While telehealth has been around for years, virtual care technology is emerging as a powerful tool that goes beyond the traditional telehealth model. What will it take to reach the tipping point of virtual care adoption?
To become the “next generation” of telehealth, virtual care will need to improve access, availability, application, and acceptance considerations. Virtual care is poised to be embraced by the healthcare ecosystem, helping to optimize satisfaction and outcomes for all.
Timing is everything in critical care situations. Providers need instant access to specialists who can make vital diagnoses and decisions on-demand. Virtual care technology enables specialists to provide an immediate consult via video and ensure that patient questions and emerging conditions are addressed. Remote video-based consults allow a specialist to examine and diagnose the patient in real time, regardless of the specialist’s location. Virtual care will move into the mainstream as more providers (whether at a healthcare facility or home health agency) realize they can obtain timely answers, prevent return trips to the ED, and minimize readmissions. Smaller and rural hospitals will be able to strengthen their role in the community by using virtual care to access offsite, specialized staff. The time-to-treatment will be reduced; providers will not need to waste precious minutes attempting to contact available specialists. And, specialists can provide the needed consult via video, without needing to rush to the patient’s bedside.
Many patients fail to follow up with their provider for post-discharge care. No-shows may result when a patient is unable to leave his/her residence due to a medical condition. Some patients are unable to secure reliable, timely, and/or affordable transportation to a follow-up appointment. Virtual care will improve the standard of care by providing patients with more convenient, comfortable, and cost-effective access to follow-up care. Once out of the hospital or nursing facility, a patient can participate in virtual visits on commodity devices such as tablets and smartphones.
Healthcare organizations typically pilot the use of virtual care in one department, with one use-case or for a specific patient population, before rolling out the technology across a facility, health system, and/or health plan’s member base. Organizations may hesitate to expand virtual care across departments if they anticipate the implementation may be disruptive to their current processes. However, virtual care technology is designed to complement (and even automate) current workflows. Providers jump on the virtual care bandwagon when they realize that the application factors in a patient’s choice of communication devices (e.g., tablet, smartphone, and computer) and language. Because the technology features the ability to include interpreters in a video call and also provide messaging in the patient’s primary/preferred language, more healthcare organizations will accelerate the deployment of virtual care as they can now engage all patients in their care and across any level of connectivity.
In urgent care situations, being able to provide timely and quality healthcare is essential to the impact and satisfaction of the ED staff and related EMS team members. Using telehealth, current ED workflows can be enhanced to increase access and make collaboration between onsite providers and offsite colleagues and specialists easier and more timely. Virtual care platforms can rapidly improve the delivery of care, effectively addressing urgent patient needs while reconciling the gap in having available specialists on-hand / in-person for immediate consults. Virtual consults are a viable and valuable solution to helping improve outcomes in emergent care situations.
Providing Critical Care On-Demand in the ED
Seconds and minutes count in the ED. With a virtual care platform, a hospital’s ED staff can quickly access remote specialists and facilitate a virtual consult between offsite specialists and patients. Instead of losing crucial minutes, hours, or even critical days in the ED to call a specialist or wait for an in-person consult, ED staff can quickly reach the first available, designated specialist who can deliver a timely virtual consult and provide guidance as to diagnosis, admission, and/or transfer. With virtual care technology, specialists can provide the needed consult from anywhere and on any device. Key decisions as to whether the patient needs to be admitted, transferred or discharged can be made in minutes (vs. hours or days). The costs involved with keeping a patient in the ED are also contained, and the hours or days which a patient spends in the ED are reduced. As hospitals struggle to have multiple specialists on-hand at any time, virtual consult platforms can empower hospitals to leverage specialists within their networks to support their patient care objectives around-the-clock.
Reducing Waiting Time and Minimizing Leakage in the ED
Virtual care platforms are also being used to reduce waiting times in the ED and deliver routine care to patients with non-emergent conditions. In a recent study published in Telemedicine and e-Health, rural hospitals using telehealth reduced the time between patients entering the ED to receiving physician care, according to University of Iowa researchers.
Virtual care had decreased door-to-provider time by six minutes. The researchers also concluded that the length of stay in the ED of the initial hospital was shorter for patients who were eventually transferred but had initially participated in a virtual care consultation. At New York-Presbyterian/Weill Cornell Medicine, the Express Care program allows patients with minor injuries or non-life-threatening symptoms to be seen virtually by an offsite provider via video. When asked by the Wall Street Journal, “What’s the number one complaint of patients in the emergency room?” Rahul Sharma, the emergency physician-in-chief at Weill Cornell, responded: “Wait time.”
The hospital reported that the Express Care telehealth program has cut the average wait time in the hospital’s ED by more than half; between 35 to 40 minutes. As hospitals struggle to prevent leakage and minimize the chance of patients leaving their ED waiting room for another healthcare setting, virtual consults can help the waiting patients access the diagnoses and care they need in a more timely and convenient manner.
Expanding Impact into the Community
ED staff can also use virtual care platforms to expand their impact within their respective communities. Rural hospitals face some of the biggest deficits in terms of having a range of specialists on staff. Providers in these hospitals can have access to a greater pool of specialists who can support urgent patient care via video when a particular specialist is not already on staff or readily available in-person. Giving ED staff the ability to facilitate virtual consults on-demand improves their impact within their own community – regardless of distance between the ED and the specialist. ED staff can also conduct HIPAA-compliant virtual meetings to drive better collaboration amongst the broader care team across the care continuum. Communication can be maintained with the appropriate care team members (including the patient’s PCP, a pharmacist, a coordinator at the next care facility, etc.) to ensure the patient’s overall health needs are regularly discussed and addressed in the ED and during the transition of care – without requiring care team members to drive to/from meetings at different locations and facilities.
One of the largest barriers of delivering mental healthcare is the critical shortage of mental health professionals across the country, despite the significant prevalence and impact of mental health conditions. The National Alliance on Mental Illness and the National Institute of Mental Health report that 1 in 5 Americans live with a mental health condition and more than half of American adults with mental illness did not receive treatment in 2016. The U.S. Health Resources and Services Administration estimates an additional 70,000 mental healthcare providers are needed by 2025 to meet the expected growth in demand. In Chicago alone, patients may wait upwards of 10 months for a psychiatrist appointment.
Timely and quality behavioral healthcare is essential for improving patient mental health outcomes and increasing provider satisfaction. Telehealth is emerging as a viable approach to traditional on-site care methods, as it can rapidly improve the delivery of care by effectively addressing patient needs while reconciling the workforce gap. Specifically, telehealth can allow for immediate consultation (especially crucial in time-sensitive situations), increased treatment capacity and collaboration across the continuum of care, and improved outcomes (especially by allowing patients to receive care in the comfort of their own home).
Increased Access to Care In a given year, approximately one in 25 adults in the U.S. experiences a serious mental illness that substantially interferes with, or limits, one or more major life activities according to the National Institute of Mental Health. The American Journal of Psychiatry reported that untreated mental illness is estimated to cost approximately $100 billion annually in lost productivity.
Patients can benefit from providers who use video-based technology to conduct “virtual consults” when providing an initial diagnosis, as well as making recommendations for admission, treatment, transfer, or discharge. Additionally, for ongoing treatment, video offers patients a way to participate in ongoing care and support via “virtual visits” with mental healthcare providers. Convenient access to care can help patients who may avoid seeking initial mental healthcare and/or ongoing treatment as some patients may unfortunately avoid visiting a nearby mental health clinic or provider for a needed diagnosis if they are wary of public recognition and social disapproval. Patients might also not adhere to scheduled follow-up appointments if visits to these “known” mental health clinics in one’s community are required. With telehealth, patients can remain comfortably at home and confidentially receive the care they need.
New applications of telehealth that enhance existing provider-to-provider communications are revealing a new way for healthcare organizations to ensure patient care remains in-network. As hospital M&A activity accelerates and organizations strive to glean the most value from their investments in technology and human resources, telehealth is recognized for its role in keeping communications and care in-network.
Telehealth is increasingly being leveraged to offer providers immediate in-network specialist expertise and to reduce ad hoc out-of-network referrals. These kinds of applications make the in-network choice convenient for providers and patients while driving increased patient engagement and more integrated care across the broader care team.
Providers are seeing that telehealth applications can be complementary – instead of disruptive – to their workflows and provide them with a new approach to practicing medicine via technology.
Immediate Communications with Colleagues
Video-based technology can help providers optimize their current workflows by facilitating faster and more flexible consults with on-demand access to in-network specialists. A provider’s network of experts can be built into the technology, which enables a provider to immediately reach the designated, first available specialist for answers. Instead of wasting valuable seconds and minutes looking for the names and contact information for specialists, providers can use telehealth to expedite provider-to-provider interactions which accomplish the critical objectives of doing what is both right and timely for the patient’s situation.
For example, a provider may be examining a patient and realize that the patient’s condition requires specialist expertise. With telehealth, the provider can immediately reach out to an in-network specialist. The specialist accepts the virtual consult request, from anywhere and on any device. During the virtual consult, the specialist can evaluate the patient and communicate the appropriate next steps. All stakeholders – the provider, the specialist, and the patient – benefit from the immediacy, efficiency, and effectiveness of a virtual consult conducted in real time.
The broader healthcare organization (whether a medical practice, a hospital, or a health system) will benefit from an increase in in-network referrals. By leveraging the organization’s network to drive better patient outcomes faster, providers can deliver lasting value for the healthcare organization and enhance its overall reputation.
Increased Patient Engagement
Technology can also help providers optimize their current follow-up processes and easily check in with patients after a hospital stay or outpatient procedure. Providers can use telehealth to offer patients appropriate follow-up care at their own home via video. This allows providers (or providers’ in-network resources) to reach out to patients based on those patients’ preferred contact methods (e.g., email or text) and languages (e.g., Spanish, German, etc.) to remind them of their upcoming video visits. The result is increased patient engagement in their ongoing treatment plan. Travel time, related transportation expenses and appointment no-shows are minimized due to this efficient method of follow-up care.
For example, a provider can facilitate a virtual visit with a patient to ensure understanding and adherence. During a virtual visit, the provider (or related in-network care team members) can evaluate the patient’s progress, answer questions in real time, provide patient education, and re-emphasize the treatment plan – all while the patient stays comfortably at home and the provider remains conveniently in the office. All stakeholders – the provider, the care management team members, and the patient – benefit from timely conversations which can drive better adherence and overall outcomes.
Many healthcare organizations refer to the at-home, at-risk patients as the “sickest of the sick.” Unfortunately, these patients may receive inadequate care and attention after being discharged and often rely on emergency medical services and/or the ED to answer questions and provide care in non-emergency situations. The model for treating these patients and attempting to keep them at-home (and not back in the hospital) has not changed substantially in decades. In an attempt to minimize re-admissions, hospitals may schedule case managers and/or nurses to physically visit these patients at-home in an effort to help the patients stay on track with their adherence.
However, this continuum of care model is not sustainable. The budget and resourcing implications are significant when most of the staff’s time is spent behind the wheel vs. in front of the patient. Significant opportunities exist for telehealth solutions to bring the care closer to the patient — at a more convenient and cost-effective manner for all involved.
Why Reducing Readmissions Matters From the patients’ perspective, returning to the ED and potentially being re-admitted is disruptive and stressful for patients and family. Patients may be put at an additional risk for hospital-acquired infections and complication. Returning to the hospital can also lower the rate of patient satisfaction and weaken overall outcomes.
From the perspectives of health systems and health plans, readmissions are costly. Since the introduction of HRRP (Hospital Readmission Reduction Program), hospitals that exceeded the national average of readmissions for specific conditions (within the 30-day window) have been penalized by a reduction of payments across all of their Medicare admissions. More than half of hospitals in the HRRP program were penalized the past five years, resulting in $528 million in withheld Medicare payments. Re-admissions can also negatively impact measures in Hospital Compare data, levels of provider satisfaction and the health system’s overall reputation in the community it serves. Re-admissions cost more than $26 billion annually but $17 billion is considered avoidable.
What Happens Today Keeping at-risk patients at-home is critical to reducing re-admissions and the associated consequences. Typical discharge programs with in-person appointment schedules often fail the at-home, at-risk patient, the providers, and the healthcare system by insufficiently engaging the patient at the point of discharge and upon returning home. The rates of patients being readmitted are significant:
Nearly 20 percent Medicare patients are readmitted within 30 days.
34 percent of Medicare patients are readmitted within 90 days and 56 percent within 1 year.
64 percent received no post-hospital care between discharge and readmission.
What happens in-hospital and at-home which leads to this situation? In-hospital experiences can adversely affect health and contribute to substantial impairments during the early recovery period, an inability to fend off disease, and simple mental error. As a result, patients may leave the hospital deprived of sleep, experiencing pain and discomfort, without sufficient nourishment, and with medications which may alter cognition and physical function.
When a patient is discharged, the patient may continue to face physical, emotional and even financial issues, depending on one’s condition, health history and home environment. A patient may be discharged without adequate instructions and information for self-care and follow-up. The patient may be provided with comprehensive verbal instructions but quickly forget the detailed instruction. Written instructions may be provided to the patient but the patient may fail to keep the information handy and/or share the information with family/friends serving as caregivers. Internalizing the discharge program and being able to practice self-care may also be negatively impacted by a patient’s level of English proficiency, health literacy, socio-economic status, gender and cultural background.
Lee Horner serves as Stratus Video’s president of telemedicine, bringing more than 25 years of experience in enterprise software and healthcare IT industry. Most recently, Horner served as the president of CareCloud, a health care technology company specializing in practice management and EHR software. During that time, his core focus was setting the direction and strategy of the company while managing the top- and bottom-line revenues. He also drove both technology excellence and platform growth to meet CareCloud’s clients’ goals. Prior to CareCloud, Lee also held executive roles at Vitera Healthcare (formerly Sage Healthcare, where I worked with him; now Greenway Health) and Eliza Corporation.
You recently joined Stratus as president of telehealth – what motivated your decision and why is this such an important field nowadays?
In today’s mobile and fast-paced world, telehealth is a necessity. Telehealth is healthcare 2.0 – it can cut wait times, costs for both the provider and the patient, inefficiencies. At the same time it can elevate the kind of expertise and quality of the care patients receive, as well as give new opportunities to connect doctors to the patients who need them most. Telehealth is the future of health. It’s not only preserving that face-to-face connection between patients and providers – which is essential to great healthcare – it’s making that connection available to so many more people in so many different contexts. By enabling these essential connections, telehealth expands the probability of people getting the care they need, and is inevitably helping to save lives.
What is your background in health IT?
I have been involved in healthcare IT for the past 10 years. I have experience operating businesses in the payer, ambulatory and health system markets. It is a great field to be in. It’s very progressive and always changing.
Why is health IT where it’s at today? What do you feel has made this industry successful?
This market is expanding rapidly and technological advancement is at the forefront of that expansion. Smart people with extreme passion for improving patient quality care are really what is making this industry successful.
What are some of the things that most inspire you about the space and it’s work?
I am inspired every time I see the changes we are making improve a patient’s quality of care. It is incredible to see our work start to make a difference.
What are the most important areas in telehealth nowadays?
One important area is how telehealth is opening opportunities for more health industry professionals – and this is in turn, leading to a more robust patient experience. Predictable disruption is a huge theme in telehealth. You saw unpredictable disruption with industries like car ride service – when Uber and other apps came out, people who weren’t taxi drivers were suddenly entering that industry. In healthcare, it’s different – apps are creating opportunities for people already within the industry, allowing more providers to help the patients who need them most and more patients to connect with the providers best suited to their needs.
A couple of other important areas are readmissions and urgent care:
The Affordable Care Act penalizes hospital readmissions, because it’s important to incentivize successful treatment. Unfortunately, the nature of healthcare and the nature of life is that you sometimes need to go back in for continued treatment or to inquire about something. But maybe you moved or you’re too sick to keep going back to your treating physician. Discharge solutions are allowing people to reconnect and get the follow-up care they need without the hassle.
Urgent and emergency care solutions are also becoming really important. Imagine a burn victim walks into an ER at 4 a.m. and needs to see a specialist – but the staff is all tied up or there isn’t a specialist working in that particular facility. Without an urgent care app, the patient would be waiting and suffering, while the provider would be struggling to give them the care they need. With an app, they’d be able to pull up a tablet and connect that patient face-to-face with the doctor they need almost immediately.