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.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

 

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.

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.

What’s wrong with telemedicine?

While studies have shown that successful use of videoconferencing and real-time communications can profoundly benefit patients and doctors alike, how do we define success?

Telemedicine has been in use now since the 80’s but due to complexity, specialized equipment, expensive network infrastructure and poor Medicare/Medicaid reimbursement policies, it remained limited to a small number of users. These challenges made it impractical to use televideo technologies for care delivery on a larger scale.

Today, low cost and ubiquitous technologies do exist that can facilitate a world in which videoconferencing has a place on the desk of every doctor, nurse and clinician. However, what is needed at the clinician level are applications designed specifically for the health care industry with televideo as a method of communications.

What does this mean?

As studies have shown that health care outcomes improve when truly collaborative communication takes place among patients, doctors and specialists, televideo is becoming more mainstream. But for televideo to be both successful and effective, televideo technologies must be user friendly, highly secure, low cost and fully customizable.

Is that all?

Fixing televideo goes beyond cost and complexity. While there are a number of innovative televideo technologies, there is still the problem of integrating televideo seamlessly into clinical workflow. The success of any technology depends only 10 percent on the technology and 90 percent on how the technology is integrated with existing workflows.

To deliver care successfully and effectively across the healthcare continuum, televideo must be mapped to existing workflows to improve patient and clinician use experiences and to minimize change management issues.

Change is good but it’s not always great.

To make televideo great, let’s start with improving the usability.

 

 

SBR Health Q&A: The mobile shift in healthcare

Everything is moving to mobile these days, and healthcare is no exception. Christopher Herot, co-founder and CEO of SBR Health, is a recognized business and technology leader who has spent years developing and evaluating video, mobile and real-time video communications solutions. In this one-on-one interview, Chris shares his thoughts and predictions for how mobile technology will transform the healthcare space and beyond. From how we buy care to keeping in touch with family, mobile’s intersection and influence on our daily lives is significant.

How have you seen this shift?

There was a time when every young ambitious professional had a day planner. The iPad is now the equivalent. It’s your phone, calendar, email, entertainment, and computer – your method of communication for everything. This has really transformed a number of industries. Retailing is now different. People can do comparison-shopping using their phone. It’s even changed travel to some degree. You can get your boarding pass on your phone and check into places on Foursquare. For the longest time, it looked like healthcare was not a tech-savvy field but this is quickly changing.

What role does mobile play in the healthcare space?

iPads are taking the medical world by storm. They’re just the right form factor for healthcare. Apple reimagined what you can do with a tablet and has provided for an entirely new experience. Doctors don’t want other tablets. They want the iPad.

Some thought early tablets failed in terms of usability based on size but Apple demonstrated it wasn’t just about size but more about the user experience. There’s something truly unique about being able to type medical information while looking at your patient. This increases physician-patient engagement.

What’s the benefit?

There’s proven clinical value. Tablets have given doctors better access to tests and other medical information. A recent study published in the Archives of Internal Medicine found that iPads help doctors be more efficient at ordering tests and procedures for their patients. My thesis is that iPads allow physicians to do more in real time and make healthcare more convenient.

The real and long-term benefit of mobile technology is in bending the cost curve in healthcare. This goes beyond getting doctors to accept lower fees and cut down on unnecessary tests. The bulk of the cost is to get Americans to stop eating so many donuts. The way you make people healthier is to make it easier and convenient for people to see their doctor. This will drastically cut healthcare costs.

Why?

The demand for mobile reflects where we’re at as a society. The doctor is not always in his office ready to take your call, and so many of us are on the go. Being able to get access to the healthcare system wherever you are – work, home, out and about – is really critical. To make that work, we have to be able to see the patient and share what we see with other people. Tablets are small enough to be portable but also have real data on the screen.

How will this be adopted?

It will happen fastest where the payment model is evolving away from the fee for service. You’re seeing this with concierge practices. Once you make it easier for patients and doctors to do a virtual visit, I expect the adoption will expand to other parts of the world. There are places like the payers and insurance companies who see this as a way to improve healthcare delivery. You’ll see this first in places that have the luxury of not having to worry about restrictions. Concierge and post-acute follow up are prime examples.

SBR Health is developing the technology that will enable videoconferencing and real-time communications to benefit patients and doctors alike. Healthcare outcomes improve when collaborative communication that’s convenient takes place among doctors, specialists and patients, and we’re working to make it as simple and secure as possible.