By Kelly Brassil, PhD, RN, director of medical affairs, Pack Health.
While the world has come to a pause during the COVID-19 pandemic, one thing that does not stop is the presence of chronic conditions. This is particularly true of cancer where many individuals are navigating the cancer continuum during the coronavirus pandemic.
An estimated half million individuals have been diagnosed since the first confirmed case of COVID in the United States earlier this year. Unlike other conditions that can be managed primarily at home, cancer often requires in-person, and sometimes, experimental treatment.
For over a decade, I’ve worked as an oncology nurse, supporting individuals across cancer diagnoses. For those who are newly diagnosed, in treatment, or in survivorship, I’ve compiled some commonly asked questions along with suggestions and tips.
Am I at higher risk for COVID and its complications?
Preliminary data suggest that individuals with cancer or a history of cancer, especially those in active treatment, may be at higher risk for severe complications of COVID-19. The best way to reduce your risk is to practice social distancing. This also applies to members of your household or your primary caregiver. If you or your caregiver must leave the home, always use precautions like wearing a mask and frequent hand washing to reduce risk of transmission.
Will I still be able to receive treatment and access care?
Health systems are exploring ways to reduce risk of transmission. One way is to reduce the number of individuals coming into hospitals. This can result in changing the timing of in-person treatment or type of treatment you receive. They are thoughtfully coming up with safe, creative ways for individuals to access care and receive treatment, ranging from implementing telehealth to provide a platform to connect with your oncology team, to transitioning to treatment that can be taken orally or infused at home.
If you are receiving care at a facility far from your home, your care might transition to a nearby cancer provider. In some cases, treatment may need to be held or postponed, particularly if you have symptoms or a confirmed case of the virus. You may be asked to undergo COVID-19 testing prior to a procedure or treatment. Your caregiver may not be able to attend your hospital visits or visit you in the hospital. All of these decisions are made to protect you—ensuring you have the strongest possible immune system and reducing risk of COVID-19 transmission.
For the past month or more, doctors in the US have had their hands full with the rapid onset and spread of the coronavirus. Affecting thousands of citizens each day, it’s all hands on deck to try to treat patients in need.
With an increased attention on patients suffering from this deadly virus, however, many doctors worry about their non-coronavirus patients. From those fighting off the flu or some other virus to those with preexisting conditions like diabetes, heart disease, and cancer, lots of people aren’t getting the care they should be.
Some patients are afraid to come forward out of fear they’ll contract COVID-19, others hold off on contacting their doctor to avoid taking up precious time or available hospital beds for those they feel are in greater need right now. In any event, the concern is that there could be a lot of people out there suffering in silence. If you run a healthcare practice and have some of these same concerns, know that there are some effective solutions to help you treat and support your non-COVID-19 patients.
Many healthcare facilities across the country have implemented telehealth options. It is a digital platform that allows medical professionals to provide care and treatment to their patients remotely. Not only can this type of platform be instrumental in helping you to pre-screen potential COVID-19 patients, but it can be used to help non-coronavirus patients as well.
Advising your patients to utilize this application when in need of medical attention allows you to meet with the patient virtually and assess their health status. You can prescribe medication, provide self-care tips to treat their problem at home, or, if necessary, advise them to get to a healthcare facility or hospital for immediate attention. This prevents them from coming in the office unnecessarily (saving thousands of lives), but still provides them with an option to get medical care if they need to.
Hospitals across the globe are experiencing a demand incomparable to any event that most of us have experienced in our lifetimes. Providers on the front lines of the coronavirus pandemic tirelessly and courageously dedicate countless hours and immeasurable amounts of energy to combat this virus, all while compromising their own safety and the safety of their families.
This strain on the health care system stretches far beyond patients with COVID-19, as people with chronic diseases such as diabetes, Crohn’s, cancer and their providers struggle with the best way to manage their illnesses. With few medical resources available and the risk of exposure to the virus, a new way of providing care is desperately needed.
The Case for Telehealth
One might ask how these patients receive the care they need if they are unable to physically visit their provider and support team. Many are being forced – or choosing – to wait indefinitely until the risk of exposure and provider demand declines. As the United States and every country moves forward and learns from this crippling pandemic, it is apparent that there is an absolute need for a bigger emphasis on remote patient monitoring and telehealth services to provide effective care. The need is so significant that legislation is being passed to support the uptake of remote treatment options and to ensure health care facilities have high quality internet connections.
Telehealth services allow patients to be seen by a provider through video calls, giving the traditional face-to-face feel that many experience in general appointments with their providers. However, the extent of the personal interaction may end with the action of the provider, such as a prescription or advice on at-home care options.
Remote Monitoring: From Improved Workflow to Empowering Self-Management
Remote patient monitoring typically includes a support platform that allows a patient to monitor and manage their disease, often with the support of their health care team, remotely and over a period of time. The term telehealth is often wrongfully used interchangeably with remote patient monitoring. The two work together, but are not the same. Telehealth interactions are often part of a larger, ongoing remote patient monitoring system.
There are various types of remote patient monitoring platforms. Some are created with the intent to enable easier workflow and patient management for the physician, others are created to support patient self-management. Some cardiology devices such as pacemakers and ICDs use remote patient monitoring directly by sharing data on the performance of the device and the heart’s response with the physician.
The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS), in conjunction with the HHS Office of Inspector General (OIG) announced a policy of enforcement discretion to allow compliance flexibilities regarding the implementation of the interoperability final rules announced on Mar. 9, 2020, in response to the coronavirus disease (COVID-19) public health emergency. ONC, CMS, and OIG will continue to monitor the implementation landscape to determine if further action is needed.
“ONC remains committed to ensuring that patients and providers can access electronic health information, when and where it matters most. During this critical time, we understand that resources need to be focused on fighting the COVID-19 pandemic. To support that important work and the information sharing efforts we are already seeing, ONC intends to exercise enforcement discretion for 3 months at the end of certain ONC Health IT Certification Program compliance dates associated with the ONC Cures Act Final Rule to provide flexibility while ensuring the goals of the rule remain on track.” – Don Rucker, MD, National Coordinator for Health Information Technology.
“Today’s action follows the extensive steps CMS has taken to ease burden on the healthcare industry as it fights COVID-19. Now more than ever, patients need secure access to their healthcare data. Hospitals should be doing everything in their power to ensure that patients get appropriate follow-up care. Nevertheless, in a pandemic of this magnitude, flexibility is paramount for a healthcare system under siege by COVID-19. Our action today will provide hospitals an additional 6 months to implement the new requirements.” – Seema Verma, CMS Administrator
With all that the healthcare system has to worry about these days, perhaps it’s time to hit the “Pause” button on health IT deployment.
While it’s certainly true that provider organizations can ill afford any disruption or downtime in their health IT infrastructure right now – one could argue a massive EHR replacement project might not be advisable at this moment – it’s equally true that effective, practical health IT is needed now more than ever. Clinicians on the front lines of the COVID-19 response need accurate and relevant patient data from the EHR system, instantly (meaning with one click, not dozens); and they need to be able to collaborate with their colleagues on urgent patient care issues at a moment’s notice, anytime, anywhere.
To that end, nothing could be more practical or timely amidst the COVID-19 patient surge than patient data access and care team collaboration capabilities on mobile devices. Smartphones and tablets are the information access and communication tools of choice for most clinicians, wherever they may be – within the hospital, in a triage tent, quarantined at home, or anywhere in between.
But for hospitals under the gun in the midst of this pandemic, is implementing such functionality really feasible?
Let’s back up, and consider a fundamental truth of healthcare IT: EHRs aren’t supporting doctors the way they were intended to, and are diverting valuable time that could be spent with patients.
Ironically, before the EHR, a physician’s biggest pain point was not having access to enough data. Patient information was siloed, typically in dusty paper charts buried in the basement or out of reach in off-site storage. Physicians didn’t have a comprehensive view of the patient. Now with EHRs, providers should have better access to patient information. Alas, that often is not the case, as vital information is buried in a sea of redundant or irrelevant data within electronic clinical notes.
It is crucial that the healthcare industry empowers physicians with tools that will make them better. Unfortunately, forcing physicians to wait their turn for one of too-few hospital workstations is not making them better. The inexplicable persistence of UIs that fail to effectively parse information in a manner consistent with a physician’s workflow or thought process isn’t helping. Obtrusive, non-emergent automated queries that foster alarm fatigue aren’t helping. System design predicated on a one-size-fits-all user experience strategy hinders delivery of care.
On the other hand, well-designed mobile apps, which afford ready and actionable access to relevant patient data, can accelerate care. And if such apps are (a) an extension of the existing EHR, and (b) as intuitive to use as any consumer app on your phone today, then training and adoption shouldn’t be a problem.
The value of “mobilizing” the hospital EHR goes far beyond effectively caring for patients under crisis conditions. It has become essential for provider collaboration on patient care generally, as physicians today are as “siloed” as patient records once were. We are not all in the same hospital at the same time. Remote access to records and the ability to easily communicate with each other within the context of a patient chart are key to the kind of collaboration that fosters better care.
By April Gill, senior vice president, solution management, Welltok.
The future of COVID-19 remains a giant question mark right now. But what is clear in this uncertain time is the significant impact everyday factors, commonly called social determinants of health (SDOH), have on a person’s health. Literature shows that up to 70% of a person’s overall health is driven by SDOH, including factors like race, income, education level and more. Knowing about these factors can improve how providers keep patients healthy year-round, but also how they engage, counsel and treat patients as individuals during a crisis like the one we are currently experiencing.
If providers understand what kinds of SDOH their patients are facing, they can better understand what health risks they have today, as well as to anticipate their future needs and risks. They can use this insight to tailor what information they share with whom, using the most effective communications channels.
Consider an elderly patient who does not own a car and relies on public transportation for everyday needs. Before COVID, a provider may have leveraged this insight to connect them to Lyft to get to a clinical appointment.
Now, a provider with this insight would likely do much more – have a telehealth appointment instead, connect them with local volunteers who will deliver groceries so they can maintain a healthy diet without leaving home, and email them facts about how to minimize risk while using public transportation to pick up a prescription, if absolutely necessary. This is just one example of how providers can improve patient care and support by understanding what they experience every day.
But are patients aware of the impact SDOH have on their own health? To find out, Welltok conducted a survey of over 2,000 consumers earlier this year, to get their views on what factors they think affect health, and which ones they would share with their provider. Surprisingly, consumers underestimated how much SDOH influenced their overall health and wellbeing – responding that they only make up about 50% of a person’s overall health. (It’s really 70%). They did have a good understanding of some factors that drive health status – like type of work or who they live with – but not more than half did not understand how daily factors like length of commute also play a role.
Not surprisingly, three out of four people also told us they experienced a change in life in the last year that impacts health. The top ones were a change in 1) stress level, 2) annual income and 3) the amount of debt they have. With most provider interactions being episodic in nature, the opportunity to get to know patients at a personal level and/or stay apprised these changes is extremely difficult. Building off this, consumers were asked to list who they would share these life changes with.
As COVID-19 cases push hospitals around the country to their limits, medical facilities are facing challenges beyond sick patients. Long hours and an uptick in cyberattacks are putting serious strain on existing cybersecurity defenses. Without the right practices, these defenses may fail, exposing patient and hospital data to hackers and cybercriminals.
Here is why security remains key as the coronavirus outbreak grows more severe — and how hospitals can rise to meet current cybersecurity challenges.
Why Healthcare Data Security Remains Important
While cybersecurity may seem overshadowed by other healthcare concerns, the current crisis makes hospital data security more essential than ever.
Many hospitals and health systems are currently expanding or introducing COVID health data collection programs to get the information needed to combat the novel coronavirus. Many of these same systems are also ramping up data-sharing between institutions to ensure that medical providers around the country have the best possible information to work with.
New operating conditions — like hospitals that set up tents in parking lots to expand their number of available beds — have also changed how hospital systems, like electronic health records, are used and secured.
Current stress on staff may make hospitals more vulnerable to hacks. Cybersecurity professionals were, on average, overworked before the crisis began — an issue that has likely gotten worse as the crisis has progressed. Doctors, nurses and hospital administrators are working overtime, and organizations are bringing on new workers to manage the increased need for professionals. Existing staff may struggle to keep up with good security practices, and new team members may not receive the full training they need to keep data safe.
New information collecting schemes are critical for medical providers — but if the data they collect isn’t secured, it may also put a lot of patients at risk. This patient information may not seem like the most valuable target for hackers — but health data is actually widely sought after by cybercriminals. These hackers use health information, along with other personal information, to construct comprehensive identity packages about individual patients.
What Hospitals Can Do to Handle Security
There are steps hospitals can take to ensure that patient and hospital data stays as safe as possible — even while the staff is under immense pressure.
During the crisis, operational security will become more critical. Doctors, nurses and hospital staff should be highly aware of what they are sharing on social media. Personal information should be kept private, and employees must take note of any information in the background of the photos they take. A cybercriminal scouring the posts of doctors and hospital workers may find what they need to break into a network — like a password taped to a monitor.
By A.J. Hanna, vice president client advocacy, SYKES.
People’s knowledge of telehealth isn’t necessarily leading to usage — at least, that is what we found at SYKES as a part of our survey on attitudes toward telehealth. Telehealth, in its purest form, has existed for decades. Physicians, whether by phone, radio, or other forms of transmission, have been calling on clinicians from outside of their communities to assist them with second opinions or provide specialty expertise for many years.
And while the internet has opened up new and more expansive opportunities for telehealth — including making it easier for the remote caregiver and the patient to interact via both video and audio — regulatory restrictions, reimbursement inconsistency, attitudes toward effectiveness and other factors have prevented it from finding its full promise.
COVID-19 and its ability to spread easily and rapidly has pushed the healthcare system in the United States and around the world to take a more expansive view of how telehealth can be used. Given the growing importance of this tool for triage of those potentially infected by the novel coronavirus, we wanted to first assess how many people even knew what telehealth was.
When presented with the question, “Telehealth is the use of communication technologies to support long-distance health care, instead of an in-person appointment. Are you familiar with telehealth?,” over 42 percent of those contacted for this survey were not even aware of the service (in excess of 1400 people). While usage of telehealth services has increased over the last several years, there are still many people who do not equate services available to them as being telehealth.
Of those few in our survey who knew what telehealth was and had actually used the service, satisfaction rates were very high. This follows trends from other studies that find that telehealth satisfaction levels exceed other parts of the healthcare industry. And not surprisingly, the primary benefit that they cite is the ability to avoid being with others in a clinical waiting room. But for those who had not been engaged in a telehealth visit, or had not considered the service, some expressed concern that telehealth would only be effective for minor illnesses and diagnoses. Others felt that a diagnosis would be difficult without the “touch and feel” aspect of a care visit.
Perhaps not surprisingly, respondents in the 55+ age group were less likely to have used telehealth or expressed concerns about its effectiveness. Because many in the upper level of this age group are likely Medicare beneficiaries, and because coverage by Medicare has been restricted to specific conditions, geographic regions and care settings, this is not surprising. Recent decisions by the federal government to relax restrictions for Medicare coverage of telehealth as a result of the novel coronavirus pandemic may help to close the gap in utilization represented in our survey.
If there is any outcome of the current pandemic as it relates to telehealth, it may be that it will encourage more people to consider using it. Nearly 60 percent of respondents indicated that COVID-19 has made them more likely to consider using a telehealth service in the future. Almost 25 percent of our respondents had not linked COVID-19 to their opinion of using telehealth. However, those numbers will surely change as the health system in the United States continues to utilize all means necessary to care for the health of people in ways that prevent further spread of the disease.
By Drew Ivan, chief product and strategy officer, Lyniate.
It is becoming increasingly popular to move healthcare outside of the clinic and into the community and the home with the use of telemedicine platforms, apps, and other digital means — and the coronavirus pandemic has dramatically accelerated that trend. Counterintuitively, this healthcare crisis has the potential to attenuate the relationship between the patient and the healthcare system, putting provider organizations at increased risk from “digital disruptors” like Amazon, Google and Apple, whose ambitions to take over consumer relationships in healthcare are stronger than ever.
As patients re-orient during the pandemic around other points of care (hospitals, urgent care, pharmacy, etc.), the relationship patients have with their PCPs (which is one of the health system’s biggest and most meaningful advantages against the advancement of healthcare disruptors), can lose value to the consumer. As such, it behooves health systems — who are understandably all hands on deck working to address the COVID-19 crisis today — to be giving serious consideration to ways of fending off digital disruptors as their big challenge in a post-COVID-19 world.
This means focusing on leveraging the unique strengths and assets they have and getting smart about aggregating and using the disparate consumer/patient data sets they manage, to deliver a consumer experience only they can provide.
Digital disruptors excel at delivering exceptional digital customer experiences by using the massive data sets at their disposal that render rich insights into customer trends, needs, behaviors, preferences, proclivities, etc. With that said, hospitals and health systems have an advantage in their exclusive access to patient data and their in-depth medical knowledge.
Health systems need to thoughtfully but aggressively leverage these advantages if they want to successfully retain primacy in the consumer’s healthcare brand relationships. With non-emergent care rapidly shifting to the digital space, digital brands have a golden opportunity to disrupt the traditional patient-health system relationship should provider organizations miss the opportunity to reinforce those relationships by delivering much more personalized digital interactions.
It’s important to remember that healthcare organizations do not need to match the digital sophistication of the big data-driven consumer tech giants. They just need to use what they already know about patients, communities and medicine to create the kinds of experience for patients that only they can.
As hospital leaders aim to protect their organizations from digital disruptors in the post-coronavirus aftermath, these three considerations should be top of mind:
By Rick Halton, vice president, marketing and product, Lumeon.
Since it was first recorded late last year in China, the spread of COVID-19 has accelerated around the world, rapidly creating a global pandemic. The number of new cases is increasing exponentially, putting the western hemisphere in particular on a frightening trajectory, as health systems struggle to battle the virus.
Though billions of individuals around the world are undergoing mandated lockdowns and committing to physical distancing, hospitals continue to be engulfed in an onslaught of COVID-19 patients. One of the most significant impacts of this virus is how rapidly it is overwhelming health systems, consuming critical resources including inpatient beds, intensive care ventilators and importantly, care teams themselves.
Fortunately, technology has incredible potential to help automate and coordinate care communication and tasks. By taking advantage of agile technology platforms, health systems can rapidly deploy new use cases to help deal with the crisis – from early risk identification, screening and patient sign-posting, to helping patients reduce anxiety and self-manage their symptoms.
By leveraging automation, health system leaders can control the curve far more efficiently than ever before. The promise of automation is to ease the COVID-19 burden on staff and resources, giving them the arsenal to fight this disease and ensuring that any future outbreaks never get the chance to evolve from an epidemic to a global pandemic. When it comes to applying automation in the fight against COVID-19, four particular use cases come to mind:
Automated Awareness Campaigns
Tech capabilities that are already prevalent in the public-health sector can also play a critical role in controlling the current pandemic and future outbreaks. For instance, most health systems use Population Health Management (PHM) or Business Intelligence (BI) software that can quickly create and segment cohorts of patients. These solutions can help to identify people and communities at highest risk of COVID-19 complications, based on variables that go beyond the patient’s medical history. Different cohorts with varying degrees of risk can be created, such as the elderly, those with a pre-existing disease including respiratory problems, or those residing in high-risk locations.
Campaigns can then be directed at these cohorts and tailored to address their frequently asked questions or wide-spread myths surrounding COVID-19, as well as advising on how to protect against the virus and self-manage symptoms. Campaigns might also include tips for social distancing or advice about the risk in their specific communities. A critical consideration is how effectively the data can be anonymized with respect to the patient’s consent, along with opt-in/out preferences.
Depending on communication preferences – often found in the Electronic Health Record (EHR) system – email, voice and SMS campaigns can be sent out to each cohort. Using these communication tools while targeting specific cohorts of the community can go a long way toward providing reassurance and preventing panic visits to health centers and hospitals.
Automation technology can also enable more comprehensive screening solutions that proactively assess risk. In this use case, a cohort of vulnerable patients is automatically engaged with a survey that screens for symptoms and, depending on the results from the survey, may then be proactively monitored for the next several weeks. If a patient’s symptoms increase in severity or frequency, they might then be directed to a nearby clinic, with the system automatically generating a list of potential locations based on the patient’s zip code.
This form of automated proactive screening can significantly improve detection of the highly contagious virus and eliminates exposure by allowing doctors to evaluate patients’ symptoms and triage without direct contact. It also limits hospital intake to patients who are most likely to be diagnosed with COVID-19, instead of flooding providers unnecessarily and straining limited resources.