Category Archives: telemedicine

Telehealth substituting for in-person follow-up visits

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A new study in JAMA Health Forum looked at post-discharge follow-up visits for 70 million commercially insured patients from April 2019 to April 2020. They found that the number of visits remained stable but the percentage that were telemedicine grew from 0% to 46%. This shows that telemedicine was a substitute for in-person and did not contribute to an overall increase in utilization and suggests that as state and federal emergency waivers expire that continuing with payment parity can provide convenience to patients without increasing costs.

 

Can Wearables and Smartphones Really Measure Blood Pressure?

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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

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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

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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.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telemedicine for inpatient COVID-19 treatment

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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

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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.

 

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.