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
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
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
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?
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
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
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.
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
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.
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)
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
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