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Healthcare without borders implementation”


Q1: #Telemedicine is moving beyond phone and video;

✔What platforms do you know of/work with?

✔What are their advantages and areas for improvement?

A1 Notable Responses:

Jamey Edwards (@JameyEdwards) #Telemedicine is multi-modality. An enterprise #telehealth offering is a platform that

integrates Phone, Email, Chat, File Sharing & Video into a cohesive solution. It is now about matching the right

#technology to the chief complaint.

Andrew Watson (@arwmd) Platforms - I am convinced remote patient monitoring #TelemedNow will be the dominant

platform in the future. I project the following graphic, taken from one of my slides. @UPMCpolicy

#RPM - asynch, scalable, data driven. MUST have #AI built in. And very ptx friendly.

Helen Burstin (@HelenBurstin) The answer depends....practice size, pt pop, integration w/ EHR....probably need to KISS

(keep it simple….) for both clinicians and patients. The best platform is one that gets used.

Andrew Watson (@arwmd) That’s a good point about integrating phones and emails. The only challenge may be that we

tend to favor the easier technology which may not be the best clinical solution. Interesting.

Arti Bhan (@ArtiBhan1) Sort of telemedicine. More like remote monitoring. We look at insulin pumps and Continuous

glucose monitoring systems all the time. The downloads are getting better each time #Telemedicine

Stacy Hurt (@stacy_hurt) I am so encouraged by the future of #remotepatientmonitoring! Cannot wait to see how it

integrates with #telemedicine #TelemedNow

Nathaniel Lacktman (@Lacktman) Asynch still has lots of untapped potential. Most of the DTC asynch #telemedicine

companies have programmed their own patient facing platforms. Some B2B white label platforms include @Zipnosis

@BrightMD_Health

Ami Bhatt (@AmiBhattMD) Asynchronous Telemedicine plays a much bigger role in value-based care, or opportunities

where companies are trying to take on the health of their employees as @stacy_hurt was thinking about. #TelemedNow

Andrew Watson (@arwmd) Helen, do you think a platform has to be integrated with an #EHR? Or does it have to be

integrated with a payer claims system? Or both..... registration and documentation and identification outside of either of

these two is a challenge.

Janice Tufte (@Hassanah2017) Asynchronous videos, educational materials and printable handouts are still very

important and it is necessary they are understandable and in languages spoken locally. Also> Teams, Skype, Texting,

instant messaging and more too. #telemedNow

Helen Burstin (@HelenBurstin) Interesting @arwmd. Definitely need #AI built into #RPM, but how do we make it

happen? If we don't, we risk overwhelming already overburdened clinicians and patients.


Dr. Salim (@dr_salim_MD) Lot of opportunities to mature the video platforms. Beyond that

√ remote monitoring platforms

√ ICU /inpatient monitoring

√ texting/ chat bots all still need several iterations /versions to deliver on promise of #telemednow

Jamey Edwards (@jameyedwards) To me its not care its replacing but care support tasks...most of the menial repetitive

things that clinicians need to deal with. #AI should allow them to practice at the top of their license.

Ami Bhatt (@AmiBhattMD) Yes. If we are going to move towards having our systems aid clinicians in providing guideline

directed medical therapy, then we need to know more about the patient. #TelemedNow

Dr. Salim (@dr_salim_MD) Agree 100 %, it is all about reimbursement, which is non existent for async #telemednow.

physicians usually get on board

Stacy Hurt (@stacy_hurt) Maybe off topic, but I want to see how employers jump into the #telehealth game to decrease

costs for their employees- maintain their own platforms too?

Ritu Thamman (@iamritu) RPM as front-end screening tool ,triage engine for health care https://bit.ly/38YuD3E

˅ Dx of AFib, w possible ˄ thromboembolism (lockdown in ,47% ˅ new-onset AF) #TeleCheckAF centers

incorporate/implement @fibricheck via RPM #TelemedNow https://bit.ly/3p5EnP7

Helen Burstin (@HelenBurstin) Agree @iamritu. Afib is an excellent use case for #RPM. But will it work as well for more

complex medical conditions or patients with multiple chronic medical conditions? Goes back to need for #AI to support

getting key info from data #TelemedNow

Judd Hollander (@JuddHollander) RPM for the sake of RPM? We need more evidence. We have technology without

evidence #TelemedNow

Ritu Thamman (@iamritu) It’s already happening #TelemedNow @CircAHA an algorithm created by AI called MI3

(Myocardial Infarction Ischemic Index),w #MachineLearning, MI3 an individualized likelihood of MI, used to ID high-risk

pts who may benefit from earlier clinical decisions

Matt Sakumoto (@MattSakumoto) "Platforms = Legos" balancing Integration vs Flexibility. Identify key info flows, but

maintain backup modalities. The actual platform choice depends on cost, ease of pt access, ease of implementation &

maintenance #telemednow

Matt Sakumoto (@MattSakumoto) PreVisit Triage vital to Virtual Care scaling and success. Multimodality w/ ChatBots,

TouchTone Phone screening calls, Patient Portals all increase access and decrease disparities. #telemednow

Ritu Thamman (@iamritu) The European group led by @Dominik_Linz has >39 centers using #TeleCheckAF that

implements @fibricheck remotely via RPM app -impressive results to be published soon! @J_Hendriks1

Q2 To overcome the #digitaldivide, what action items are being taken to better engage at-risk communities?

A2 Notable Responses:

Jamey Edwards (@jameyedwards) Overcoming #digitaldivide requires better #broadband access, better #smartphone

penetration, #tech education & community onramps (at libraries & community centers) to #internet. This is necessary in

rural & urban areas alike!


Ami Bhatt (@AmiBhattMD) Is there legislation on the hill that we should be pushing for now to make #telemedicine

more accessible ? #TelemedNow @Cardiology @hmkyale @DrQuinnCapers4 @DocStrom

Andrew Watson (@arwmd) Disparities and #TelemedNow - https://bit.ly/3iD3zdp @AMIAinformatics

#jamia by @rumichunara 140 18 pxt who sought care at NYULH during acute pandemic period Mar 19 - Apr 30, 2020

Roots of disparate use are complex- reflect individual, community, and structural factors

Janice Tufte (@Hassanah2017) Fund local digital navigators / offer and cover audio only telehealth visits / offer

sustainable discount broadband options are all equally important to address the #digitaldivide in #TelemedNow

Stacy Hurt (@stacy_hurt) I’m HOPING in 2021 we see someone step up to provide universal broadband access as a basic

utility...#TelemedNow

Aditi Joshi (@draditijoshi) has to be community driven to improve patient trust and engagement. platforms in different

languages at front end. if healthcare/insurance becomes more widespread and pays for visits for all, that will help the

most. #sdoh #TelemedNow

Helen Burstin (@HelenBurstin) #Universalbroadband still needed! Important insights @elainekhoong on equitable

access to #TelemedNow, including pre-visit screening w/assist to access

.https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0123…

Andrew Watson (@arwmd) Yes and we said a hearty goodbye to our friend @AjitPai this AM. Always welcome to chime

in Ajit (as long as you don’t crow about your football team). #TelemedNow

Dr. Salim (@dr_salim_MD) we are working on it from several angles

√ engage the community #patients to assess #digitaldivide gaps. ( don't just assume what it is, what's needed )

√ partnering with #faith based organizations, @YWCAUSA, #nonprofit to create #digital access points to receive

#telemednow

Jorge Rodriguez (@translatedmed) I believe the latest COVID relief package includes support ($50) for internet access

for patients of low SES. It's not quite universal broadband, but it's a start. #Telemednow

Janice Tufte (@Hassanah2017) $75 for indigenous individuals too. Though this is not sustainable and the possible more

common lowest monthly bill that are being talked about are $15. In Seattle we have at least three $9.95 plans /25mbps

#TelemedNow

Ritu Thamman (@iamritu) ˄ Health literacy by 1. pay for CHWs @SpatzErica CHWs pay for themselves ˄ revenue in

getting more people on reimbursable telehealth platforms (i.e. televideo vs telephone) + ˅ ED visits + ˄ performance

metrics #TelemedNow http://bit.ly/3mZW7Lj

Nathaniel Lacktman (@Lacktman) April Mims of @wearehims is doing new work in telehealth equity. Amd @CTATech

launched the HEAL initiative last fall. #telemednow

Jamey Edwards (@jameyedwards) There are so many good infrastructure projects for the new administration to take on

:) Hoping #5G rollout and end points become more affordable! #TelemedNow

Andrew Watson (@arwmd) Does 5G solve the access issue in rural areas? I’m not sure it does. #TelemedNow

Jamey Edwards (@jameyedwards) Doesn't solve but significantly helps. Cuts down on travel for simple appts etc...Still


need to solve for what happens when in person visit is required and community lacks those resources. In time, we will

be able to push more care to distributed model.

Rasu Shrestha (@RasuShrestha) Data. Critical for us to risk stratify our populations and provide services that matter

most to individual communities. Context is king.

Matt Sakumoto (@MattSakumoto) ALL my fave ppl/orgs have deeply studied and piloted solutions in this space! Best

resource is “Telemed Health Equity Toolkit” https://careinnovations.org/resources/telemedicine-for-health-equity-

toolkit/…

Q3 What does #healthcare look like without borders / walls? Dare to dream ... let's hear it!

A3 Notable Responses:

Janice Tufte (@Hassanah2017) Timely evidenced based affordable healthcare offered in patient preferenced based

location and manner #TelemedNow

Stacy Hurt (@stacy_hurt) Please, please, PLEASE...second opinions for #cancer patients nowhere near an @theNCI

center who fall victim to community hospital siloed approaches which compromise care, outcomes, & QoL

#TelemedNow

Ritu Thamman (@iamritu) Culturally sensitive interventions needed for pt engagement -human factors are roadblocks in

delivering optimal Rx to patients #HealthTech may help engage patients in self-care, #EPICHF & #MYROAD h/t

@SpatzErica

Andrew Watson (@arwmd) No walls - #Telemedicine #TelemedNow - virtual first. Good article by @BeckersHR-

https://bit.ly/39WovIC “Virtual-first health plans: Keeping patients connected between #telehealth visits”

Aditi Joshi (@draditijoshi) no barriers from geography, connectivity, language to get best care where and when needed.

getting ability to understand better with addition of more specific health data to use for better patient care.

#TelemedNow also, the chat is drowning in gifs, who will win

Arti Bhan (@ArtiBhan1) No licensing requirements by state. Universal licensing. Capability to see my Canadian patients

without them having to cross the border. Ease of obtaining second opinions. #Telemedicine

Ami Bhatt (@AmiBhattMD) So many people would love this ... @Lacktman will state attorney generals object to

universal licensing? #TelemedNow

Resa Lewiss (@ResaELewiss) global health delivery. we do telemedicine ultrasound with @PURE_Updates

@DrTrishHenwood and @MSF

Rasu Shrestha (@RasuShrestha) Here's what we need to do: Move from episodic care, to continuous, ubiquitous,

always-on care.

Helen Burstin (@HelenBurstin) Healthcare without borders shifts care ≥ #TelemedNow & other virtual care This

"downstream” shift:

˄ access

˅ self-care

˄ prevention

˄ coordination


˅ costs https://lek.com/insights/care-distance-telehealth-expanding-beyond-borders…

Jamey Edwards (@jameyedwards) To achieve healthcare without walls we need more progress on #interoperability,

especially when it comes to patient data. True portability & the patient owning their record & granting access to

clinicians would represent a sea change of progress.

Ami Bhatt (@AmiBhattMD) Yes, and people are used to getting so many other services at home ... it's no longer a stretch

to imagine healthcare at home #TelemedNow

Jamey Edwards (@jameyedwards) And that's only going to improve over time. Hard to imagine, but think about a time

when homes may have a robotic surgery /procedure suite. Distributed #healthcare is the future...

Dr. Salim (@dr_salim_md)

√ first making it normal to deliver #healthcare outside in #home, #office, etc. w/ #TelemedNow

#virtual #primarycare #specialty center of excellence become common place

√ hospital at home accelerate

Irma Rastegayeva (@IrmaRaste) When it comes to #interoperability of #patient #data, our friends @Seqster have a lot

to say (and show) for it! #TelemedNow @EvanKirstel @eViRaHealth

Ritu Thamman (@iamritu) interoperability requires legislation #TelemedNow if patient is in charge of their data, &

healthcare systems must compete for that patient’s business, interoperability becomes a more attractive business

proposition.”https://bit.ly/3iGUtKY @rashmeeushah

Matt Sakumoto (@MattSakumoto) A Reimagined healthcare economy. The current “Ecology of Healthcare” incentives

are centered on acute/procedural care, while prevention is less emphasized. New models of care, new models of

payment will focus on “value and outcomes” not “location and volume”


Q4 What are the key elements to the foundation of a virtual practice?

A4 Notable Responses:

Ami Bhatt MD (@AmiBhattMD) We covered the advantages of stand alone vs integrated platforms (agility vs more

patient info) ... we covered connectivity ... how about the clinicians, is virtual care for everyone? Should it be?

#TelemedNow

Stacy Hurt (@stacy_hurt) A memorable, pleasant, & personalized digital #patientexperience #TelemedNow

Jamey Edwards (@jameyedwards)

1) Easy to Use & Affordable Tech...

2) ...That Molds to & Streamlines Existing Workflows...

3) ...Helps differentiate instead of commoditize...

4) ...with a highly evolved user experience for patient & provider alike...

5) w/ integrated language services ;)

Ritu Thamman (@iamritu) s-aided virtual care & RPM powered by predictive analytics & self-care

algorithms,asynchronous communication w patients, economics will focus on outcomes as part of value business model

will change from transactional to one that rewards continuous care #TelemedNow


Arti Bhan (@ArtiBhan1) Buy in from the patient and the care provider both. Seamless integration into daily practice and

real time elbow support for technical glitches. #Telemedicine

Andrew Watson (@arwmd) Ami, I strongly believe that virtual care will end up much like laparoscopy. It’s good for

people the majority of the time, you should always try it upfront. And it really helps people down the road.

#TelemedNow. Much less “invasive”

Aditi Joshi (@draditijoshi) it CAN be for everyone depending on what the patient, clinician or practice needs as it's only

delivering care virtually. It allows for improved consults/info/sharing of specialty/second opinions. Will it is a different

question. #telemednow

Nathaniel Lacktman (@lacktman) Meaningful. Clinically Appropriate. Legally Complaint. Scalable.

Helen Burstin (@HelenBurstin) Great question @AmiBhattMD. All clinicians will need to embrace virtual care, though it

may look very different depending on specialty and setting. Potentially more provider-to-provider telemedicine v

provider-to-patient telemedicine for some #TelemedNow

Resa Lewiss (@ResaELewiss) hardware software wifi standards of practice. Financial modeling

Jamey Edwards (@jameyedwards) #Telemedicine has the ability to significantly improve clinicians lives, allowing them to

practice from where they are, reduce friction in the encounter, see more patients and more. All of this could contribute

to reducing #burnout.

Jessica Spencer Castner (@DrCastner) Excellent point. Workplace violence is a major issue in my speciality, telehealth &

family presence for inpatients by virtual connections can reduce opportunities for these occupational exposures

#TelemedNow

Ritu Thamman (@iamritu) Many clinicians (heart) #virtualcare esp once they know how to ask the right questions &

know what is acute VS chronic so feel comfortable with triage- can offer flexibility to work from home & may ˅ burnout

#TelemedNow

Ami Bhatt (@AmiBhattMD) Getting a clinician to try their first virtual visit is key!

Janice Tufte (@Hassanah2017) Alot covered there, though this cognitive checklist could happen at every patient

encounter. #telemedNow

Dr. Salim (@dr_salim_md) the key is to start thinking of establishing a #telemednow virtual practice learned a lot with

our launch of full #virtual #primarycare https://bit.ly/2LHaTZF need dedicated physician, staff, workflows just like a brick

& mortar would

Q5 How do we implement #telemedicine & #digitalhealth on a large scale? What policies do we need to support

clinical decision making about #Virtual vs in-person care?

A5 Notable Responses:

Andrew Watson (@arwmd) This is such a good question Ami. I think a lot of it revolves around interoperability again.

Making sure that #Telemedicine is part of standard clinical workflow. It all seems to come back to the “I” word.

#TelemedNow

Jamey Edwards (@jameyedwards) Implementing #DigitalHealth broadly is about changing fundamental human behavior.


It's not just about great #technology, it has to be supported by change management, better policy, reimbursement &

incentives.

Janice Tufte (@Hassanah2017) Whatever appointment format is available ask the patient up front if they would prefer a

virtual visit or in person visit. Then inquire for more details which will prompt #CDM regarding medical visit details

#TelemedNow

Nathaniel Lacktman (@Lacktman) Give doctors freedom to use new technology in their clinical judgment, and have rules

emphasizing quality of care. #telemednow

Ritu Thamman (@iamritu) Pay for remote digital health tools :insurance/ government -pay for sensor-aided virtual care

&RPM -RPM shown to be effective in controlling hmgbAIC http://bit.ly/2XOd54d #TelemedNow -https://bit.ly/3caBf11

Home BP monitoring is more reliable than office BP/ABPM

Helen Burstin (@HelenBUrstin) If #TelemedNow is “virtual front door,” can we train clinicians to “prepare for and

escalate care when patient safety is at risk"? What is role of policies? Strong interest @TJCommission

Matt Sakumoto (@MattSakumoto) A Focus on the people and process. Not the Tech. Platform << Provider/Patient

support. Invest in a virtual MA or realtime onboarding support. Platforms as just the connector, not the solution.

#telemednow

Aditi Joshi (@draditijoshi) part of clinical practice by starting to use it and teach as part of #meded and its counterparts

for other HCW. not make it a separate entity but essential and all the way to spread (reimbursement/regulatory)

#telemednow

Dr. Salim (@dr_salim_MD) I think we need new #innovative models of #healthcare via #telemednow lets the

innovations be adopted across the board as a program. we need fewer policies, i am afraid policies will hamper

#telemednow

Ritu Thamman (@iamritu) ban “anti-steering” clauses in insurance contracts(practice “must use” Vendor X if they want

those claims paid)

- ˄ cyber security to tighten pay kickbacks for “leads” ie patient identifications& insurance information, of persons who

may need durable medical equipment #TelemedNow

Stacy Hurt (@stacy_hurt) Possibly a bit biased here, but I would love to see buy-in & #telehealth promotion/expansion

from all of the major patient #advocacy organizations - we would get some major fire power you have NEVER seen

passion until you see #patients out there for a cause #TelemedNow

Ami Bhatt (@AmiBhattMD) Education for #Telemedicine and #digitalhealth need to begin early and have a curriculum

the traverses med school residency and fellowship!

Helen Burstin (@HelenBurstin) Agree @stacy_hurt. If patients drive #TelemedNow, change will happen much faster!

Even more so, if we combine forces between clinical community AND patients!

Aditi Joshi (@draditijoshi) 100%! we certainly have all those levels at TJUH including our fellowship. the need for visit

standardization for quality assurance is now necessary as we take a step back after the rapid expansion. #telemednow

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