Sophisticated Call Handling


Many electronic health record systems include a rudimentary capability for virtual visits, such as being able to send the patient a link to a Vidyo or Zoom meeting, but what if you need a way to connect a patient with multiple parties, either in parallel (group meeting) or series (hand-off)?

With SBR Health you can do both. A provider can bring in a family member, caregiver, or colleague or interpreter, hold a multi-party call and then hand off the call to one of the providers. Alternatively, the patient can be put in a virtual waiting room until the next staff member is ready for them, e.g. for a receptionist to send a patient to a provider or for a provider to send the call to someone who can schedule a follow-up. The patient just makes one connection while the system does all the work.

The video shows an example of how this works using Zoom. You can also use it with Vidyo.

 

Telemedicine for inpatient COVID-19 treatment

When the COVID-19 pandemic created an enormous surge in hospitalizations, health delivery organizations turned to telemedicine to reduce the need for face-to-face interactions. One innovative application at Massachusetts General Hospital used the SBR Health system to reduce unnecessary exposure and conserve PPE for inpatient care. The system used iPads affixed to mobile IV poles that could be placed in a patient’s room and allowed the clinicians to initiate a virtual encounter without requiring any action by the patient. The system was deployed in less than a week by configuring the SBR Health system that was already in place for outpatient visits.

There is a write-up of the usage at one site in The American Journal of Emergency Medicine. At its peak, the system supported more than 1,000 iPads across the MGH/Brigham network.

There is also an article and accompanying video here: www.wired.com/story/ipads-crucial-health-tools-combating-covid-19.

Zoom Bombing – how to prevent

Researchers at Boston University and Binghamton University recently published a paper A First Look at Zoombombing describing the phenomenon of malefactors joining online meetings with the goal of disrupting them and harassing the participants. This prompted Zoom and other suppliers to require additional security measures, such as requiring passwords for meetings. The researchers found that these measures were ineffective, since anyone who has access to the URI for the meeting most likely has the password as well. Instead, the authors recommend that meeting products create a unique URL for each participant. Zoom offers a way to do this but requires the meeting owner to distribute the links and for each user to log in first.

Fortunately, SBR Health recognized this problem at the inception of the company and provides three very simple but effective mechanisms for controlling access to meetings. The video meeting takes place over Zoom or Vidyo but all invitations and access control are handled by SBR. Health care systems can choose any one of these mechanisms or combine them as they see fit:

  • Email Link. Each patient, or guest can automatically be sent an email when a visit is scheduled whether that visit was create in the SBR system or within the electronic health record (EHR) system, e.g. Epic. The email contains a URL that is unique to each participant. When the patient clicks on the link to join the meeting, the system knows the identity of that participant and displays the name and other identifying information (DoB, MRN, etc) to the provider.
  • Patient Portal. if the health system has a patient portal or other web site, the SBR system can display a button to bring the patient into the visit. This way the patient portal performs the authentication without the patient needing to supply any additional credentials.
  • Username and Password. An account can be created for each patient on the SBR system. This can be done by the office staff, using SBR’s Admin site, or it can be created automatically upon receiving the information from the EHR. The office staff can give the information to the patient or the SBR system can automatically generate an email.

In this way, SBR provides a secure and convenient way to satisfy the HIPAA requirements for identifying the patient and prevent intruders from entering the visit.

 

Telemedicine parity enacted in Massachusetts

On January 1, 2021 Governor Charlie Baker signed An Act promoting a resilient health care system that puts patients first (S.2984) which previously passed the Massachusetts Senate 157 – 0.

The new law contains a number of provisions including several important changes to the use of telemedicine:

  • Expands the definition of telemedicine to include video, telephone, remote patient monitoring, and asynchronous tools
  • Insurance coverage is mandated with no restrictions on the site where care is delivered, e.g. patient at home is now included
  • Payment for primary care and chronic disease management is at parity with in-person services

The requirement for coverage expires two years. The requirement for payment parity expires 90 days after the end of the Covid emergency.

The new provisions have yet to be incorporated in the codification of the General Laws but the text of the Act is available here.

The Act modifies the following chapters of the general laws

  • 118E – DIVISION OF MEDICAL ASSISTANCE (Medicaid)
  • 175 – Insurance
  • 176A – REGULATION OF RATES FOR CERTAIN CASUALTY INSURANCE, INCLUDING FIDELITY, SURETY AND GUARANTY BONDS, AND FOR ALL OTHER FORMS OF MOTOR VEHICLE INSURANCE, AND REGULATION OF RATING ORGANIZATIONS
  • 176B – MEDICAL SERVICE CORPORATIONS
  • 176G – HEALTH MAINTENANCE ORGANIZATIONS
  • 176I – PREFERRED PROVIDER ARRANGEMENTS

For each of them, it inserts essentially the same language. The exact text for Chapter 175 [Insurance] is below:

Section 47MM
(a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings: “Behavioral health services”, care and services for the evaluation, diagnosis, treatment or management of patients with mental health, developmental or substance use disorders. “Telehealth”, the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

(b) An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance and any group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth; provided, however, that an insurer shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered to have an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request. Coverage shall not be limited to services delivered by third-party providers.

(c) Coverage for telehealth services may include utilization review, including preauthorization, to determine the appropriateness of telehealth as a means of delivering a health care service; provided, however, that the determination shall be made in the same manner as if the service was delivered in-person. A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth shall not be required to reimburse a health care provider for a health care service that is not a covered benefit under the plan or reimburse a health care provider not contracted under the plan except as provided for under subclause (i) of clause (4) of the second sentence of subsection (a) of section 6 of chapter 176O.

(d) A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth; provided, however, that a patient may decline receiving services via telehealth in order to receive in-person services.

(e) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth that provides coverage for telehealth services may include a deductible, copayment or coinsurance requirement for a health care service provided via telehealth as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person consultation or in-person delivery of services. The rate of payment for telehealth services provided via interactive audio-video technology may be greater than the rate of payment for the same service delivered by other telehealth modalities.

(f) Coverage that reimburses a provider with a global payment, as defined in section 1 of chapter 6D, shall account for the provision of telehealth services to set the global payment amount.

(g) Insurance companies organized under this chapter shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health service delivered via in-person methods; provided, that this subsection shall apply to providers of behavioral health services covered as required under subclause (i) of clause (4) of the second sentence of subsection (a) of section 6 of chapter 176O.

(h) Health care services provided via telehealth shall conform to the standards of care applicable to the telehealth provider’s profession and specialty. Such services shall also conform to applicable federal and state health information privacy and security standards as well as standards for informed consent.

Congratulations, Viewcare

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Congratulations to our Danish partner, Viewcare, and their customer Holbæk Hospital, for winning the prestigious Digitaliseringsprisen (Digitization Prize) for 2019 for their Virtual consultations project built on the SBR Health platform.

Google does a pretty good job translating the prize site:

With virtual consultations, Holbæk Hospital has made their interdisciplinary health efforts available at the individual citizen. The solution is thought from the outside, with the patient as the starting point. It connects citizens, relatives and healthcare professionals across specialties and geographical location. Citizens save transportation time and can have the consultation where they like, the region saves transportation costs and the consultations become more targeted and efficient.

Push Notifications


Starting with version 3.3.40, the SBR Health mobile applications support Push Notifications. This is a feature of the iOS and Android platforms that allows the SBR server to send messages to the mobile client even when the device is asleep or the SBR app is not running. Because the messages are sent via servers at Apple and Google, the battery consumption is very minimal.

Sone of the ways push notification can be used:

  • A patient checks in for a scheduled appointment or submits a request for an on-demand visit. If the provider has the application open, the device makes a ringing sound and displays the patient information as usual. If the application is in the background or the phone is asleep, the phone beeps and displays a notification. If the app is not running at all, but the provider has previously logged in from that device, a notification appears in the device’s notification area. In any case, with one click, the provider can answer the call.
  • A provider makes a virtual Rounding call to a patient. If the patient has the application open, a dialog box opens as usual asking if the patient wants to accept the call. With push notifications this can happen even if the phone is in the patient’s pocket.
  • A provider wants to call in a colleague for a consultation. Pressing the button for that colleague will cause his or her phone to beep and display the request even if the phone is asleep. Pressing a button for a specialty will try each of the on-call specialists, whether their phone is in the foreground or background.

Each user can opt in our out of push notifications and they can be turned on or off for an entire institution. And of course the SBR product continues to provide the previous notification methods, such as customizable email templates, pager alerts, and text messages.

Interpreter Services

We have partnered with InDemand Interpreting to provide interpreters within any SBR Health virtual visit.

Whether you are running an international medical program or serving a local population with limited English proficiency a single click gets you one of InDemand’s medically qualified interpreters within seconds.

No reservation or advance notice is required. You can call the interpreter before you connect with the patient or add an interpreter at any point in a patient visit.

To add an interpreter, go to the Requester tab to select the language from the 28 that are offered.

Within 10 -15 seconds an interpreter will be added to the call.

This feature is available to all SBR Health customers but does require establishing an account with InDemand. Contact your SBR representative for details.

SBR Health at Brigham & Women’s Hospital

 

As virtual doctor visits take off, debate over who should pay heats up

Melissa Bailey, writing in the new Pulse of Longwood column for the Boston Globe’s Stat News leads the piece with a description of how the SBR Health virtual visit platform is being used in endocrinology at Boston’s Brigham and Women’s Hospital. Not only does the patient love it, but the doctor says it’s improved patient attendance.

American Telemedicine Association Presentations

The 20h annual American Telemedicine Association conference starts tomorrow in Los Angeles and we are proud to announce that several of our customers are giving presentations this year:

Understanding How Patient Centered Design Improves Provider Adoption: Mayo Clinic and Mass General Hospital

Sarah Sossong, MPH
Director of Telehealth.
Massachusetts General Hospital

Steve Ommen, MD, Medical Director
Centers for Innovation & ConnectedCare.
Mayo Clinic

Neurosurgery-Aneurysm Virtual Visits: Linking Providers to Patients in Home Settings

Sarah Pletcher, MD, MA
Medical Director.
Dartmouth-Hitchcock Medical Center

Robert Singer, MD,FACS
Staff Physician.
Dartmouth Hitchcock Medical Center

Ellyn Ercolano, MS
Telehealth Outcomes Analyst
Dartmouth Hitchcock Medical Center

How a Major Urban Health System Leverages Telemedicine

Steve Dean, MS
Telemedicine Administrative Director.
Inova Health System

Theresa M. Davis, PhD, RN, NE-BC
Clinical Operations Director.
Inova Health System

Albert Holt, MD, MBA
Medical Director TeleICU.
Inova Health System

Rina Bansal, MD, MBA
Medical Director Telemedicine Institute
Inova Health System

Applying Care in Novel Models of Non-Acute Teleneurology

Adam B. Cohen, MD
Teleneurology Director
Inpatient Neurology Director
Massachusetts General Hospital

VillageCare

We would like to welcome VillageCare Wellness Innovations to our family of customers. VillageCare recently received a Health Care Innovation Award from The Center for Medicare and Medicaid Services Innovation Center (CMMI) to pilot “Treatment Adherence through the Advanced Use of Technology” (TAAUT). This program aims to increase patient activation and treatment adherence for people living with HIV and AIDS by providing a multi-faceted intervention involving a social platform for behavior change, virtual visits, text reminders and peer support.

From the VillageCare site:

VillageCare Wellness Innovations expects to improve adherence in the most cost-effective manner by delivering education and support through technology. Participants will be able to access a customized private social network, virtual video support groups, treatment adherence professionals for questions, and text messaging for medication and appointment reminders. In addition, peer mentors will provide one-on-one encouragement and mentoring for behavior change.

“VillageCare has long been a leader in care for people living with HIVAIDS in the New York City area,” says Emma DeVito, President and Chief Executive Officer for VillageCare. VillageCare developed the first comprehensive AIDS Day Treatment program in New York and since then, has continued to create effective and innovative care models. “We are excited for the opportunity granted to us to develop a new and innovative way to encourage adherence and wellness for those living with HIVAIDS.”

The overall goal of the program is to improve viral loads and CD-4 counts, thereby simultaneously improving health and reducing overall health spending for the population. VillageCare was awarded just over $8.7 million to create and operate this program for three years. CMS will be conducting evaluations during and upon completion of the pilot program. More information may be found by visiting www.villagecare.org.

The project described is supported by Grant No. 1C1CMS331353-01-01 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.