First published in New York Medical Group Management Association New York Beat e-newsletter August 2020
In a recent webinar, a colleague showed a slide with a multiple choice question: Who led the digital transformation of your company? A. CEO B. CTO C. COVID-19 Of course, choice C was circled in red. From schools to retail, the coronavirus pandemic has forced us to change how we perform everyday tasks we hardly paid a thought to last autumn. Necessity may be the mother of invention, but COVID is triple espresso she is drinking to fuel her innovation.
Medical practices have been, for quite some time, flirting with the idea of telehealth and more recently with remote patient monitoring. Largely left to large or hospital-owned practices, the idea of treating patients virtually has been seen as more of a Jetsons age novelty than an indispensable resource. But the pandemic has forced many to think differently and act in ways that best serve patients and support the sustainability of the practice. Healthcare has been pushed to elevate the use of technology in order to stay safe, effective, relevant, and viable.
Chances are your practice is now doing some form of telehealth and you were not doing much prior to COVID. It’s likely the implementation of this technology was a disruption for which you weren’t fully prepared. This begs a few questions: What else is on the horizon in healthcare innovation that we may not be expecting? Are there better ways to do what we quickly implemented? Do we need to modify our workflows? Can we better impact outcomes, satisfaction, revenues, or profits by enhancing what we’ve done?
Let’s examine a few of the upcoming transformations you can prepare for to ensure the next major disruption is more of a tremor than a quake to your everyday operations:
Telehealth Expansion
The vast majority of healthcare practitioners who have only recently moved into the telehealth space have no intention of reverting. As insurance reimbursement scales to meet the demand, the benefits of using remote communication to treat patients will continue to grow. Wider adoption, increased usage among vulnerable populations, and higher acuity use cases will continue to be evident. Telehealth will be increasingly used to care for patients who are traveling or snowbirds as well as provide more consistent tracking of patients with chronic or complex conditions. The impact of avoiding unnecessary hospital and ED visits will further increase its cost-effectiveness. Patients have come to trust telehealth as a viable alternative and will come to expect the option when making healthcare decisions. Being prepared for this will position your practice as one that is patient centered, and as an employer who can provide flexibility for clinicians who are unable or unwilling to attend in-person visits. Look at the telehealth program you may have implemented as a result of COVID. Are there ways to strengthen the system to shift into a more permanent and integrated one?
Advances in Wearables and Remote Patient Monitoring
Once only sported by early adopters and elite athletes, the age of Apple Watches and Fitbits is now is full swing. The technology is improving, easier to clinically incorporate and capture into EHRs in a meaningful and actionable way. Advantages of getting accurate readings for, say, blood pressure or blood glucose between clinical encounters provides more frequent touchpoints, faster feedback about interventions, and earlier warning for trends and impending events. This new stream of data can help increase revenues, enhance patient outcomes, reduce operations costs, and enhance patient experiences. Technology improvements in cardiac monitoring and other metrics are advancing rapidly and this evolution means you will not be bombarded with a flood of data but only values that will help in making decisions. If you’re not currently thinking about how to incorporate wearable data into your daily workflow, you should be.
Enhancing the Patient Experience with Digital Health Apps
In addition to adopting telehealth and remote monitoring to engage patients between encounters, innovative practices are also adopting a myriad of other tools and capabilities to enhance the patient experience. Enabling patients to find a doctor, schedule an appointment, message their provider, pay their bill, get directions, rate their experience, report how they feel, confirm compliance, get educational content, and access their clinical record from their smartphone can significantly enhance their perception of providers. While many of these functions can be addressed individually, providers will find more patient satisfaction and retention if they deploy comprehensive, integrated apps that provide a single point of access for all of these functions.
Virtual Reality
Senior living facilities have been using VR in the treatment of memory care. Experiences from the past can feel fully immersive and trigger memories, conversations and new mental connections. VR is increasingly being used by surgeons to visualize complex surgery and improve interventions by superimposing virtual images over the actual patient. We are only beginning to scratch the surface of what is possible in this arena. Stay tuned for the near future of VR applications that will be useful in your everyday workflow.
Advances in technology are but one piece of the puzzle you need to stay ahead of an ever-evolving healthcare landscape. To survive and thrive, it is necessary to stay flexible and informed. Don’t wait for the next pandemic to embrace the inevitable, assess your situation and create a roadmap for your future. In the end, we all want to provide the highest quality care for our patients and adopting useful and meaningful technology can help to do exactly that.
Throughout the course of this pandemic, a great deal of attention has been paid to testing. Most of us think of testing as a single person driving through a tented testing site and waiting a few days for their swabbed results to be returned to them. Pooled testing is no different from the tested person’s standpoint: you still have a swab test just as if you were being individually tested, but the difference is in how the lab processes the collected tests and how the results are reported.
In pooled testing, biological samples from several people are mixed together prior to analysis. If the pool is negative, a large group of people can be deemed to be negative. The advantages to doing so are several:
Performing a single pooled test can quickly and efficiently check a large sample of people for presence of COVID.
The cost of a pooled test that includes many people is substantially less than the costs of individual tests for the same number of people.
Capacity of testing increases tremendously, permitting high numbers of people to be tested frequently with much less strain on the laboratory systems.
There are several caveats to be aware of, however, that make pooled testing slightly less than perfect. When pooled testing yields a positive test, it is impossible to know which pooled specimen is positive, so they must be retested individually. This is fine if a positive test appears only infrequently of if the pool is small. Pooled testing is best used in populations where positive tests are not expected: think colleges rather than nursing homes; communities who have not seen an outbreak versus an area with a lot of COVID hospitalizations.
Strategies such as split testing can help with the work of retesting positive results. If a pooled test shows a positive, the pool samples are split in two groups and retested. If one of the splits is positive, that sample is split again and retested while the negative split is cleared. Rinse and repeat as necessary. This reduces the amount of retesting necessary and eliminates fairly large groups of negatives.
There is also the issue of false negatives, which are slightly higher in pooled tests than in individual tests due to the diluted samples in a pool. Analyzing the pooled sample more than once appears to reduce this risk, but even single tests have false negatives.
Pooled testing is an effective, efficient strategy in communities where COVID-19 is not prevalent and early detection is desired. It safes time, money, and leads to earlier control through contact tracing and quarantine. Every day people with COVID are undetected and mix with their immediate population, the risk of uncontrollable spread rises exponentially. Several of the countries who have had the most success in managing their pandemic outbreaks have relied on pooled testing and research from Israel has shown that pools of 32 samples can detect a single positive sample (with a 10% false negative rate). Greater samples, up to 64, can be detected as well but require a technique called amplification samples. The US should be leveraging the pooled methodology immediately in areas where it is applicable to improve our capacity for testing and increase the speed of detection in the community. And once there are detected positives, using a remote patient monitoring solution to track progress of those who are positive will further help extend thinning healthcare resources.
Two clients of Strategic Interests: Rochester Regional Health and the Monroe County Department of Public Health presented their experiences and best practices of COVID-19 remote patient monitoring. The webinar was recorded and is available here:
AZ HIMSS Remote Patient Monitoring for COVID-19 Webinar
Strategic Interests worked tirelessly with Rochester Regional Health and Datos to rapidly deploy a COVID-19 remote patient monitoring solution in under a week! See the press release below for more details…
The number of COVID-19 cases in the United States is accelerating rapidly and if you or your organization is responsible to monitor these people, you know it requires immediate efforts to practically manage patient care. Hospitals soon will be swamped with patients and we need, as much as possible, to keep the ill and those suspected to be ill at home while providing them with care and the ability to monitor them closely.
Datos, a leading digital health startup from Israel, in conjunction with Strategic Interests, a health tech consulting firm, are offering a capability to your organization to implement and begin monitoring your patients in as few as two days. The Datos Automated Remote Care Platform utilizes proven technology and is already monitoring and caring for COVID-19 and flu/virus symptomatic patients in Israel. (See the video: Datos Automated Remote Care Platform – You Tube)
Jointly we are now offering this service in the United States, at a very low cost to help our providers care for us. We prioritize community care over profits – especially at this critical time.
The Datos Automated Remote Care Platform features capabilities via our HIPAA Compliant, private cloud-based solution with a mobile app that can be private branded for your practice, IPA, health system.
Patient Monitoring
Two electronic patient reported outcome (ePro) surveys – Assessment form and daily symptoms
Clinical Data – Temperature/Blood Pressure/Pulse Oximetry
Built-in/configured reminders and automatic messages to patients
Virtual visit capabilities
Care Team – Patient Management
Fully configured COVID-19 dashboards
All patient views, sorted by alerts based on symptoms severity
Detailed statistics on vitals and symptoms, including locations updates if/when needed
Virtual visit capabilities
Strategic Interests will work with your organization/practice to implement in as few as two days. Please visit https://www.strategicinterests.com/covid19 and let’s schedule a short conference call to get started. If you know of someone who can use this platform to save lives and manage scarce resources, please let them know.
Stay safe, stay home (if you can), and wash your hands.
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