Selecting Telemedicine Platforms

Updated: Apr 29, 2020

Tweetchat Summary

#TelemedNow Twitter Chat Wednesday, April 22 – 8 PM ET Introduction & Welcome: Andrew Watson (@arwmd) – Moderator What platform to use for telemedicine?

Q1 Live video visits from an independent platform * What stand alone platform do you use? * What type of service do you provide? * Challenges? * Examples? * Benefits?

A1 Notable Responses: Jamey Edwards (@jameyedwards) Ideally a unified approach to #Telemedicine makes the most sense in the long-run. Single interface for clinicians & patients drives more adoption & surrounds patient with care team. #TelemedNow This is why @TeladocHealth acquired @InTouchHealth & @Amwell acquired Avizia. Jamey Edwards (@jameyedwards) #Telemedicine platforms should break down silo's in #healthcare not create them. Closed non-interoperable #tech reinforces silo's instead of breaking them down both Inter & Intra #Hospital. Seek #platform instead of point solution. #TelemedNow Jackie Lee (@jacki3lee) Seeing the current issues with online classes with Zoom and Zoombombing, one major challenge would be patient privacy. Ami Bhatt (AmiBhattMD) I do think that environment is changing. Before we felt very stuck with one product, however now with the demand created this spring, it is truly a capitalist society where we can change the software we are using to fit our needs. #TelemedNow Jagdish Patel, MD (@jpkca)Limitation of integration with EHR is EHR has to integrate. If you are part of the health system than you have Epic with ZOOM. If you are in remote area than platform has a different meaning as offices and users need simple solutions

Ceci Connolly (@CeciConnolly) I can share insight from our Fl member @AvMedHealth is pleased w/ MD Live, has seen virtual visits since start of pandemic; all shared w/primary care doc. Easy to use @_ACHP #TelemedNow Kevin J. Fowler (@gratefull080504) Have there been challenges for lower income + older patients with implementations due to barriers? If so, how have your addressed them? #telemednow Ami Bhatt (AmiBhattMD) Zoom and seem popular as stand-alone platforms. Doximity's beta video is a great HIPAA secure facetime like version and may generate competition for ease of use when it launches for all. #TelemedNow Kevin J. Fowler (@gratefull080504) Was Zoom used in #telemedicine prior to #COVID19 ? Jordan Strom, MD, MSc, FACC, FASE (DocStrom) We are using Virtual Visit which is a HIPAA compliant platform. Telehealth is so important for maintaining continuity of care. @BidmcCvi was an early adopter and we now use frequently. Evan Kirstel (@evankirstel) check out Addison, a virtual caregiver @addisoncare #TelemedNow @IrmaRaste @eViRaHealth #telehealth #Telemedicine #patientmonitoring James Legan MD (@jimmie_vanagon) #TelemedNow I use a platform called at @Updox which is a very functional #healthCRM and works fantastically well Ceci Connolly (@CeciConnolly) One thing we’ve seen w/ #COVID19 is adaptability is key to meeting needs. Thanks to new flexibility, plans such as @_HealthPartners able to use Google Duo, & others have used Facetime & Zoom for consults #telemednow @_ACHP Rafa Ifthikhar (@rafaifhikhar) One challenge I can imagine is navigating difficult situations - for ex. suspected IPV, elder or child abuse come to mind. Do #telemed platforms have features to address these challenging scenarios to ensure #patientsafety and #confidentiality ? Cory Simpson (@CorySImpsonMD) Love waiting room on 4 #TelemedNow. Sends me text when pt checks in so I don't have to be glued to screen. Single simple website can be texted/emailed to pts instantly/anonymously & 1 click puts them in my queue. No app/download needed! Love it 4 #Telederm Hjstern (@hjstern) #Telemedicine would be a great platform for maintaining healthy lifestyle education/coaching related to diet, exercise, sleep, etc. for primary care patients. Clinics could enlist nutritionists/physical trainers to run continual contact programs for patients. #TelemedNow

Q2 Next platform, video driving out of EHRs (not a stand al one platform) #TelemedNow * Benefits (such a scheduling)? * Differences vs Q1 stand alone platforms? * Do you have / see challenges here? * What do patients think of this? A2 Notable Responses: James Legan MD (@jimmie_vanagon) I don’t think patients really care whether it is a standalone or out of an #EHR, just as long as it is easy to use, and easy to get a hold of the office to make an appointment #TeleMednow Evan Kirstel (@evankirstel) I see value in enabling one-to-one or group video conferencing, secure messaging, coordinating patient care, and file sharing that integrates with leading video platforms from Google, Cisco Avaya or Microsoft( for example) Ying Liu (@Yingiu40146323) From the patients view, maybe they trust a platform embedded within the EHR more than a standalone platform regarding the HIPAA/Privacy. #CovidPittClass #TelemedNow Ami Bhatt (AmiBhattMD) When the double click from your #EMR brings up the patient's face, it is magical. EMR integrated video needs to continue to improve UI/UX but once a clinician finds a good one, the stand alone seems cumbersome #TelemedNow Jackie Lee (@jacki3lee) may be beneficial to have integrated platform so multiple providers from different systems can potentially collaborate for one patient. Ami Bhatt (AmiBhattMD) #Telemedicine out of #EHR allows for very clear scheduling protocols and data acquisition for practice patterns #TelemedNow #telehealth @ACCinTouch @DrJRums Ami Bhatt (AmiBhattMD) Patient portal access for a virtual visit creates a one-stop shop for all communication and is less confusing for #patients #telemedicine #telehealth #TelemedNow Jamey Edwards (@jameyedwards) #EMR / #EHR driven solutions help unify #tech, but haven't mastered #telemedicine #workflow yet, although they are getting there. Issue is they are starting to compete w/ partners, limiting client options. Interested to watch how they evolve #telehealth offerings #TelemedNow Q3 Okay, what about remote patient monitoring? #TelemedNow This one is quite different - mainly it is asynchronous * How can you use it? (i.e. PROs, chronic diseases..) * Education / coaching - how do they fit in? * Use cases? A3 Notable Responses: Ceci Connolly (@CeciConnolly) Not an expert here but remote monitoring seems fundamental when you contemplate burden of chronic conditions in the US. Envision group appointments w/peer coaches, so convenient for patients Evan Kirstel (@evankirstel) With RPM we’re connecting from the patient to the clinician, as well as to the extended team, and especially to the family caregiver. Thoughts @ElectronicCare? Sachin Mehta (@SachinsWorld17) It will be ubiquitous #TelemedNow CoronaPandemic-pitt (@CoronapandemicP) During my rotations, I noticed that remote patient monitoring is already used in some hospitals to monitor them while being hospitalized. I cannot see why it cannot be extended. #telemednow CoronaPandemic-pitt (@CoronapandemicP) Already, some countries are using phone gps data for contact tracing. So, next logical progression is remote monitoring! #telemednow Ritu Thamman (@iamritu) A3. asynchronous feature is key to enable scale Education videos can be pushed & modified immediately Patient reported outcomes from designed survey questions can be texted to/fro Self-entered data such a BP or temperature can be integrated into the workflow #TelemedNow Ami Bhatt (AmiBhattMD) Asynchronous data leads to better #patient engagement and collaboration in care! #TelemedNow Ying Liu (@Yingiu40146323) Remote monitoring is great for to monitor some measurements (eg. BP or glucose) for chronic disease to achieve a better management. An efficient way to update and organize those data is needed to avoid physician burnout James Legan MD (@jimmie_vanagon) I have 11 years of #EHR data points such as blood pressure’s, weights, lab results that I can graph out&send either by way of #securetext or #patientportal before an appointment with a #securevideochat that can be helpful so folks can see response to their treatment #telemednow Q4 Store and forward platforms (the bread and butter of #TelemedNow). Examples are tele-rad, derm, ophtho, path.. * Do you use these? * Are they so routine they are just "medicine" * Have we integrated them enough? * Their use for 2nd opinions?

A4 Notable Responses: Jamey Edwards (@jameyedwards) #StoreandForward has a bright future in #Telemedicine. #Asynchronous #Telehealth allows for #timeshifting of #healthcare (like a #DVR does for #TV). #Email, #Chat & #Image sharing are key to its success. Apps like @captureproof who are doing great things CoronaPandemic-pitt (@CoronapandemicP) I think integration at this point is very poor. I have personally seen patients bringing loads of paper when visiting a doctor for second opinion and such. I also seen patients struggling to get their own medical records from hospitals! Ami Bhatt (AmiBhattMD) Imaging store and forward enabled a massive increase in #cardiology second opinions. Networks of care have been developed based on that #technology. When paired with #EHR #interoperability, what excellent high #quality complex #healthcare we can deliver! #TelemedNow CoronaPandemic-pitt (@CoronapandemicP) How about developing a centralized repository for all medical records like credit histories!!? May be telemedicine is a move in that direction. #telemednow

Q5 Last but NOT least, the new and innovative platforms? With #Covid19 there is market pressure to evolve. Thoughts good or bad? #TelemedNow * Do they innovate or distract? * Are they filling a need or just business opportunities? * If they lack #interop, still of value?

A5 Notable Responses: Jamey Edwards (@jameyedwards) #COVID19 has been a tremendous catalyst for #innovation in #healthcare. #Telemedicine in particular has benefited from rapid adoption. Patients & providers are building muscle memory w/ #telehealth that wasnt possible before. The genie is out of the bottle #telemednow Evan Kirstel (@evankirstel) Innovation? @HealthTap is offering a free US primary care doctor consult to anyone in the US with flu-like symptoms including millions who have no #healthcareinsurance! Andrew Watson MD MLitt (arwmd) I think there’s a lot we can do with new innovative platforms that are more lightweight. It’s a good time for us to see a wide array of offerings, as long as they have meaningful integration, especially with patient identification. @MyCommonHealth can help us. #TelemedNow Katie Fuentes (@KatielFuentes) Love innovative platforms but-as an engineer myself- hard to get compliant. Lengthy process. Great right now with exemptions being made but what happens when we go back to norm? #telemednow #pittcovidclass Ritu Thamman MD (@iamritu) Innovation is the lifeline of #telemedicine & will remain so as new needs are identified by our use #TelemedNow #CovidPittClass Sandeep Pulim (@SPulim) Combining VR + Telemedicine @XR_Health #telemednow

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