Can Wearables and Smartphones Really Measure Blood Pressure?

The Journal of mHealth posted a detailed article on how wearables and smartphones attempt to measure blood pressure without the traditional method of measuring the external pressure sufficient of occlude the blood flow.

Bottom line: Most of these devices use Pulse Wave Velocity to estimate how much the blood pressure has changed from previous readings. They require frequent calibration using a conventional sphygmomanometer. Some of the more sophisticated techniques combine sensor data with machine learning and can give good estimates of blood pressure, but may not be useful in some important circumstances:

The collateral data alone can make a good estimate of your blood pressure. What it finds is the normal blood pressure for a person of your age, height, sex and weight. Since (by definition) most of us are normal, this gives a good estimate in most cases. Of course, it does not find the people who are abnormal, for whom accurate and early detection is vital. The international standard for blood pressure meters measure the average accuracy, so wearables or devices that tell you what your blood pressure should be can pass because the few anomalies are lost in the large number of normal people.

It’s worth reading the entire article: thejournalofmhealth.com/wearables-smartphones-and-apps-do-they-really-measure-blood-pressure

 

 

KFF: More Than 1 in 4 Medicare Beneficiaries Had a Telehealth Visit Between the Summer and Fall of 2020


The Kaiser Family Foundation released a report on how Medicare beneficiaries used telemedicine during the height of the COVID-19 pandemic.

  • Nearly two-thirds (64%, or 33.6 million) of Medicare beneficiaries with a usual source of care say that their provider currently offers telehealth appointments, up from 18% who said their provider offered telehealth before the pandemic. However, nearly a quarter (23%) of Medicare beneficiaries do not know if their provider offers telehealth appointments, and this share is larger among rural beneficiaries (30%).
  • A majority (56%) of Medicare beneficiaries who had a telehealth visit report accessing care using only a telephone, while a smaller share had a telehealth visit via video (28%) or both video and telephone (16%).

The report describes in detail how Medicare’s rules loosened the restrictions on telemedicine during the pandemic and how they are are in danger of going back unless the changes are made permanent.

 

Publications

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


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.

 

Sophisticated Call Handling with Zoom


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.