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Research Cover - May 2020
May 2020
Telehealth News:
Research & News Recap

Interest in remote patient monitoring (RPM) and its positive impact has skyrocketed in the wake of the COVID-19 outbreak. Providers across the country are implementing expansive telehealth programs to enhance patient monitoring and disease management while reducing the strain of healthcare resources.

Explore recent research on the efficacy of telehealth in response to the COVID-19 pandemic in HRS’ May 2020 Research & News Recap.

Part I. Research Findings - Remote Patient Monitoring and Telehealth

In this section, hear from healthcare organizations across the country who rapidly deployed telehealth programs within the last few months in response to COVID. The articles demonstrate the feasibility of telehealth and remote patient monitoring to combat the COVID outbreak and to extend patient care beyond the COVID pandemic. Additionally, the articles shed light on how providers across the country are embracing video visits as they transition to remote care.

Article 1

Development of a Telehealth Geriatric Assessment Model in Response to the COVID-19 Pandemic

What was studied?

Thus far, 80% of reported deaths in the US from COVID have been patients age 65 or older. Elderly patients, as well as those with underlying medical conditions, are at a particularly high risk for adverse outcomes from the disease. Already understanding that telehealth had  proven effective in extending care and improving care coordination across specialty-palliative and hospice organizations, the University of Rochester Specialized Oncology Care and Research in the Elderly (UR SOCARE) quickly responded to the COVID outbreak by launching a telehealth program.

UR SOCARE was established in partnership with the University of Chicago to provide specialty consultations to oncology patients over the age of 65 years. The University of Rochester SOCARE team offers a multidisciplinary approach to geriatric oncology with a team of geriatric oncologists, clinical nurses, physical therapists, occupational therapists, pharmacists, social workers, and dietitians.  

Telemedicine Modifications:

  • Phone-based Assessment: Initial assessments generally provided through an e-mail questionnaire were altered to be phone-based. Assessments were performed the day prior to the patients’ scheduled pre-visit evaluation and did not result in any additional workflow complications for SOCARE staff.
  • Pre-visit Evaluation: Shortened to enhance reliability via the phone.  Established Cancer and Aging Research Group (CARG) Toxicity score, base-line for depression screening, and identified of areas of vulnerability.
  • Telehealth Clinical Encounter: SOCARE opted for voice-only visits to reduce the technology requirements for patients. The platform used allowed for multiple providers to join from various locations and for family caregivers to participate as well. Following each visit, patients received education materials via the mail outlining the GA-based interventions discussed on the call.

 The UR SOCARE program was able to rapidly adjust to the COVID outbreak by and providing essential care to  vulnerable patient populations via telehealth. Moving forward, SOCARE will look to implement video conferencing alongside their phone-based and audio-only visits to enhance patient evaluation and communication. As well, SOCARE will pilot an expansion program to extend their GA program to rural communities and patients with transportation or mobility limitations.

Access the full article, here

Date Published: April 2020

G. DiGiovanni, K. Mousaw, T. Lloyd, et al., Development of a telehealth geriatric assessment model in response to the COVID-19 pandemic, J Geriatr Oncol, https://doi.org/10.1016/j.jgo.2020.04.007

Article 2

Rapid Response to COVID-19: Health informatics Support for Outbreak Management in an Academic Health System

What was studied?

In this article, from the University of California, San Diego Department of Medicine, Jeffrey Reeves et al. focus on the broad and imperative role that technology has played in combatting the COVID pandemic. Reeves and his co-authors present the 2014 Ebola outbreak as the first lesson in utilizing health-technology to combat global health crises, but argue that US health systems squandered this opportunity to learn and must now rapidly develop and deploy health-tech platforms in the age of COVID.

Using University of California, San Diego Health (UCSDH) as their pilot program, Reeves et al. present the specific informatics tools and organizational to efficiently and effectively leverage these health-tech resources and contain the Coronavirus. Along with an Incident Command Center, established by UCSDH in early February, a key element presented in their pilot program is the integration of telehealth into the health system's EHR. 

Organizational Actions Taken:

  • Expanded telemedicine platform from UCSDH outpatient clinics to departments across the health systems, shifting in-person visits to virtual and reducing patient and staff exposure.
  • Rapid and consistent deployment of training and novel resources surrounding COVID-19 distributed to clinicians and staff via an EHR.
  • Creation of an "order panels" in the EHR across departments featuring COVID-19 lab orders, appropriate isolation orders, and additional screening and instructions.
  • Enrolled discharged, recovering COVID patients (as well as CCM patients) on telemedicine to prevent ED visits, provide video counseling, and symptom observations.

Access the full article, here.

Date Published: March 2020

Reeves, Jeffery J, et al. “Rapid Response to COVID-19: Health Informatics Support for Outbreak Management in an Academic Health System.” OUP Academic, Oxford University Press, 27 Apr. 2020, academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocaa037/5811358.

Article 3

Telemedicine in the Era of COVID-19

What was studied?

At the end of March, the Journal of Allergy and Immunology published an article on the importance of patient education and management of patients across the healthcare spectrum during the COVID outbreak. Dr. Jay Portnoy, et al. argue that education and communication between providers and seemingly "low-risk" patients is essential for proper containment of the virus. Patients across medical disciplines must understand the risk-factors to receiving in-person care and understand their options for care virtually. The most efficient way to educate patients and provide care without immediate contact is through telemedicine.  

While much attention has been given to patients with obesity, COPD, or other chronic conditions, the authors also take the opportunity to highlight asthma and other immunodeficient patients as having an increased risk adverse outcomes, given that COVID-19 is a respiratory virus. Portnoy, et al. point to telemedicine as an efficient way to monitor medication compliance and disease optimization to ensure non-emergent patients continue receiving the necessary care during the outbreak.  

Common challenges:

  • Individuals often revert to usual practices and therefore choose not to use telemedicine.
  • Individuals are concerned about seeing their regular provider via telemedicine. 
  • Telemedicine utilization among allergist is still relatively low, despite  the fact that many COVID symptoms may be confused with common allergy symptoms.

Benefits experienced:

  • Telemedicine can help reduce spread of Coronavirus between patient and physician, protecting patients and healthcare providers.
  • HIPPA and CMS regulation shave been relaxed during this time to allow for increased telemedicine usage.
  • Telemedicine can help determine which members of the population are most in need of COVID-19 testing based on their medical history and risk factors. This could reduce exposure as well and improve the allocation of limited resources.
  • Patients with chronic illness, more likely to contract COVID-19, can receive treatment without entering high-risk areas such as the hospital.

Access the full article, here

Date Published: March 2020

Portnoy, Jay, et al. “Telemedicine in the Era of COVID-19.” The Journal of Allergy and Clinical Immunology: In Practice, The Journal of Allergy and Clinical Immunology, 24 Mar. 2020, www.jaci-inpractice.org/article/S2213-2198(20)30249-X/fulltext#secsectitle0025.

Article 4

Telemedicine in Liver Disease and Beyond: Can the COVID-19 Crisis Lead to Action?

What was studied?

About half of all hospitalizations for cirrhosis-related complications result in specialty care due to the limited access to speciality care providers in rural, underserved communities. However, access to specialty care for patients with liver disease has been strongly linked with higher patient adherence and improved clinical outcomes. The authors of this study began their research in 2017, initially to investigate the use of telehealth to extend speciality gastroenterology or hepatology care for cirrhosis.

In light of the current COVID outbreak, the authors expanded the study’s scope to evaluate how healthcare organizations will adapt telehealth in a post-COVID world. Using their research in tele-hepatology as the backdrop, Marina Serper, at al., present the benefits of broad telehealth implementations as well as the barriers that may delay implementation of this essential healthcare service.

Common challenges:

  • Reimbursement: Prior to the COVID-19 outbreak, reimbursement has been limited at best for telemedicine services. Patients in the tele-hepatology program were provided through a grant.
  • Interstate licensure: Interstate programs, in which patients can receive care from speciality providers across state lines, are currently difficult to establish and navigate. In the tele-hepatology program, patients received care from specialty providers at in in-state healthcare organization.
  • Infrastructure and resistance to change: technology startup costs were minimal, requiring merely two monitors, two cameras, two microphones, and staff scheduling time. The partnership was established based on mutual need and desire for innovation, thus clinical buy-in was high with little resistance to change.

Benefits experienced:

  • Improved clinical observation and outcomes: 45% of patient visits resulted in new testing, 45% resulted in medication changes, and 18% led to subsequent liver transplant referrals, indicating superior care through specialty virtual visits.
  • EMR Integration: Both the local GI site and the specialty hepatology provider utilized the same EMR system, allowing for patient medical records to be readily available at both sites, increasing care coordination before and after each visit.
  • Provider Satisfaction: Providers stated the program was “convenient” and “seamless” within their clinical workflow. Reducing travel for patients and providing an overall service to a generally underserved community.
  • Patient Satisfaction: Patients quickly developed relationships with their distant, specialty provider, despite never receiving in-person care.

Access the full article, here.

Date Published: April 2020

Serper, M., Cubell, A., Deleener, M., Casher, T., Rosenberg, D., Whitebloom, D., &amp; Rosin, R. (2020, April 10). Telemedicine in Liver Disease and Beyond: Can the COVID‐19 Crisis Lead to Action? Retrieved May 11, 2020, from https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.31276

Part II. Reimbursement Updates

Throughout the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) have made changes to their policies in order to make telehealth more accessible across the country. Insights from our reimbursement team are included below.

Reimbursement Updates