When it comes to wreaking financial havoc on healthcare organizations, Covid-19 did not — and does not — discriminate. And while many might point to hospitals and practices in hotspots as sustaining the most damage, in reality, every facility that was forced to close its doors or limit procedures has taken a hit.
“We planned for the worst,” said John Kravitz, Corporate CIO at Geisinger Health, a large integrated delivery network located in Pennsylvania. Although the organization wasn’t inundated with Covid-19 cases, perhaps with the exception of three campuses located close to New Jersey, it did suffer economically from having to shutter clinics.
As a result, Geisinger, like many others, relied on telemedicine to provide continued care without putting patients and staff at risk. Also like many others, it saw a significant spike in video visits during the early days of the pandemic that has since leveled off. But it didn’t do so without leaving a mark, perhaps forever altering the delivery of healthcare.
“It’s going to continue, which is good news. That’s the direction we need to go,” noted Kravitz. The big question is, where does telehealth go from here, and how have IT organizations cleared some of the hurdles that have long stood in its way? During a recent webinar, he discussed these issues, along with Kathy Ross, CIO at Broward Health, and Adam Seiver, MD, PhD, Chief of Medical Affairs and Patient Care and Monitoring Solutions with Philips.
One of the key challenges is the fact that many organizations lacked the infrastructure — or experience — to support widespread adoption. Broward Health fell into that category, and was forced to “quickly devise a strategy to minimize the frequency in which physicians or clinicians had to enter rooms,” said Ross. To that end, her team quickly set up iPads with Microsoft Teams to enable remote monitoring. And although it had to be stood up quickly, it has been adopted “exceptionally well” and has changed the perception many clinicians had about telehealth. In fact, a significant portion of inpatient physicians have reported being “more engaged with patients” than they were before.
Once that obstacle is overcome, there are others that must be dealt with, including workflow. Because while using devices like iPads certainly make some facets of care coordination easier, they can also be “cumbersome,” according to Dr. Seiver, who spent 14 years as medical director of the eICU at Sutter Health. “You need a camera person to aim the iPad. It doesn’t allow you to have your hands free, or the control to move images around.”
Managing workflow challenges, however, is nothing new — particularly as pop-up clinics and virtual wards have become commonplace in recent months. In these types of situations, clinicians often find themselves “scrolling through large lists” to find the patient information they need, said Dr. Seiver. Ross agreed, noting that the configuration changes needed to build out EHRs for makeshift ICUs has been a constant struggle. “We’re making changes on a daily basis.”
Focus on Wellness
Fortunately, as organizations become more comfortable with various aspects of digital health, it becomes easier to navigate the challenges, said Kravitz. “It’s a change; it’s something you have to adjust to.”
For Geisinger, the focus now has shifted from leveraging telehealth to “make up for acute patient visits,” to coming up with more innovative uses for the technology. For example, the organization has launched a proof of concept for contactless check-in at two of its clinics, with plans to quickly expand. With this technology, patients will be able to check in from the safety of their vehicle, and receive a secure text message notifying them when the exam room is ready. “There are a lot of processes we’re building into that to provide a lot of automation,” said Kravitz. “We think that’ll be important for us not to have to shut down clinics in the future.”
And it doesn’t stop there. As an organization heavily focused on population health, Geisinger hopes to improve its home monitoring capabilities to more effectively identify gaps in chronic disease care and keep patients out of the hospital. As part of its goal to improve communication among care team members, Geisinger plans to provide iPads for patients in need.
“We want to look at healthcare in terms of how we can provide the most wellness,” said Kravitz. And although treating the sickest of the sick is a critical piece, “the more we can do in a population health environment to keep people well, the more advantageous it is for everyone. That’s been our model.”
Geisinger is also providing telehealth services in skilled nursing facilities — where Covid-19 mortality rates have been disproportionately high — as is Broward. According to Ross, the Florida-based organization is growing its HealtheIntent platform and leveraging care navigation to keep patients out of the hospitals and even the ambulatory settings, which is critical since the area is a hotspot. “We want to ensure better communication and better understanding of health versus just treatment of illnesses,” she said. Once the pandemic has subsided, she believes telehealth “is going to be more prevalent than ever before in how we deliver holistic healthcare.”
For next-generation telehealth to become a reality, however, a few pieces need to fall into place. The first, according to Kravitz, is the use of wearables to collect data in real-time and send to EHR systems for clinical response. This is particularly true among patients with conditions like coronary artery disease, whose fluid levels need to be closely monitored. “Management of that through telemedicine is hugely important,” he said.
Ross believes that as Bluetooth-enabled home devices become more commonplace, it will become critical to develop more integration between patients and physician practices, “so that we can tie in analytics and be able monitor their blood pressure, glucose, weight, and activities, and take actions to avoid admissions when possible.”
Another is leveraging machine learning to comb through historical data to identify trends and apply algorithms. “Data analytics and AI definitely will play a continued role, and it will improve over time,” added Kravitz. “I think we’ll be able to do a lot more for high acuity patients in the home setting.”
The final — and arguably most pivotal — pieces don’t involve technology at all, according to Dr. Seiver. “What will really be important is to change the people, the processes and the incentives, including reimbursement. That’s what needs to happen to make all of this work.”
To view the archive of this panel discussion — Telehealth: Redefining Delivery of Care & Igniting Radical Change in Healthcare (Sponsored by Philips) — please click here.