Category Archives: SBR News

Publications

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Here are some abstracts of publications from healthcare delivery organizations who have been using SBR Health for their virtual visit programs.

Boston Children’s Hospital
Boston Children’s Hospital CEO weighs in on leading amid the pandemic: 6 notes
Telehealth services currently account for about 50 percent of care at Boston Children’s and are definitely here to stay, Ms. Fenwick said. Initially, the hospital’s 9,000 employees moved to work remotely, and 85 percent of ambulatory work was done via telehealth at the height of the pandemic. In the beginning, the telehealth services were less satisfactory to both patients and clinicians, but people adapted quickly, soon hitting nines and 10s on a zero-to-10 satisfaction scale. Currently, the quality department is working to determine where telehealth has improved care and what areas should still be conducted in person, Ms. Fenwick explained.

The Use of Telemedicine for the Postoperative Urological Care of Children: Results of a Pilot Program
There was 96% technical success when using the software. A total of 125 postoperative virtual visits were completed in 83 patients. Median age of the children was 3.4 years and 87% were boys. Clinicians found that the virtual visit was “very effective” in 86% of cases, delivering the same care that they would have provided during a visit in person. Families were estimated to have saved a mean $150 travel cost and a median of 113 minutes of travel time per visit. No adverse postoperative outcomes were observed.

Virtual Visits in Ophthalmology: Timely Advice for Implementation During the COVID-19 Public Health Crisis
Virtual visits (VVs) are necessitated due to the public health crisis and social distancing mandates due to COVID-19. However, these have been rare in ophthalmology. Over 3.5 years of conducting >350 ophthalmological VVs, our group has gained numerous insights into best practices. This communication shares these experiences with the medical community to support patient care during this difficult time and beyond. We highlight that mastering the technological platform of choice, optimizing lighting, camera positioning, and “eye contact,” being thoughtful and creative with the virtual eye examination, and ensuring good documenting and billing will make a successful and efficient VV. Moreover, we think these ideas will stimulate further VV creativity and expertise to be developed in ophthalmology and across medicine. This approach, holds promise for increasing its adoption after the crisis has passed.

Dartmouth-Hitchcock
Delivering High Value Inflammatory Bowel Disease Care Through Telemedicine Visits
Delivering High Value Inflammatory Bowel Disease Care Through Telemedicine Visits
Forty-eight patients were included in the analysis. Most patients travel more than 25 miles each way, take half a day off, and on average incur an additional out-of-pocket cost of $62 for an in-office visit. Most patients (98%) agreed that there was enough time spent with their physician, 91% agreed that they felt like the physician understood their disease state, and 78% reported that they clearly understood the follow-up plan after the visit. Analysis of quality outcome measures did not show any drop in the overall quality of care, after initiating the telemedicine program.

Outpatient Virtual Visits and the “Right” Amount of Telehealth Going Forward
Three hundred thirty-six providers completed the survey representing 51 specialties. The most common response regarding the proportion of outpatient visits that could be delivered by video going forward was 21–50% (n = 104) followed by 6–20% (n = 99) and >50% (n = 71).

Feasibility and acceptability of a rural, pragmatic, telemedicine‐delivered healthy lifestyle programme
Of 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16‐week programme sessions (27% attrition). Mean age was 46.9 ± 11.6 years (88.9% female), with a mean body mass index of 41.3 ± 7.1 kg/m2 and mean waist circumference of 120.7 ± 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 ± 0.58 on 1‐5 Likert scale—low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 ± 3.18 kg representing a 2.1% change (P < .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P < .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30‐second sit‐to‐stand test, a mean improvement of 2.46 stands (P = .005) was observed.

Mass General Brigham
Patient and Clinician Experiences With Telehealth for Patient Follow-up Care
Most patients (62.6%) and clinicians (59.0%) reported “no difference” between virtual and office visits on “the overall quality of the visit.” When rating “the personal connection felt during the visit,” 32.7% of patients and 45.9% of clinicians reported that the “office visit is better,” but more than half of the respondents (patients, 59.1%; clinicians, 50.8%) said that there was “no difference.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sophisticated Call Handling with Vidyo

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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 Vidyo. You can also use it with Zoom.

 

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

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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

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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

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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.

VillageCare

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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.

Boston Globe on Telemedicine in Mental Health

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Last week, the Boston Globe ran an article Virtual therapy expanding mental health care, that mentioned how two of our customers, Partners HealthCare and HealthLinkNow were using our product to provide virtual therapy sessions.

The article quotes Janet Wozniak, a child and adolescent psychiatrist who is the associate director of the Bressler Program for Autism Spectrum Disorders at Massachustts General Hospital:

For Wozniak’s patients, mainly children and teens on the autism spectrum with psychiatric disorders, simply coming to the office can be harrowing. So when the opportunity arose to take part in a pilot program for telepsychiatry, Wozniak was hopeful. She approached a few families she thought might be interested — ideally, those who lived far from the hospital and had some degree of “computer savvy.” All they needed was a computer or tablet with a camera, speakers, and Internet connection to download the hospital’s telemedicine software. Skype and other similar applications aren’t strictly compliant with HIPAA privacy rules and regulations, and so while some practitioners — like Carmichael, who alerts her patients to this potential drawback — do use Skype, MGH uses its own software.

The software cited is SBR Health’s ResourceManager.

The article also quotes Peter Yellowlees, Chairman of HealthLinkNow:

Anyone who’s used Skype, particularly for romantic reasons, knows that you can have very intimate conversations. The extra distance might actually allow more self-revelation,” noted Peter Yellowlees, a professor of psychiatry at the University of California Davis, who conducts research on online consultation services and uses video-conferencing technology in his own practice. “I’ve had many people tell me things on video that they wouldn’t necessarily share in person.”

We are proud to say that HealthLinkNow isn’t using Skype, they are using SBR Health.

 

 

SBR Health 2011: What We’ve Learned

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As we start a new year, I looked back on all that we learned from the hundreds of conversations we had with doctors, patients and hospital administrators to pinpoint the top lessons that really stood out from 2011.  There was a lot of frustration with the fee-for-service model and the fragmented care that it engenders, but there were a few points of concern that surprised us that I thought I would share with our readers.

When we asked patients what they wanted from their doctors, we heard they wanted someone who would really listen, take them seriously, and didn’t keep them waiting. When we talked to doctors, we learned they were frustrated by patients who didn’t show up for their appointments, follow up with their treatment plans or take their medications. While it is often said that anecdotes don’t equal data, there are corresponding statistics on the sorry level of readmissions, which can often be traced to a lack of coordination among caregivers and the need for patient engagement.

As we looked into where video communication might help, we observed that video had two very different roles to play in medicine. The obvious role, as pioneered in dermatology and neurology, was using video as a diagnostic tool, for example looking at a photograph of a patient’s skin or observing his performance in a neurological examination.  The other role, which may be equally if not more important, was more of a consultative role to establish rapport and engender trust between the parties. Doctors refer to the “doorknob syndrome,” where the patient mentions the most significant problem as he has his hand on the doorknob to leave the room. As this is something that occurs most likely in person and least likely over the phone, video is more like being there in person. Video, like an in person visit, ensures a higher level of trust between the patient and doctor.

We also heard a lot from hospital administrators about “change management.” Doctors are avid consumers of technology, from surgical robots to smart phones, but they have little patience for tools that are supposed to help and instead create more work. Electronic medical records (EMR) are a case in point. Implementation of an EMR can cost millions (or even billions in some cases) but we have yet to encounter a health care professional who hasn’t expressed frustration with one. Enterprises everywhere need to deal with the high level of expectation conditioned by consumer IT, and health care is no exception.

When it comes to video communication, the technical requirements are pretty straightforward: high quality, low bandwidth, interoperability with existing systems, and straightforward user experience. While there may not be one technology that satisfies all those requirements at once, we at SBR Health see an opportunity in crafting a solution that combines the best of the available video technologies with applications that are compatible with the day-to-day workflow of busy clinicians, improve communication among clinicians, patients and family members, and enable more efficient and compassionate delivery of health care.

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Chris Herot is the CEO and co-founder of SBR Health. Prior to launching SBR in 2010, Chris was Chief Product Officer at VSee Lab, a provider of high quality, low bandwidth and low cost videoconferencing solutions to enterprises and governments. Chris has been a successful business and technology leader in several high growth companies, and directed the advanced technology group for several years at Lotus Development (now IBM) where he was responsible for video, mobile and real-time communications solutions.

Chris received his BS and MS degrees from the Massachusetts Institute of Technology where he was on the faculty of the group that became the MIT Media Laboratory.

Blog: herot.typepad.com

 

 

The Intimate Dissection of Healthcare Reform at the 8th Annual AHCC

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Reform is a loaded word. At the 8th Annual American Health Care Congress, the challenges, strategies and objectives of healthcare reform were intimately dissected.

Among executives and thought leaders from across the healthcare industry at the two-day congress, the topic of value was a major focus point. The integration of new delivery models and providing value through collaborative partnerships between hospitals, physicians and healthcare was set as the ultimate task at hand, regarding healthcare reform.

Value is both a challenge we face and an outcome we hope to achieve. Throughout the discussions on innovation and strategies for enhancing quality, integration, engagement, outcomes and so forth, value was defined in a variety of ways. Included here, are highlights from sessions at the two-day congress.

  • On Clinical Integration Strategies for Improved Outcomes and Reduced Costs, speakers Robert Pryor, president CEO of Scott & White Healthcare and Douglas Strong, CEO of University of Michigan Hospitals and Health Centers, offered some valuable insight on their approaches to transitioning to value-based care with a consumer focused business model, sharing core competencies and delivering value through risk sharing partnerships, and creating employee engagement.
  • On Managing Financial Risks of Accountable Care – New Health Care Delivery Models, speaker Richard Afable, president and CEO of Hoag Memorial Hospital Presbyterian, shared some forward thinking ideas regarding new health care delivery models and how Harvard Business School professor Michael Porter’s idea of ‘shared value’ has really influenced their business model at Hoag.

‘Achieving high value for patients must become the overarching goal of health care delivery, with value defined as the health outcomes achieved per dollar spent. This goal is what matters for patients and unites the interests of all actors in the system. If value improves, patients, payers, providers, and suppliers can all benefit while the economic sustainability of the health care system increases.

The failure to prioritize value improvement in health care delivery and to measure value has slowed innovation, led to ill-advised cost containment, and encouraged micromanagement of physicians’ practices, which imposes substantial costs of its own. Measuring value will also permit reform of the reimbursement system so that it rewards value by providing bundled payments covering the full care cycle or, for chronic conditions, covering periods of a year or more. Aligning reimbursement with value in this way rewards providers for efficiency in achieving good outcomes while creating accountability for substandard care.’

Afable went on to provide examples in which value can be created that includes innovative, market based cost reductions; exceptional patient experiences; superior, safe, consistent clinical outcomes; and demonstrates improvements in the health of a community.

  • On Revolutionizing American Health Care using 21st Century Information Technology, Robert Pearl, Executive Director and CEO of Permanente Medical Group, ended with a demand for innovation. Through the adoption of new delivery models, real value can be achieved. “Choice is more important than circumstance. We must offer the same convenience and capabilities to Americans to provide a high value quality of care and enable health care reform.”