In a pandemic, providers need telehealth today
By Lia Novotny | April 13, 2020
“The old bias that patients would be slow to adopt or that providers would dislike balancing the technology with the exam has been proven wrong,” according to Lindsey Baron, athenahealth’s executive director of customer and partner communities. “Telehealth has been easily adopted on both sides of this equation, which will fundamentally change the way patients interact with their healthcare providers in the future. Technology is once again proving that we can advance medicine quite simply from our own homes.”
Given that reality, athenahealth recently spoke to a physician and a telehealth vendor to understand best practices and considerations for selecting, deploying, and using telehealth tools, today and in the future. Here are their top tips.
Selecting a platform or partner
In an ideal world, the first step is for a health system or practice to define its care goals and how telehealth can help accomplish those goals before selecting from the many HIPAA-compliant telehealth products available. For example, if the goal is simply to conduct virtual visits for a small group of conditions, it may not be necessary to have a tool that opens an encounter in the EHR. But if remote monitoring or care management are part of the plan, this kind of integration will be critical.
In this time of crisis, many practices have chosen to go with free telehealth platforms that can deploy quickly but do not integrate with their EHR. “Right now, integration is not as important as cost and speed,” says Jeff Drasnin, M.D., of ESD Pediatric Group in Milford, Ohio. To balance the demands of social distancing with patients’ need for care (and the practice’s need to keep its business running), ESD chose a free tool, doxy.me, because it was cost-effective and easy to use. Some key considerations were the ability to create a virtual “room” for each provider with a consistent online address, and a virtual “waiting room” so patients can sign in early.
Going forward, for healthcare organizations looking to add remote care management to their services, “EHR integration with a virtual care platform will be key to practices achieving their overall care strategy and quality goals as well as satisfying future patient demands,” says Justin Barnes, board member at Qure4u, a provider of digital healthcare tools and athenahealth partner. “Practices will need to look at how the virtual care platform integrates with devices and EHRs when choosing a partner. They don’t have the time or bandwidth to manage these integrations and compliance.”
Deploying quickly and safely
At ESD, it was critical to get a solution in place quickly and with minimal training required so that providers could see patients without exposing themselves to unnecessary risk. “For the safety of our patients and our staff, especially with limited PPE,” says Drasnin, “we looked at how to get this up and running ASAP.” Facing other providers with similar needs and the temporary relaxation of HIPAA-compliance requirements, athenahealth quickly implemented an integration with FaceTime as a short-term solution to let providers initiate a video call directly from within the athenaOne mobile app.
Going forward, practices will want to be more deliberate about telehealth deployment, without sacrificing any of the current ease of use. Barnes suggests starting with a particular segment of your patient population, like patients with diabetes or another chronic condition, so “if you have a hiccup, you can fix it without having it exposed to your whole population – best practice is to start small if you can.”
Choosing the right use cases
Deciding how and when to use telehealth has often been the sticking point for widespread telehealth adoption, for both providers and patients. “We researched telehealth in the past,” says Drasnin, “but never pulled the trigger because in pediatrics, we rely on the ability to look at an ear, do a strep test…listen to lungs.” COVID-19 has changed all that, and providers and patients alike are recognizing just how much can be done via telehealth.
And in the current climate, almost all practices, including ESD, are requiring telehealth screenings for COVID-19 symptoms before any in-person visit to limit the spread of the disease and risks to providers and other patients.
Most providers already believed virtual visits could handle medication re-checks or mental health follow-ups. But the current crisis has demonstrated that it is possible to listen to a patient’s breathing or examine a rash on a video call.
As Drasnin says, “In a pandemic, you can supplant that need for physical exam with a really good history to get the right answer and reduce risk for everyone.”
Building a telehealth schedule
At ESD, the process of scheduling visits remains very much the same, with front desk staff booking appointments every 15 minutes, with a 15-minute gap every third visit in case visits run over. The only difference is that they share a link that the patient can click on when it is time to check in. According to Drasnin, this is allowing their providers to comfortably see 18 to 20 patients each day.
If any lab tests such as for strep or mono are recommended, ESD is currently scheduling curbside lab tests with patients prior to their appointments. Patients simply pull up and call the front desk, then a nurse meets the patient at their car, collects the sample, and sends the patient on their way. Results can be posted to the patient portal and discussed at the scheduled telehealth visit.
Ensuring full reimbursement for telehealth
ESD providers have been “pleasantly surprised,” according to Drasnin, that CMS is paying for these visits just as if they were in-person. The only difference has been setting the location as “2” for “not in office.” And insurance companies have been accepting and processing these claims.
For ESD, this has been a real eye-opener, and they already plan to offer more extensive telehealth offerings even when the pandemic ends. “Once we knew our bottom line wouldn’t be affected by adopting and we could improve patient convenience, it was kind of a no-brainer.”
Engaging patients through telehealth
“We have reached a tipping point for telehealth across America, and maybe globally,” claims Barnes. “Patients are going to be demanding this and expecting it.”
Drasnin says, “Launching during a pandemic made this easier – families don’t want to come in anyway.” But having their hand forced has shown patients that, even via telehealth, they are still heard, their concerns are still addressed, and they still receive high-quality care. Drasnin says both patients and providers have responded positively, asking how they can continue to use telehealth in the future.
Barnes believes the opportunity for patient engagement is huge. As practices begin to truly integrate not just virtual visits but true virtual health — remote monitoring, automated outreach, remote care management, and medication checks — the increased data and touch points will engage and empower patients. It will provide more opportunities to educate patients about their conditions and about why medication adherence is important, which could begin bending the cost curve in healthcare.
Improving access through telehealth
At a systemic level, the telehealth solutions jumpstarted by the COVID-19 pandemic could result in a huge increase in patient access. Qure4u has deployed virtual health tools for 3,000 new providers since the beginning of the pandemic, including many in rural areas and locations as remote as Alaska. New deployments have included FQHCs and rural health systems.
And telehealth can not only make care more available, it can also reduce wait times. As Barnes says, “Virtual care will equalize access to care, making sure every patient in America will have access to the right care at the right time – and hopefully make it more affordable.”
To hear more from physician Jeff Drasnin, M.D., and Justin Barnes from telehealth platform Qure4u, watch the webinar.
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