Grading #telemedicine from multiple perspectives. How is telemedicine doing?

#TelemedNow Twitter Chat Wednesday, September 2 – 8 PM ET Introduction & Welcome: @arwmd – Moderator Grading #telemedicine from multiple perspectives. How is telemedicine doing?

Opening Poll: What does the rollback represent? Is there an inherent problem within telemedicine or are we fighting cultural change in #healthcare? This is a directional question, NOT a criticism / judgment…. - Lower grade, innate issue - Culture change problem

Q1 What overall grade would #providers / #doctors give #Telemedicine’s performance? #TelemedNow (Grade A-D, no F!). And why? Are we happy with it? Does the IT work well? Enable clinical care?

A1 Notable Responses: Jamey Edwards (@jameyedwards) B+ from #Providers / #Doctors #Covid19 helped clinicians get used to #telemedicine & see how it could benefit #workflow, build #patient connection, time shift #healthcare & improve satisfaction. Not an A as reimbursement (making a living) remains unclear. Janice Tufte (@Hassanah2017) Grade #B= #Beneficial #Boostsclinicalcare #Baselineopportunities #Betterinsights into Patients lives #BehavioralHealthBoon #kepttheBallrolling #TelemedNow Helen Burstin (@HelenBurstin) Suspect different grades from providers (health systems) v doctors for #telemedicine performance Grades from docs: - Adopting new tech/workflow during pandemic (C+) - Keeping patients/clinicians safe during pandemic (A-) #TelemedNow score from docs = room for improvement Andrew Watson (@arwmd) And good point Jamey. #TelemedNow. Also, I think we need more seamless operational models, this is such a big cultural change. Everyone is trying. Arti Bhan (@ArtiBhan1) I would give it a B now. Mostly on the technical level. Patient and physician satisfaction is high when technology is easy. Interesting how our patient satisfaction was higher during peak pandemic and lower now. #TelemedNow Ami Bhatt (@AmiBhattMD) C. Although we love to use video, there have been significant challenges to the technology, integration with EMR, availability of peripherals as part of the system, and a lack of tech support after initial engagement. Much that we can improve upon! #TelemedNow Ritu Thamman (@iamritu) B:we’re building the car while driving it: Grade B :it’s necessary for us given #Covid19 #risk & #PPE lack #TelemedNow has been a whirlwind transition & has raised more?? Like when to guide people about when to call VS sched an appt #Triage what should happen in “waiting room Andrew Watson (@arwmd) Really like this answer Helen. #TelemedNow. A good way to segregate the thinking. And game on with GIF. Salim Saiyed (@SalimCMIO) We surveyed our docs @UPMC_Pinnacle to find a majority were happy with #telemednow A. The IT / #telemednow platforms are still 1.0 generation... there is a lot of room for improvement. C... low B. ACHP (@_ACHP) Smart take. #Telehealth provides an opportunity, but a lot of systems that rolled it out for the first time might be ironing out kinks stills. Matt Sakumoto (@MattSakumoto) Agree and I'd say our "diversity" grade (for optimizing multiple modalities - phone, video, texting) is a D. So much room for improvement (and research needed) for matching modality to level of care needed. Ritu Thamman (@iamritu) 100 so much potential in this space- love thinking about what if or could we do “x” - thinking creatively & using #designthinking will help us @BonKu #TelemedNow Cory Simpson (@CorySimpsonMD) Highly depends on platform used for #TelemedNow and workflow supported by employer/institution. If you are told to make do w/a clunky app and are given no logistical/tech support to make sure it works for you & pts, it won't be a fair assessment of #telemedicine's true potential. Lisa Levitt (llevitt800) This list is interesting to me... seems like the issues support clinical care however are not tied to to interaction with provider and patient. #TelemedNow Lisa Levitt (llevitt800) Also for choice of #TelemedNow modality let's factor in by patient preference / situation/ communication style. Some people may NEVER want to be on camera. Others will only feel connection to their doctor if they can see them etc. Or bad internet means phone only more reliable

Q2 How would government grade #Telemedicine’s performance in 2020? #TelemedNow (Grade A-D, no F!) Take any perspective, or an aggregate: White House, congress, State, HHS, CMS. Are policymakers? A2 Notable Responses: Jamey Edwards (@JameyEdwards) B from the Government Gov't has moved quickly to make #healthcare more accessible via #telemedicine, staying regulations that could be major obstacles such as practicing across state lines & @CMSGov payment. Still a long way to go, but good progress here. Janice Tufte (@Hassanah2017) Government Grade: #A= #Accessible #Affordable #Assistedgreatly #AttitudeAdjustment #AppleHealth #AntisepticofferingduringCOVID19distancing #TelemedNow Cory Simpson (@CorySimpsonMD) If supporting/reimbursing #TelemedNow for outpatients is keeping at least some pts from otherwise seeking urgent/emergent care ($$$) during a pandemic (and it definitely is), it has to get a good grade from @CMSGov Helen Burstin (@HelenBurstin) Actions speak louder than words/grades. Permanent #telehealth expansion, payment parity suggest strong @CMSGov support. Potential to improve access and outcomes, while reducing cost. As @SeemaCMS said: “The genie is out of the bottle on this one.” Grade B+ Stevland Sonnier (@StevlandS) B+ for public payers - we've seen an explosion in use for #rural and #urban benes. It's also offered novel insights into telehealth use with #PT #OT and #SLP. More preventive care options, less healthcare dollars down the road Arti Bhan (@ArtiBhan1) I think they have realized that ease of telemedicine doesn’t translate to overuse. Improved access for the elderly and underserved populations may also have helped. Telemedicine is here to stay! #TelemedNow ACHP (@_ACHP) @SeemaCMS and @CMSGov has already indicated they're looking at making some of the recent changes they've made permanent, so that suggests that @HHSGov at least recognizes the potential of #telehealth. #TelemedNow ACHP (@_ACHP) And i think it's telling lawmakers, such as @SenBrianSchatz, are pushing for additional funding for #telehealth programs. #Healthpolicy can be contentious, but it seems like federal officials understand and recognize the potential here Ami Bhatt (@AmiBhattMD) B+ Huge Kudos to our Congress for bipartisan efforts to make #telehealth expansion permanent post COVID! #TelemedNow Salim Saiyed (@SalimCMIO) The government will grade #telemednow performance highly for the #pandemic Though CMS/ state have yet to enact permanent changes such as inter-state license requirements, etc. The real test comes how much the agencies retain after the #pandemic aka exam. Tricia Guay (@TBG_ACHP) Overall, there has been bipartisan support for #TelemedNow performance during COVID. But they still want to see the data before extending permanently. Andrew Watson (@arwmd) I wish there was more of a collective state voice about #Telemedicine. States did relax licensing but we expect this to roll back. Sam Lippolis (@samiamlip) I give an B+ for immediate PHE action. I was very happy and surprised how quickly the PHE allowed #telemednow from patients home via video But I give Congress a D+ because they still haven't changed the rural and home restrictions. Connie Hwang (@hwangc01) CMS gives #telemednow an "A." Seema Verma in Health Affairs: "Early CMS data have shown telehealth to be an effective way for people to access health care safely during the COVID-19 pandemic." CMS assessing which flexibilities to make permanent. @_ACHP Ami Bhatt (@AmiBhattMD) Bills before Congress aim to continue telehealth policies implemented in the CARES Act and expand access for seniors; study telehealth, promote cross state line care, and more. Now waiting for more action! Jordan Owens (@JF0wens) if you evaluate success based on protecting the greater good, you have to score it an “A.” Without #telemed, routine care would have declined to zero and we’d be worried about what ailments we will discover when a vaccine is avail. #TelemedNow Jordan Owens (@JF0wens) if you instead evaluate based on what could be better next time, you have to give a lower grade. To me, demonstrated success deserves to be celebrated. Yes, improvements can be made. But that’s always the case. To the future! #TelemedNow Jessica Spencer Castner (@DrCastner) 672 documented health care worker deaths from #COVID19 to date, telehealth continues to get an A as a crucial way to prevent pathogen exposure #TelemedNow

Q3 What grade would #patient’s give #telemedicine in Sept 2020? #TelemedNow (Grade A-D, no F!). And why? Safe during #Covid. No travel. Easy access. Worse disparities? Hard to use IT? Better long term care. A3 Notable Responses: Jamey Edwards (@jameyedwards) A- from Patients: Some bumps in the road ion #websidemanner initially, but increased access & meeting patients where they are outweigh transition friction. @KPShare & @VeteransHealth are evidence of #Telehealth's potential & pt. willingness to adopt Andrew Watson (@arwmd) I ask all of my patients, “what do you think of this #telemedicine”. 100 positive. BUT, I don’t ask them how hard it was to set it up. Curious to dig into @PressGaney and out PRO data. Ritu Thamman (@iamritu) Grade depends on your ACCESS: access to internet & there arebarriers for women, older pts, pts whose first language isn’t English, & those with the lowest income - those pts may give #TelemedNow a C Helen Burstin (@HelenBurstin) Good grades from patients for #telemedicine during pandemic. @caseymross in @statnews raised key issue - does declining use reflect "shifting patient preferences and needs?" what is driving the decline? Matt Sakumoto (@MattSakumoto) Patient's would prob rate #telemednow as B-. Some love it, some clearly preferring a return to the clinic. Need to shift expectations to new uses, not substitutes for in-person care. Matt Sakumoto (@MattSakumoto) That being said, my patient satisfaction scores and NPS for telemed visits are through the roof! #TelemedNow Stacy Hurt (@stacy_hurt) I would give it an B due to all the different platforms (can we agree on one please?), lack of universal access for those adversely affected by #SDOH, lack of #healthliteracy training for #telehealth use, & lack of clinician adoption #TelemedNow #patients Maram Museitif (@MaramMPH) Today I give it an F! I couldn’t believe it would take me few weeks to see my doc via telemedicine and only a day in person. I was so outraged!! Connie Hwang (@hwangc01) So many patient surveys showing positive experience w/ #telemednow, even among 1st time users. @_ACHP & @amcporg conducted consumer poll in May showing 89% satisfaction rate for recent telehealth visit, w/ 46% saying they are comfortable already. Arti Bhan (@ArtiBhan1) Depends on demographics. Patients with poor access to technology: C Others: B. Mostly because of the value based on a physical exam. During Pandemicpeak: A++ Sam Lippolis (@samiamlip) I have been texted and told by every friend whose used #TelemedNow 85% have loved it. So that's a B+ Only time they don't like it when clinician was not prepared OR they were told 'you can't come in so we have to do telehealth' Andrew Watson (@arwmd) I think a lot of this has to do with the patient education, what do you think? If we educate patient would they better understand it and use it more? #TelemedNow Salim Saiyed (@SalimCMIO) For patients that use it they would grade A to solid B For patients that don't make it to #telemednow, they would rate it lower, D to F. It is our challenge now to close that Digital divide. clayforsberg (@clayforsberg) I believe too many in healthcare are too impatient with telemedicine. The technology will improve, doctors will get better at using it (or just improve their attitudes) and patients will try it and never want to go back. It’s a commitment to change — not a test run. #TelemedNow Stacy Hurt (@stacy_hurt) Yes. Totally. Education breaks down fear and fear impedes change. BUT through these last 6 months what systems have been put in place to educate #patients on #telehealth? Whose job is that? #TelemedNow Jordan Owens (@JF0wens) as a patient, I have to give it an A. Was it perfect? No. Do we need to make things better for the future? Absolutely. But did it do the job that it needed? No doubt about it! I’m safer, healthier, and better connected because of #telemedicine. #TelemedNow Ami Bhatt (@AmiBhattMD) A for patients! Patients love #telemedicine because #telehealth visits are more convenient than in-office appointments #TelemedNow allows easier scheduling They find that follow-ups/communications post-appointment are easier on #telemedicine Jennifer Co-Vu (@DrJenniferCo_Vu) Patients would grade #Telemedicine A. Esp the ones who needed to travel to get care. Will be extremely impt to dec exposure for my vulnerable pt population during this winter viral season on top of the #COVID pandemic. #telemednow Tricia Guay (@TBG_ACHP) Speaking from the patient perspective, I love #TelemedNow and would give it an A. The time saved via a video call with my doc is tremendous. Not having to stop working for half a day to travel to the office and endlessly sit and wait is priceless. Stacy Hurt (@stacy_hurt) We are definitely glad just to have this option- meeting patients where they are cannot be stressed enough #TelemedNow Jamey Edwards (@jameyedwards) E-Consult models can serve as a warm handoff. Also, imagine #transitionsofcare like patient with broken leg in ER who has ortho consult and meets doctor who they will follow-up with over video before leaving emergency room. Lisa Levitt (@llevitt800) Cleaner patient data comes from patient allowed to respond privately / anonymously with #telemednow opinion e.g. ipad in waiting rm. In live conversations, risk of bias, trying to please person asking, especially authority figure like their doctor (who they may like a lot) Lisa Levitt (@llevitt800) Education will help with #telemednow adoption and perception. However ultimately ACTION will tip the balance - helping patients see that there are better features that will benefit their health or pocketbook ONLY available through #telehealth. #patientexperience #patientcentric

Q4 How would #payors grade #telemedicine and how it is helping them in 2020? #TelemedNow (Grade A-D, no F!). And why? Did #Covid prove Tmed? Close HEDIS gaps? Enough access? Virtual 1st benefit design in 2021? A4 Notable Responses: Jamey Edwards (@jameyedwards) B+ from Payors #RPM & #VirtualVisits give payors ability to better manage #ChronicConditions & provide a #DigitalFrontdoor to #healthcare that helps guide members to appropriate care levels w/ acuity escalation that keeps costs down. Ritu Thamman (@iamritu) If payors are only looking at immediate $, then they will miss a chance to really change healthcare because #TelemedNow won’t necessarily cut costs as shown in this @HealthAffairs But it’s being driven by consumer electronics & whatever they say & buy ACHP (@_ACHP) Our nonprofit, community-based plans have embraced it wholeheartedly. Plans, such as CommunityCare in OK and @Security_Health in WI, have aggressively expanded #telehealth coverage and are seeing uptake for vital services such as #mentalhealth #TelemedNow Janice Tufte (@Hassanah2017) PayorGrade #A = #SavedTheir #Our #Arses #AddressedChronicCareConditions #PrimaryCareCatchUp #DeferredAppointments+ #PrePostTreatments #ProblemSolver Helen Burstin (@HelenBurstin) Fairly high grade for #telehealth from payors given potential for cost reduction, decreased inappropriate utilization, and improved outcomes. But still struggling to ID payment model that works for payors, patients, and providers. #TelemedNow score for payors: B+ Jennifer Co-Vu (@DrJenniferCo_Vu) #Payors should give #Telemedicine an A. Because with pts being seen early/on time, this would have decreased admissions/morbidity or ER visits. #Telemednow Andrew Watson (@arwmd) IMO a B+. It creates access. Remote monitoring is early. But the net #value has yet to be quantified. #TelemedNow There is so much opportunity here, esp MC. Ami Bhatt (@AmiBhattMD) What a challenge. A for patient experience and gratitude B+ for access for patients, chronic disease follow up C for understanding what payment systems will incorporate #TelemedNow Salim Saiyed (@SalimCMIO) I think the #payors would give an early B. Most of their members had a venue that otherwise would not have had. Our #primarycare quality metrics remain unaffected mostly due to the thousands of preventive visits conducted via #telemednow As this goes on, we would need regrade POLL 2: Who would give #Telemedicine the highest grade? #TelemedNow Who is MOST satisfied with how we are doing so far? - Patient - Provider - Payors - Government/policy Q5 How would we grade the #IT / technology behind #telemedicine? (Grade A-D, no F!). And why? #TelemedNow Are the platforms secure? Easy to use? Do patients like them? #Interoperability? How to mature them? A5 Notable Responses: Jamey Edwards (@jameyedwards) A- on #Telemedicine #Technology #Healthcare needs to think more enterprise & less point solution. Regardless, #Telehealth's obstacles have less to do w/ #Tech & more to do w/ industry incentives & behaviors. #Interoperability needs to improve & will create oppts. #TelemedNow Andrew Watson (@arwmd) And the IT / platforms may get easier to use or incorporate with some of the market consolidation going on. #TelemedNow Helen Burstin (@HelenBurstin) Overly complex #telehealth tools have made access difficult for patients and clinicians. Need simple tech/apps, interoperable solutions, easy access to broadband. Hard to grade since some issues attributed to “tech” are really “people/culture” #TelemedNow tech grade: B+ Jordan Owens (@JF0wens) this is much tougher question to answer. Today, horizontal products are deployed in vertical applications. We in the industry have a lot to do specifically to enable #TelemedNow. Doesn’t have to be dedicated products, but does have to have dedicated value Janice Tufte (@Hassanah2017) TechGrade = #AI #Capacity #Patients #EaseOfUse #Affordability #TechnicalQuality for provider, clinician, patient & or caregivers Ritu Thamman (@iamritu) C Technology could be helpful by streamlining data capture & automating workflow but interoperability is the key Yet bringing data together for pooled rapid analysis is difficult because healthcare systems speak different languages Salim Saiyed (@SalimCMIO) I would rate them a D. Very few of us had to use #telemednow, so the development $$ were lacking. Now with the attention & need I am hoping we can move the platforms along. It has to be so simple, easy, fun that #patients keep coming back Jim St.Clair (@jstclair1) I'm saying A+ for technology, D- for awareness. There are tech solutions getting inadequate visibility. #TelemedNow Connie Hwang (@hwangc01) Sounds right. At start of pandemic, even smaller physician practices were able to ramp up surprising quickly, choosing from a wide range of #telemedNow tech options. Challenge ahead is optimizing the tech and clinical workflows for the long run. @_ACHP Ami Bhatt (@AmiBhattMD) #telemedicine adoption was poor before #COVID because it lacked design thinking. Now, we have a chance to take the patient/clinician journey and model #TelemedNow to fit our collective needs and goals. Sam Lippolis (@samiamlip) It's all over the place A- for ones that have been around and know the space D usually for integration into EMR D- for pandemic start ups that do not know clinical care, patients or doctor C- for free versions Stevland Sonnier (@StevlandS) B+ There are an incoming amount of #teleplatforms so healthy competition abounds and lots of best practices to be gleaned. Critical that these platforms are built with patients AND providers in mind. Big role for #UX design in the area of #accessibility and #interoperability Jordan Owens (@JF0wens) It's all over the place A- for ones that have been around and know the space D usually for integration into EMR D- for pandemic start ups that do not know clinical care, patients or doctor C- for free versions Gregory Menvielle (@greg_menvielle) Another issue, one we are faced with, is realistic adoption. I’ve seen lots of startups - not just ours 😊 - with really cool tech but the reality is that very few large groups will go for such platforms because of purchasing requirements and perceived risk factors.

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