In 2020, much in our daily lives can be accomplished virtually. From clothes shopping to ordering groceries, there is a growing desire to accomplish important tasks remotely, allowing individuals to save time and effort on fewer in-person trips.
But with so much technology available, why does healthcare feel like it’s lagged behind?
Traditional telemedicine — typically involving phone calls and occasionally video chats with providers — has helped allow individuals to contact their doctors remotely, which can be a tool for both providers and their patients. The utility of telemedicine, however, has its limits, and it’s crucial for both healthcare professionals and average consumers to understand those limitations and move toward a better method.
That better method is represented by virtual health, a new way of thinking about remote doctor visits that combines the benefits of traditional, in-person doctor visits with the convenience and accessibility of telemedicine by establishing a virtual health hub that can accomplish nearly everything that a traditional visit can. This model involves providers on both sides of the visit, known as a “tele-presenter” model.
As a new decade begins, healthcare needs should be addressed through the innovative technology that drives much of our life. And with the correct shift in emphasis, virtual health can help improve healthcare for people who need it.
Here are three ways virtual health and telemedicine differ, and why the disruptive new platform is worth embracing:
Accurate, Detailed Visits
For the sake of a patient’s wellbeing, receiving an accurate diagnosis from a healthcare professional is critical. But with many telemedicine strategies, a detailed and accurate assessment can be difficult.
With a simple phone call or video chat, a doctor needs to rely on the patient to self-diagnose and can only ask them questions about their symptoms and how they’re feeling. While this can sometimes be effective, a doctor can’t give their best assessment without being in the room with a patient.
Fortunately, virtual health can bridge that gap by allowing a second professional to help the physician assess and diagnose the patient. In the case of the Health In Motion Network’svirtual health hub at Indian Lake High School — a partnership with Mary Rutan Hospital in Bellefontaine, Ohio — a school nurse is on hand with the patient to help relay information to doctors, providing information that typically needs to come from an in-person meeting.
We have all heard of the COVID-19 (Coronavirus) which is believed to have originated in the Wuhan province of China. Which it then started spreading across the globe from major outbreaks in countries like Italy, Spain all the way to the United States. We know now there have been a number of countries who have gone in a nationwide lockdown (Italy, Spain, France, Germany).
Here in the United States, many states have been doing everything they can to limit the spread. For example, most restaurants, bars, and other social gathering areas have been closed or limited. Unfortunately, for healthcare workers, you are on the frontlines of this pandemic. Which will mean you may be the best source of information for family friends and clients.
Here are some tips as to what you may want to do. First, let’s start off with yourself. As we mentioned you are one in the thick of this epidemic and you need to make sure you are being safe and keeping yourself healthy and alert.
Of course, you need to follow the usual protocols of keeping your distance from others (when you can), make sure to be washing your hands when you can and, maybe the hardest for many of those working inside hospitals and clinics, make sure to get a good night’s sleep and eat as healthy as you can to keep up your energy.
Being alert will not only be crucial to keeping yourself safe but it can save a patient or coworker from being exposed to the virus. Whenever a new patient or individual comes to your clinic or emergency room take note of any symptoms they may be experiencing. Some of the known indicators of the COVID-19 (Coronavirus) may include some flu-like symptoms such as cough, fever, sweating, shortness of breath, fatigue and muscle pain.
Advancements in technology make your life easier every day. In the past decade, you’ve seen the smart home become a reality and cell phones are no longer used simply to text and place calls.
Thankfully, technology is also advancing in the medical field and, as such, dramatically helping to improve patient care. Many wearable devices are helping patients not only improve their quality of life but that also allow them and their doctors to monitor medical conditions.
Portable Oxygen
Some devices, such as the oxygen tank, have come a long way in recent years. Instead of having to lug a bulky tank from place to place, many people can now use a smaller design that you simply wear over your shoulder–similar to a purse–or transport in a tote. However, the cost of this device is not covered by all insurance companies. Additionally, many of the people who rely on daily supplemental oxygen are the elderly and they are on Medicare. Using health insurance, such as Medicare for oxygen usage, isn’t always covered 100 percent, making it hard for seniors on social security to live life comfortably.
ECG Monitors
In the past, a person had to visit their doctor periodically to have an EKG performed to monitor their heart health. Today, through advancements in technology, patients can monitor their health from the comfort of their homes. These portable, handheld devices are easy to use and provide almost instantaneous recorded measurements within just a few minutes. This lets patients retain a complete history of their condition over an extended period of time, allowing doctors to review it and use it as a valuable tool to make further recommendations regarding a patient’s health. Additionally, should an alarming reading occur, a patient can contact their doctor and head straight to a hospital.
Blood Pressure
Today patients with a history of high blood pressure can monitor their blood pressure from virtually anywhere. The smartwatch by HeartGuide is worn like a watch on your wrist. It works similarly to the traditional wrap-around blood pressure cuff found in a doctor’s office; only this one expands and then tightens at your wrist. The first of its kind, it has a 100 reading storage capacity and the patient can transfer them to a mobile app called HeartAdvisor. This lets their physician review the readings and proceed with life-saving treatment options.
Carrot Health has developed the COVID-19 Risk Index, which predicts those populations and communities that are most susceptible to the negative impacts from a coronavirus outbreak. The risk index does not predict where and when an outbreak will occur, rather it helps inform public health and intervention decisions at the national, regional and community levels by identifying who is most vulnerable.
Because risk variations across a single metro area can be significant, Carrot Health is also preparing to publish an interactive dashboard that shows the COVID-19 Risk Index and allows users to drill into the data down to the zip code level to identify granular pockets of risk and model different outbreak scenarios. This information can help inform coordination of resources to protect those who are most vulnerable.
Kurt Waltenbaugh
“With the right data, public health personnel can turn panic and passivity into preparation and progress, directing intervention efforts and resources more effectively and appropriately,” said Carrot Health CEO Kurt Waltenbaugh. “It allows for better informed decisions about the types of advance preparations that are necessary and where to divert scarce resources like ventilators and test kits in the event of an outbreak, and identifies populations that require closer monitoring so rapid interventions can be staged with when circumstances warrant.”
Carrot Health Insights | Predicting Coronavirus Risk, which includes multiple charts and graphs breaking down population-based risk, can be accessed online here. It will be updated as more data and scientific studies become available.
Research also suggests that approximately 2% to 4% of people with the virus die, depending on where they live. So far, deaths are higher in males and much higher for those over age 65.
By coupling this information with its extensive database of social determinants of health information and consumer insights, Carrot Health was able to predict COVID-19 vulnerabilities. The following map shows forecasted COVID-19 population risk at the county level (red = high, green = low):
Source: Carrot Health
New data and additional studies might change the assumptions upon which this initial analysis was based. In addition, the actual infection rate may be higher than reported, which would mean that mortality rates could be lower than currently estimated. To that end, the COVID-19 Risk Index will evolve over time.
“These insights are not meant to inspire panic, but to promote thoughtful preparation. Data-driven insights will be critical in saving lives, deploying resources, and minimizing disruption, both for this public health crisis and for future ones. While the U.S. currently remains less affected than some parts of the world, it is nonetheless more vulnerable due to a healthcare system that does not promote prevention or early intervention,” said Waltenbaugh. “Fortunately, we have powerful data tools at our disposal to better prepare and deploy resources, and a culture of helping those who are vulnerable.”
By Dr. Jason Hallock, MD, chief medical officer, SOC Telemed.
Dr. Jason Hallock, MD
On March 13, President Trump declared the novel coronavirus (COVID-19) pandemic a national emergency. The declaration opens more than $42 billion in federal funding to combat the virus by expanding resources in key areas, including telehealth across the nation. While COVID-19 is novel there’s nothing new about telehealth solutions that are now moving to the forefront care in light of this virus.
Funding will support an increase in COVID-19 testing and expand telehealth services to virtually care for patients. HHS can waive licensing regulations to allow out-of-state physicians to treat patients via telehealth wherever outbreaks occur. And, critically, the declaration of emergency allows for $500 million in Medicare waivers for telehealth restrictions.
The action comes at a critical moment, as the U.S. health care system is confronted for the first time in its modern history with the possibility of a hospital capacity crisis. If too many COVID-19 positive cases descend on our hospitals at once, we could be in the unenviable position of lacking the onsite equipment, the beds, tests, staff and other resources to provide life-saving care for all. Such dark medical realities are already true elsewhere in the world.
As the contents of the national emergency declaration show, telemedicine is poised to play a key role in the fight against COVID-19. It’s not by accident.
While the virus spread rapidly to pandemic status, the reality is that the healthcare industry long anticipated the possibility of a fast-spreading global contagion. As we in the industry planned for the possibility of such an event, telemedicine was always among the solutions.
The role of telemedicine in the time of a pandemic is not an experiment or for use in a limited trial—it’s actively being used to treat COVID-19 today. In fact, the Centers for Disease Control and Prevention (CDC) continues to urge doctors and hospitals first to assess potentially infected patients remotely whenever possible, and to care for patients with mild COVID-19 symptoms from home using virtual check-ins.
As COVID-19 continues to spread in the United States, health care providers are turning to technology to help treat patients who may be infected and also prevent the spread of the illness.
While there are no known cases of COVID-19 in Alabama, plans to use telehealth technology to fight the spread of the virus are already in place at the University of Alabama at Birmingham.
According to Eric Wallace, M.D., the medical director of UAB eMedicine, UAB is considering using telehealth through three approaches to help care for patients both in Birmingham and around the state.
Keep patients at home
The first approach is to keep as many patients who do not have upper respiratory symptoms at home, especially those who have weakened immune systems. The most common COVID-19 symptoms are fever, runny nose, dry cough, shortness of breath, fatigue and body aches.
“We plan to use telehealth technology to see as many patients in their homes as possible, especially those who are most at risk, such as the elderly and immunosuppressed patients,” Wallace said. “For example, if you have a urinary tract infection, the last thing you should do is go to the doctor’s office and wait in a waiting room when you could have had your UTI treated from home.”
If you have any of the COVID-19 symptoms, you should call your health care provider first before going to the doctor’s office. If you do not have any of the symptoms, but need medical care, Wallace recommends calling your doctor or using UAB’s eMedicine online service. The service allows doctors to diagnose and treat patients for a variety of common conditions online. Furthermore, UAB’s eMedicine online service is now serving as a location to help screen patients with COVID-19 symptoms to determine whether referral for in-person testing is necessary.
On Mar. 9, 2020, the U.S. Department of Health and Human Services (HHS) finalized “two transformative rules that will give patients unprecedented safe, secure access to their health data.” Issued by the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), the Final Rules implement interoperability and patient access provisions of the 21st Century Cures Act and support President Trump’s MyHealthEData initiative.
In its release announcing the Final Rules, HHS noted that together “these final rules mark the most extensive healthcare data sharing policies the federal government has implemented, requiring both public and private entities to share health information between patients and other parties while keeping that information private and secure, a top priority for the Administration.”
Cures Act Final Rule implements the interoperability provisions of the 21st Century Cures Act, passed by Congress in 2016 to promote patient control over their own health information while still allowing providers to choose the IT tools that let them provide the best care for patients without excessive costs or technical barriers.
Specific to patient matching, the Cures Act Final Rule adopts as standard the first version of the United States Core Data for Interoperability (USCDI v1), making its use a requirement as part of the new application programming interface (API) certification criterion.
According to ONC, adoption of the USCDI standard “supports improved patient matching through the exchange of USCDI and its patient demographic data elements.” The Final Rule integrates additional data elements to the patient demographics data class to improve patient matching:
Current Address
Previous Address
Phone Number
Phone Number Type
Email Address
Karen Proffitt
“Any improvement strategy must include data standardization and promote a more consistent, comprehensive collection of patient data at all entry points,” said Karen Proffitt, MHIIM, RHIA, CHP, vice president of industry relations and chief privacy officer, Just Associates. “The Final Rule requirement for adoption of USCDI standards, including historical data and more relevant data elements such as phone number and email address, represents a significant step toward improving interoperability and minimizing MPI errors overall.”
Interoperability and Patient Access Final Rule gives patients access to their health information when they most need it, in a way they can best use it. It is focused on driving interoperability and patient access to health information by leveraging CMS’s regulatory authority over Medicare Advantage, Medicaid, CHIP, QHP issuers and FFEs to free patient data.
Specific to patient matching, which was one of two requests for information included within the proposed rule, CMS noted that while “accurate patient identity management is critical to successfully delivering the right care to the correct patients,” patient matching challenges are beyond the scope of the current rule. However, the comments provided will be taken into consideration for potential future rulemaking.
“As a healthcare community, we must recognize the critical role improved data capture and MPI data quality play in enabling patients to have more comprehensive access to their health information by ensuring complete and accurate data is available for viewing or transmitting,” said Proffitt.
She adds, “any process to incorporate patient verification of data along the way could be very beneficial.”
The U.S. Department of Health and Human Services (HHS) recently finalized a new rule to support seamless and secure access, exchange and use of electronic health information (EHI). The legislation aims to drive sharing of patient EHI, allowing for greater coordination of care. It also takes a strong stance against information blocking and would hold health IT developers accountable as a condition of certification.
The regulations take a crucial step forward for nationwide interoperability and health care by requiring open, standardized application programming interfaces (APIs) for patient and population services. The rule is designed to promote data transparency between health organizations through a central and secure exchange of EHI. For hospital systems, this includes clinical notes and admits, discharges and transfer (ADT) files. For payers, this includes anything from claims to clinical data, including labs, pharmacy, immunizations and vitals.
For stakeholders, having access to real time and actionable information at the point of care is a significant improvement over information from claims filed 60-90 days after the care was provided. This also demands that patients be fully informed about how apps will use their personal data and information.
As many health IT developers know, the challenge is that EHRs are only as good as the information fed into them. The moment a patient goes outside of that circle of care, the user loses all sight into the services being provided.
Improving on the Current EHR
The current absence of interoperability creates a burden for hospital systems and undermines payer efforts to achieve high quality care and more appropriate utilization. It also impacts reimbursement and profits. When more information is shared historically, it allows payers to manage the whole patient experience.
This is where an innovative EHR browser extension comes in.
The ideal browser extension serves as a population health solution built upon an EHR foundation and completes the circle of care by aggregating information through continuity of care documents, claims, labs, health information exchanges, vendors, ancillary providers and hospitalists groups to not only answer the question of “who is in my office now?” but also “who should be in my office?”
This is done through alerts, defaulted based on the systems history, or on the specific user based on what they care to see. The concept centers on creating a user journey that notifies the provider of an admission through real-time application programming interfaces (APIs), sending care alerts to the case manager, flagging the risk-bearing entity to a potential future cost and relevant information to patients and caretakers via a mobile app.
As COVID-19 continues to spread in the United States, health care providers are turning to technology to help treat patients who may be infected and also prevent the spread of the illness.
