to government regulations regarding telehealth resulted in an over 100-fold increase in demand within weeks. The COVID-19 has raged across Latin America for most of 2020, with associated high rates of illness and death. The objective of this article is to review some of the successes and challenges of telehealth in Latin America and highlight opportunities for action within the context of COVID-19.

We identify several positive trends in telehealth adoption across the region as well as some promising case studies on the use of telehealth platforms for delivering care when needed. We also identify barriers that have limited the scale of telehealth in Latin America during the current phase of the pandemic. Limiting factors include inadequacies in long-term evolution telecommunication availability and access to digital trainings for healthcare workers. In addition, political commitment, legislation, and regulation have yet to catch up with demand.

Finally, we present opportunities to more effectively scale these technologies, across Latin America for the current emergency, as well as reducing or controlling healthcare costs, addressing health disparities, and providing improved health care, especially in rural areas.

COVID-19 and the Digital Transformation of Health Care

2020-11-28T07:22:01-08:00

The global COVID-19 pandemic demonstrated the vulnerability of healthcare delivery to patients worldwide and challenged healthcare providers—not only in treating patients with coronavirus but also in trying to maintain optimal care for non-COVID patients at the same time.

But challenging times often provide a fertile environment for innovation, and we have certainly seen major transformation in health care this year, via technology and global models, with the goal to democratize health care and provide greater access and more efficient and effective delivery of healthcare services to patients, regardless of their income or geography.

Some of the world’s top leaders and influencers in healthcare delivery transformation and health technologies, including blockchain and telehealth, converged at the 4th Annual CONV2X 2020 Symposium held virtually from November 10 to 12, to talk about healthcare transformation.

By far, one of the most widely discussed topics in the many sessions that took place over the 2-day event was virtual health.

Using Telemedicine to Reduce Suicide Ideation and Behavior: A Systematic Literature Review

2020-09-29T07:31:30-07:00

Objective: To review the published research for reported effectiveness of telemedicine in reducing suicide ideation and behavior in patients already diagnosed with a psychiatric disorder.

Design: A thorough literature search on the PubMed, Web of Science, PsycInfo, Cochrane Library, and TRIP (Turning Research Into Practice) Medical Database was conducted. Phrases such as “telemedicine,” “telehealth,” “remote consultation,” “mobile health,” “psychiatric disorders,” “suicide,” “suicide, attempted or ideation,” and “telepsychiatry” were employed in a variety of combinations. The primary inclusion criteria encompassed peer-reviewed articles published in the past 5 years. Secondary inclusion criteria comprised: (1) the diagnosis of any psychiatric disorder for all patients included in the study, (2) the absence or presence of use of telepsychiatry to offer consultation and communication, and (3) reported outcomes involving suicide rates or attempted suicide rates. The research publications passing inclusion criteria were assessed, and all their corresponding outcome measures were included in a meta-analysis.

Results: A total of 705 studies were identified by applying the initial search strategy to the electronic databases described. Of these, 205 passed the primary inclusion criteria. After excluding duplicates and non-English articles, 105 articles were screened using the secondary inclusion criteria. Nine articles remained, including three systematic reviews that were excluded. Finally, a total of six independent, non-overlapping studies were included in this meta-analysis, encompassing data for 576 participants.

The 18 outcome measures in this meta-analysis included five “positive” measures: perceived ability to cope with suicidal ideation, optimism, gratitude, positive affect, and the Mini Mental State Exam. The “negative” measures included: suicidal ideation intensity, hopelessness, depression, suicidality, HAMD (Hamilton Depression Rating Scale) score, HAMD score without suicide item, medical admissions, number of days of medical hospitalizations, number of psychiatric hospitalizations, number of emergency room visits, suicide ideation questionnaire (SIQ) from baseline to posttreatment, and SIQ from baseline to follow-up. Overall, this review found support for the hypothesis that telemedicine can reduce suicide ideation and behavior. There was a moderate effect size for the 18 measures analyzed. Based on the four different forest plots presented in this analysis, all average effect sizes calculated showed that the intervention of telemedicine has a small-to-moderate effect on the measures studied, which translates loosely to a small-to-moderate effect on the patient’s suicide ideation and behavior.

Conclusions: Telemedicine appears to be a promising way to reduce suicidal ideation, although how this translates into reductions in self-harm and/or suicide attempts is unclear from this review alone.

Fireside Chat with Authors

2021-02-23T01:23:00-08:00

Medical Students to the Rescue: Fighting COVID-19 with an Outpatient Pulse Oximetry Monitoring Protocol

2020-12-03T13:09:51-08:00

VA Video Telehealth and Training Programs During the COVID-19 Response

2020-12-02T08:19:54-08:00

Objective: The U.S. Department of Veterans Affairs has a robust telehealth program supported by a training infrastructure for VA clinicians and staff. In fiscal 2019, over 909,000 VA patients received a portion of their VA care through telehealth, and over 60% of VA’s primary and mental health care providers participated in one or more Clinical Video Telehealth (CVT) appointments to a patient’s home.

In March 2020, during the initial spread of COVID-19, Veterans Health Administration leadership issued guidance for providers to transition from in-person care to virtual modalities for routine care not requiring a physical encounter. VA’s comprehensive training infrastructure helped providers quickly become capable of delivering CVT care to meet the needs of their patients, and the VA Office of Connected Care Quality and Training (QT) Division adjusted the program as providers’ needs evolved.

Design: As clinical staff faced new and increasing demands to respond to needs during the pandemic, the QT Division streamlined existing training programs to deliver essential content and enable providers to acquire necessary telehealth skills more quickly. This included reducing the number of core courses required to become telehealth-capable from four to two by introducing an integrated course. The QT Division reorganized and edited content from other accredited courses to convey key topics. To shorten courses for providers with full schedules, the QT Division removed accreditation from some courses, such as the COVID-19 VA Video Connect for Providers course.

Results: The QT Division’s pandemic response resulted in over 80,000 new course completions in the first month and over 20% more primary care and mental health providers conducting CVT visits in the first five months. During this period, the number of CVT appointments increased by over 1,000%.

Conclusion: VA’s telehealth training infrastructure, implemented by the QT Division, enabled VA to enter the COVID-19 public health emergency fully prepared for the rapid growth in telehealth care. As CVT became increasingly important during the COVID-19 response, the QT Division made necessary curriculum adjustments to meet provider and patient needs.

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Fireside Chat with Authors

Moderator: Lyle Berkowitz, MD, FACP, FHIMSS, Editor-in-Chief, Telehealth and Medicine Today