Telehealth and Medicine Today

Pragmatic Approaches to Interoperability – Surmounting Barriers to Healthcare Data and Information Across Organizations and Political Boundaries

Bharath Perugu, MBA — 2023-07-24

Objective

This paper provides a review of the landscape of interoperability efforts in healthcare from 2010 to 2023, in the US and abroad. Interoperability, in the context of this paper, is “the ability to share information across time and space from multiple devices, sources, and organizations”, as defined by the IEEE (Institute of Electrical and Electronic Engineers). This review is followed by recommendations for future work toward improving the standardization of heterogeneous data in the healthcare setting.

Methodology and Results

A literature review was conducted on established interoperability standards and systems in healthcare, based on information obtained from journal publications, government, academy reports, published materials, and publicly available websites. The review emphasizes four interoperability parameters: device/equipment interoperability, compatibility issues, involved organizations, and migration and conversion issues. It evaluates adoption levels for each standard, evaluating factors supporting and/or limiting systemic adoption. Estimations on the number of users – both medical professionals and patients – for each system were made in instances where verifiable data were available.

Examples of specific interoperability efforts and an evaluation of their feasibility were conducted at three levels of healthcare interoperability, as defined by the National Academy of Medicine: Inter-facility (macro-tier) interoperability, Intra-facility (meso-tier) interoperability, and Point-of-care (micro-tier) interoperability.

Conclusions

Despite many parallel ongoing efforts to improve the standardization of healthcare information, in the mobile devices, IoT, and EHR sectors, there is still more space for improvement. The recent development of the TEFCA framework has greatly reduced the friction of data exchange in many healthcare contexts. In addition, funding architectures for mediating data between separate healthcare organizations, or middleware architectures, may also be an effective strategy for consolidating healthcare data and improving information exchange.

Surmounting Barriers to Healthcare Data and Information: International Case Studies

Bharath Perugu, MBA — 2023-07-24

Objective: In this article, the authors review the progress in healthcare interoperability from 2010 to 2023 from an international perspective. Countries covered here include the Republic of China (Taiwan), the Republic of Croatia, the Republic of Estonia, and the Commonwealth of Australia. Interoperability, in the context of this paper, is “the ability to share information across time and space from multiple devices, sources, and organizations,” as defined by the Institute of Electrical and Electronic Engineers (IEEE). This is followed by recommendations for future work toward improving the standardization of heterogeneous data in the healthcare setting.

Methodology: A literature review was conducted on established interoperability standards and systems in healthcare based on information obtained from journal publications, government, academy reports, published materials, and publicly available websites. Examples of specific interoperability efforts and an evaluation of their feasibility were conducted at three levels of healthcare interoperability, as defined by the National Academy of Medicine: 1) inter-facility (macro-tier) interoperability, 2) intra-facility (meso-tier) interoperability, and 3) Point-of-Care (micro-tier) interoperability. The authors assessed the adoption levels of each standard by looking at factors that support or limit its systemic adoption. Estimations on the number of users—medical professionals and patients—for each system were made in instances where verifiable data are available.

Results: Presented here is an evaluation of four interoperability parameters: 1) device/equipment interoperability, 2) compatibility issues, 3) involved organizations, and 4) migration and conversion issues.

Conclusions: Despite many parallel ongoing efforts to improve the standardization of healthcare information in the mobile devices, Internet of Things (IoT), and electronic health records (HER) sectors, there remains space for improvement. The recent development of the Trusted Exchange Framework and Common Agreement (TEFCA) framework has significantly reduced the friction of data exchange in many healthcare contexts. In addition, funding architectures for mediating data between separate healthcare organizations, or middleware architectures, may also be an effective strategy for consolidating healthcare data and improving information exchange.

Surmounting Barriers to Healthcare Data and Information: Cases in Point, the U.S. Experience

Bharath Perugu, MBA — 2023-07-24

Objective: The authors review the progress in healthcare interoperability from 2010 to 2023 in the United States. Interoperability, in the context of this paper, is “the ability to share information across time and space from multiple devices, sources, and organizations”, as defined by the IEEE (Institute of Electrical and Electronic Engineers). This is followed by recommendations for future work toward improving the standardization of heterogeneous data in the healthcare setting.

An evaluation of four interoperability parameters: 1) device/equipment interoperability, 2) compatibility issues, 3) involved organizations, and 4) migration and conversion issues are presented. The evaluation assessed the adoption levels of each standard by looking at factors that support or limit its systemic adoption. Estimations on the number of users—medical professionals and patients—for each system were made in instances where verifiable data were available.

Results: This review reveals that…

Conclusions: Despite many parallel ongoing efforts to improve the standardization of healthcare information, in the mobile devices, Internet of Things (IoT), and electronic health record (HER) sectors, there remains space for improvement. The recent development of the Trusted Exchange Framework and Common Agreement (TEFCA) greatly reduces the friction of data exchange in many healthcare contexts. In addition, funding architectures for mediating data between separate healthcare organizations, or middleware architectures, might also be an effective strategy for consolidating healthcare data and improving information exchange.

Patient Satisfaction and Perception of Physician Empathy in Outpatient Community General Neurology Telemedicine

Karen A. Truitt, DO — 2023-07-24

Abstract

Introduction: We assessed patients’ satisfaction and perception of physician empathy after implementation of video telemedicine service for general neurology follow-up visits at two community spoke clinics that serve patients in rural areas located approximately 45 miles from a medical center hub.

Methods: Consecutive patients who completed a telemedicine neurology follow-up visit from February 12, 2020 to January 13, 2021 at the spoke clinic in Red Wing, MN and from July 21, 2021 to January 21, 2022 at the spoke clinic in Austin, MN were asked to complete a paper-based survey at the conclusion of the telemedicine visit. The neurologist conducted the telemedicine visit from the medical center hub site in Rochester, MN or from their own home using the InTouch (Teladoc Health™) operating system mobile telehealth platform. All patients had previously completed an initial traditional face-to-face consultation at the spoke clinic with the same neurologist performing the follow-up telemedicine visit. Primary outcomes were Telemedicine Patient Satisfaction Measure and Consultation and Relational Empathy scores and mean total favorable survey responses.

Results: 31 patients at our clinic in Red Wing, MN and 38 patients at our clinic in Austin, MN participated in telemedicine neurology follow-up visit, completed the survey, and were included in the final analysis.

The mean Telemedicine Patient Satisfaction Measure scores (possible score of 12-60) were 55 (range 42-60), and for all items ‘agree’ or ‘strongly agree’ was rated on average 94% of the time. The mean Consultation and Relational Empathy scores (possible score of 10–50) were 44 (range 28–50), and for all items ‘very good’ or ‘excellent’ was rated on average 90% of the time.

Both neurologists conducting telemedicine visits reported that this model of care improved work-life balance with reduced travel time.

Discussion: We successfully implemented a telemedicine service for general neurology follow-up visits at two community spoke clinics serving patients in rural areas without compromising on perceived care. We were able to bridge the gap between patients’ needs for local care and physicians’ need for work-life balance. Patients’ perception of physician empathy and satisfaction with telemedicine neurology follow-up visits was high. This model of telemedicine avoids the barriers of limited internet access in rural areas and minimizes technology related anxiety that is often present in telemedicine visits to patients’ homes. This model allowed for high quality neurological examination with high resolution pan-tilt-zoom camera on a mobile platform, incorporation of vital signs, nursing support, and lab services that may have contributed to the patients’ and neurologists’ satisfaction. Our study supports our continuation and expansion of this TM model in our community clinic spoke sites and may help to improve access to neurological care for patients in rural areas.

Keywords: Telemedicine, patient satisfaction, empathy, general neurology, teleneurology

Impact of Telehealth on Hospitalization of Skilled Nursing Facility Patients During the COVID-19 Pandemic

Francis X. Campion, MD, FACP — 2023-07-24

Importance: This very large claims data analysis documents lower rates of hospitalization among patients receiving telehealth during a skilled nursing facility stay compared to patients who did not receive telehealth. These findings from care during the COVID-19 pandemic support the call for telehealth to become a routine option even after the public health emergency has ended.

Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. This focused analysis can assist program development for the large population of patients cared for in skilled nursing facilities.

Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC) and Telehealth Impact Study to respond to the pandemic. We report trends using a data set of 668,533 patients cared for in skilled nursing facilities (SNF) between January 2020 and March 2021.

Main Outcomes and Measures: We compared rates of hospitalization within 60 days of admission to the skilled nursing facility for patients who received telehealth and those who did not receive telehealth during their SNF stay. We analyzed subgroups of patients based upon the clinical diagnoses for which they received professional services from physicians and other providers.

Results: Of the 668,533 patients meeting criteria for an admission to a SNF facility, 97,204 (14.5%) had one or more telehealth visits. 40.1% of patients received one TH visit per 30 days during their SNF stay; 9.4% received ten or more TH visits per 30 days. Patients in all six diagnostic cohorts experienced significantly lower rates of hospitalization compared to patients who received no telehealth despite having a higher average disease burden measured by the Charlson Comorbidity Index. Absolute rates of hospitalization rates dropped between 1.25% (dementia) and 1.87% (orthopedic) for clinical groups. The relative rates of hospitalization dropped between 22% (cardiovascular) and 33% (dementia).

Conclusions and Relevance: This study underscores the potential benefits of using virtual care in skilled nursing facilities to lower rates of hospitalization and improve outcomes. We encourage continued study of the use digital health services for patients in post-acute settings and promotion of insurance coverage in the years to come as new best practices emerge.

Remote Patient Monitoring in India

Dr Haleema Yezdani — 2023-07-24

Panelists discuss the clinical aspects of remote patient monitoring (RPM) in telehealth and clinical enhancements including technologies such as translational AI, and the benefits of RPM on acute and chronic medical conditions.

Questions include

What is RPM and how is it beneficial in chronic disease management?
How is Telemedicine different from RPM?
What is the role of AI in RPM?
How has RPM taken over and changed the life of people?
Have patients at large accepted the concept of RPM?