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Sustaining Telehealth

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Sustaining Telehealth

  1. 1. www.himss.org Sustaining Telehealth: Balancing Telehealth & In-Person Care from the Operations Perspective April 13, 2022
  2. 2. 80,449,398 cases on 4/12/22 with 985,826 deaths https://coronavirus.jhu.edu/us-map COVID-19 in the United States: TOTAL
  3. 3. https://www.nytimes.com/interactive/2021/us/covid-cases.html COVID-19 Hot Spots
  4. 4. Philadelphia re-instates indoor masking
  5. 5. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
  6. 6. Are the numbers going up? • Less testing now… – Using at-home rapid tests – Not reported • Several states, including AZ, HI, NV and OH stopped reporting daily Covid data to the CDC – “Their alarm bells won’t go off until we see a rise in hospitalizations and deaths, which are lagging indicators” » Gregg Gonsalves, an ID doc at Yale’s School of Public Health The information we are getting from the CDC is going to be less reliable, more spotty, and lose momentum,” Dr. Bright – Rockefeller Institute
  7. 7. What is circulating? covid.cdc.gov/covid-data-tracker/ #variant-proportions
  8. 8. Practical advice for the HCW: • Trust your knowledge, instincts – What’s going on locally? • Increase in visits? – Trajectory of case numbers? • rate of increase 5% a week vs 50%? • how long cases have been rising? Case counts lag transmission • Know risk profiles of patients – High risk? – Vaccine status?
  9. 9. Practical advice for the HCW: • Continue with the ‘team approach’ – What can my colleague help with? www.confermed.com
  10. 10. Trusted Resources • Johns Hopkins https://coronavirus.jhu.edu/map.html • CDC https://www.cdc.gov/coronavirus/2019-ncov/index.html https://emergency.cdc.gov/coca/calls/2020/ • WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 • Others https://www.nytimes.com/interactive/2021/us/covid-cases.html https://www.thelancet.com/coronavirus https://covidactnow.org/
  11. 11. Sustaining Telehealth: Balancing Telehealth & In-Person Care from the Operations Perspective April 13, 2022 Sydney Kennedy (he/him) Jen Stewart Barrett (she/her)
  12. 12. Spread of Care & Visit Types • In-person care – Medical providers – Specialist providers (with the exception of dietitians) • Telehealth care – Behavioral health – very few providers are on-site – MATs (Medically Assisted Therapies) • MATs (i.e., Suboxone treatment) – Limited group of providers can do MAT – Telehealth is used to manage the distance and availability of MAT sessions – MAT providers can treat across the state, as opposed to treating at a specific site • Benefits of Telehealth Visit Types – 1 BH provider can provide care to multiple schools per day – Holding visits outside of school hours • Rooms available for patients on-site who lack equipment for telehealth appointments
  13. 13. Telehealth Changes for Providers • Not one size fits all for visit type • Telehealth vs. in-person reviews are completed case-by-case to analyze provider utilization • Providers prefer blocks of time with telehealth or in-person visits • Communication with patients & actual appointment start time – Patients have different expectations for telehealth visits – Virtual waiting room enhancements help providers ease patients
  14. 14. Patient Communication • Distinguishing the need for a telehealth vs in-person visit – Distinction made based on nature and clinical need of the visit – Patients may struggle to understand the difference, or hesitant to attend in-person • Limited access for in-person visits – Restrictions in place for number of individuals allowed in-person – Spouses/parents with children cannot come in together, unless needed for assistance • COVID-19 testing – Patients presenting COVID symptoms require virtual visit with a provider prior to testing
  15. 15. Impact of Telehealth for Patients • Convenience & accessibility – Telehealth reliable for patients with transportation issues – Requires less travel and wait time from a patient’s day – Ability to provide alternative hours for Behavioral Health visits • Creating ease of access with telehealth technology – Automated link sent prior to visit – One-click Zoom link to join visit – App install requirements removed – Waiting room videos and enhancements
  16. 16. Waiting Room Video Clip
  17. 17. Ongoing Telehealth Challenges • Reimbursement guidelines for duration of visit: – Video: Once all clinical measures are met, time is not a consideration – Phone: Regardless of clinical measures being met, set length of time must be met • Location for virtual (phone or video) visit must be in-state only in CT • Changes to legislation always evolving • Behavioral Health group sessions cannot use phone visits • Overall confidence in e-Consults – The next COVID-19 variant may not impact our visit types – Pandemic conditions are monitored daily
  18. 18. Provider Lessons Learned • Billing department had to change billing process, increasing time to bill claims due to review of encounter note requirements • Chart auditing is completed regularly – Video/phone/in-person reports are monitored to understand what our utilization is – Provides insight into continuous operational improvement • Communicating changes to holding phone or video visits with teams – Employees must understand the importance and intention behind changes • For example, understanding changes to duration of phone and video visits • Telehealth doesn’t always work for providers • Slow internet speed when connected to VPN (virtual private network) – VPN is needed to secure health records
  19. 19. Patient Lessons Learned • Phone calls rejected or marked as spam by companies – If possible, use clinic phone number instead of any individualized, wholesale IP lines – Staff must communicate with patients to expect a phone call during visit time • Medical needs cannot be physically shown during a phone visit – Patients must send images through secure medical records process • Lack of integration between our telehealth system and our health records – Micromanagement required to ensure our systems align • Ensure that your patient engagement platforms are up to the challenge going forward

Editor's Notes

  • Welcome everyone – today’s topic is sustaining Telehealth; something that was brought to the fore because of the Pandemic
  • 4/12/22
    28-Day: 877,409 | 20,702



  • Intro: Here you can see from the map the ‘hot spots’ occurring around the country. The Darker colors mean more active infections

    4/11: reports of new coronavirus cases in the United States have been generally flat in the past two weeks.

    4/11: Some states have increased: particularly in the Northeast where the BA.2 subvariant is widespread.
  • 4/11: COVID-19 cases have risen more than 50% in 10 days driven by highly transmissible BA.2 subvariant of omicron
    CDC says community spread in Philadelphia remains low, a level at which the agency says that masking can be optional

    New York City is now averaging around 1,800 new cases per day, about three times higher than in early March when New York began easing rules. That does not include the many home tests that go unreported to health officials.
  • 4/11: hospitalizations across the country have continued to decrease. Hospitalizations have fallen to an average of roughly 15,000 per day in the past two weeks, the lowest they have been since the first weeks of the coronavirus pandemic

    4/11: Deaths also remain on the decline. Around 600 deaths from Covid are being reported each da
  • national network of specialists in adult and pediatric fields with board certification in their specialty or subspecialty

    supports practices nationwide looking to improve access and reduce the cost of specialty care
  • 12/1: Welcome everyone – today’s topic is Supporting Staff During COVID-19

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