Q1 What do we know about the effect of telehealth on chronic illness management?
A1 Notable Responses:
Jamey Edwards (@jameyedwards) #Telehealth allows for caregivers & clinicians to "have eyes on a patient" without
being in the same geography. This means more people can be connected to the #healthcare system in real time being
monitored for intervention.
Jim St.Clair (@jstclair1) Can provide a continuous flow of data and information about the patient to be far more
proactive and preventative in care #TelemedNow
Jagdish Patel (@jpkca) Reference article by @Lacktman
Andrew Watson (@arwmd) An excellent article from @Health_Affairs about chronic disease and self management
#TelemedNow https://bit.ly/2AJ6jEs "Ongoing management - .. escalation to telemedicine specialists.." "Customers
then connect to a qualified doctor via telemedicine"
Andrew Watson (@arwmd) At today's Senate hearing on #telemedicine, TY @jkvedar, @SenAlexander was quoting
884,000,000 visits / year in US, was looking for 20% of these being virtual in future. https://bit.ly/2N96R9u
#TelemedNow Such a need for this national perspective and leveraging SoMel.
bloomrhealth (@bloomrhealth) Shortens service delivery time
Evan Kirstel (@EvanKirstel) Telemedicine can improve chronic illness management by keeping patients in touch with
their providers, reducing the chances of a lapse in treatment and hospital readmission rates!
Helen Burstin (@HelenBurstin) Strong research evidence that #TelemedNow improves chronic disease management:
better symptom monitoring, improve access to specialists when needed, and reduces chance of exacerbation, ED visit
and hospitalization. Good stuff!
Ceci Connolly (@CeciConnolly) #Telehealth gives consumers more agency, makes monitoring more convenient &
enhances communication. Leads to better care coordination, which tends to lead to better outcomes. #TelemedNow
Ceci Connolly (@CeciConnolly) We've focused for so long on #telehealth as a convenience & fun shiny object but in
recent weeks my eyes have been opened to its power as a fundamental vehicle for vastly improving access to vulnerable
pops, including patients w/chronic conditions #TelemedNow
Matt Sakumoto (@MattSakumoto) Chronic illness mgmt with less office visits, more frequent “quick check-ins” - Helpful
with Diabetes (@omadahealth) and psych (many examples) #TelemedNow
allows 360 view of patient experience, medical care ongoing connection, real-time #healtheducation, facilitates 2-way
data exchange, plus patient coordination with #familycaregivers
wish as a #primarycare I can see all my patients make these changes
Ceci Connolly (@CeciConnolly) I am trying not to get too worked up about privacy/security of that stroll. Current
enthusiasm is awesome but will need #telehealth community to help shape future guardrails to protect patients, ensure
evidence drives decisions, outcomes tracked #TelemedNow
Ryan Louie (@ryanlouie) Agree. And I think #cybersecurity needs to be built into med school curricula and residency
Stacy Hurt (@stacy_hurt) And we patients want to see you where we are using #telehealth, like when I was too sick,
fatigued, and nauseous from chemo to even move from my bed but needed the support of my medical team
Salim Saiyed (@SalimCMIO) A recent study of 1,800 patients showed 83% patients would engage in #telemednow after
the pandemic. I think this is the key, patients want it. If we deliver care in the way that works for them, its going to have
Katie Bates (@katiebatesdnp) anectdotally the “no show” rate has been essentially zero with telemed as patients don’t
have to decide between 2-3 hour drive and a conversation with me. Keeps the “momentum” of med titration alive
provided you have some objective data. #telemednow
Matt Sakumoto (@MattSakumoto) I think it is a combo of 1) scheduling to actual appt latency (often pt will call and get
telehealth appt within days...vs waiting weeks for an in-person clinic spot), and 2) patient convenience (no time off
work, drive, park) #TelemedNow
Elaine Khoong (@elainekhoong) I also think we should recognize that due to shelter-in-place / loss of jobs, patients are
quite readily available at home. Unknown what will happen in a more steady state. We need to see if no-show rate does
truly improve (suspect it will, but should assess). #TelemedNow
Ritu Thamman (@iamritu) The no show rate was reported by the @PennCardiology group (A total of 2,940 patients
were scheduled during the study period. Of those, 1,339 (46%) had completed #TelemedNow encounter & 1,601 (54%)
patients had canceled/no-show visit) https://t.co/HTCzAxzjHr?amp=1
Helen Burstin (@HelenBurstin) From same Penn study: "The COVID-19 pandemic has been the great unequalizer,
revealing the many ways in which the American healthcare system fails to provide equitable care." Emphasized
inequitable outpt access to #TelemedNow
Kamala Tamirisa (@KTamirisamD) Inequitable care & outcomes there from are real: Factors that contribute towards this
- Language barrier
- Not comfortablew technology
-Poverty: lack of access to technology or embarrassment about showing their living conditions” (a pt’s story...)
Q2 How can we prospectively evaluate the benefits of improved quality, access and outcomes related to use of
A2 Notable Responses:
Jim St.Clair (@jstclair1) probably a good starting point with some meta-analysis. Moving forward, AI and other clinical
decision tools could help compile that information #TelemedNow
Matt Sakumoto (@MattSakumoto) Start with evaluating ACCESS first. Can’t assess quality or outcomes if the patient
Jamey Edwards (@jameyedwards) Need to find measurements targeted at quadruple bottomline:
˅Avg Cost per Encounter & Overall System Level Acuity.
Irma (@IrmaRaste) @jameyedwards is “quadruple bottomline” here = quadruple aim? That’s one of our goals at
Jagdish Patel (@jpkca) Following list can help us to follow Quality and out come data #Telemedicine
Rasu Shrestha (@RasuShrestha) Love that this list includes community and social services. Often missed, never
Helen Burstin (@HelenBurstin) Why it matters? Look no further than the Senate HELP Committee hearing today: Senator
Alexander: "Our job should be to ensure that change is done with the goals of better outcomes and better patient
experiences at a lower cost"
Shari Erickson (@SEricksonACP) We need to ensure that telehealth codes are fully incorporated into meaningful
performance measures - otherwise we will not be able to know these answers! #TelemedNow
Ami Bhatt (@AmiBhattMD) One of our first goals is to assess who is using #telemedicine and ensure equal access to care
the art and science of how we look at the new frontier Flexed biceps
Ceci Connolly (@CeciConnolly) Not surprised to see @SenTinaSmith embracing #telehealth. Our members in Minn are
leaders in improving access to coverage &care, including via #virtual options
Ritu Thamman (@iamritu) prospectively collect data through: (1) patient focus groups, interviews & questionnaires, (2)
healthcare, hospital and staff interviews & questionnaires, (3) routine quality improvement & service evaluation data
(4) Data registries https://twitter.com/CircOutcomes/status/1273345797615226881?s=20
Jorge Rodriguez (@translatedmed) Speaking of access to telehealth, 2 recent studies looking at this during COVID-19:
1. Primary care: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767244
2. Cardiology: https://ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.048185
Salim Saiyed (@SalimCMIO) I think the initial focus should be measuring patient satisfaction. There are already calls that
months. Great provider and patient feedback about improving access for vulnerable pop while keeping them safe @
June Ho-Kim (@junehokim) Nice primer on global #telehealth for maintaining access to routine/essential services during
Q3 How can we effectively integrate data from remote patient monitoring and peripherals (e.g., blood pressure,
glucose, and weights) into chronic illness management?
A3 Notable Responses:
Ami Bhatt (@AmiBhattMD) Bluetooth remote connectivity directly into electronica medical records is key for achieving
the ability to clinically manage the data that comes in
Ritu Thamman (@iamritu) Agree @AmiBhattMD efficiency & lack of redundancy is the key aspect of the design of
#TelemedNow Need to be better not just have more data to deal with
Andrew Watson (@arwmd) Example of remote monitoring integrated into EHRs - #telemedNow Uses smartphones
Thumbs up https://bit.ly/2UPHUUB Education, questions, alerts, the core of monitoring. “Our patient portal has
consistently improved communication with patients, and as a result" Chronic DZs.
Katie Bates (@katiebatesdnp) Tech possibilities probably limitless but on the most basic level many pts don’t have BP
cuffs or scale and limited income to purchase. Exploring grants 4 large scale purchase of these. Staff “prepping” visit
with call day prior for vitas is helpful. #telemednow
Jamey Edwards (@jameyedwards) Agreed. Device pricing needs to come down to make them more accessible. Then
issue becomes one of making it cool to be healthy & turning devices into lifestyle items so people will actually use them.
Ritu Thamman (@iamritu) Dashboards data needs to be streamlined & efficient & visually digestable & payments for
RPM enough so onboarding & patient education on the program, the device supply, patient monitoring & management
of their condition all covered
Jagdish Patel (@jpkca) 1.All RPM datas need to managed using portal of RPM technology.
2. One staff has to log in daily and check the outliers
3. Call patients with abnormal numbers either on phone or A/V visit
4. Managing RPM data of 100 patients is not easy task
@bloomrhealth We are integrating various wearable and in-home device platforms using API's #TelemedNow
Janice Tufte (@Hassanah2017) Eye on the prize I heard today that our HealthCare Authority provided thousands of
phones, yep that is right, thinking our of the box
Ceci Connolly (@CeciConnolly) Important to focus on OVERALL health outcomes when discussing quality of care. Shifting
toward value-based model—with robust measures of total health—will give physicians flexibility to use whatever tools
Shari Erickson (@SEricksonACP) Not only does RPM need to be effectively used, it needs to be integrated efficiently - in a
manner that physicians can manage within their workflows. It can and will be a huge help for chronic care management,
but only if it is not overly burdensome.
Helen Burstin (@HelenBurstin) It sounds SO good to think about integration into EHRs, but how hard is it to do in
practice? for patients? for clinicians? Poll by @RasuShrestha still emphasized role of tech as rate limiter to
Jim St.Clair (@jstclair1) This focus of the EHRs the central point for all information and workflow has got to stop
Ami Bhatt (@AmiBhattMD) Such a challenge. However after systems have spent so much money on electronic medical
records, hard to see a way out. #TelemedNow
Lisa Levitt (@llevitt800) Agreed! RPM real-time #chronicillness connection also creates risk of information overload.
to industries with monitoring dashboards e.g. air traffic etc.
Connie Hwang (@hwangc01) Recent JACC article notes that true virtual care leverages RMD captured b/w visits to better
inform decision making and optimize care. Data like BP/HR/EKG changes, can be reviewed during a #TelemedNow visit
or trigger proaction by the care team.
Ritu Thamman (@iamritu) ”virtual care implies outcome tracking,not just “one-off/cross-sectional” visits..means adding
longitudinal care& engagement as part of clinical practice, following pt data,& using it to demonstrate short-term
outcomes,long-term adverse events, &care efficiency” #TelemedNow
Elaine Khoong (@elainekhoong) I think the tech solution exists for integration, but I'm unclear about who is going to
review this data? How that time be compensated? As a #primarycare clinician, my InBasket is already overwhelming. We
need support & time to review pt-generated data. #TelemedNow
Q4 How can we effectively integrate data from remote patient monitoring and peripherals (e.g., blood pressure,
glucose, and weights) into chronic illness management?
A4 Notable Responses:
small, insightful & actionable. Data should not only matter to clinician. Key is to make it matter to the patient to effect
positive behavior change and health.
Jeff Wessler (@jwessler) 3 views needed:
1 - patient facing to see trends, focus on one variable at a time
2 - clinician facing to view dashboard of multiple relevant variables with option to see granular data
3 - analytics layer to validate and query missing or abnormal data fields before presenting
Shari Erickson (@SEricksonACP) RPM can definitely help with greater patient engagement, but also need to be careful
not to make it overwhelming. Not only b/c of cost, but time and hassle burden too. Take baby steps to build habits.
Jagdish Patel (@jpkca) Having Tele-technology plus RPM could be somewhat intimidating for older folks and may not be
compliant with RPM. Keeping things little simpler will increase compliance #TelemedNow
access it. Building safe, secure networks that talk to each other needs to be major priority. #TelemedNow
Janice Tufte (@Hassanah2017) In WA state our Medicaid payment for telehealth is same $$ as a clinic visit. #Parity is
important if telehealth is to be a success #TelemedNow
Jagdish Patel (@jpkca) Anu one has any experience using #Telemedicine with help of home health care agency ?
Q5 How can telehealth with RPM encourage more patient engagement and chronic illness self-management?
A5 Notable Responses:
Janice Tufte (@Hassanah2017) If the opportunity is made available, I expect patients will be more than glad to
Matt Sakumoto (@MattSakumoto) Realtime feedback with “cause and effect” - Meal tracker+Glu+BP shows effect of
summer BBQ on PM Glu and BP the next day. Totally agree with gamification!
from remote devices ca n help guide #patient's decision making, but information needs to be digestible. @Livongo has
Ami Bhatt (@amibhattmd) Presented @CES with @ACCinTouch with @Livongo and was impressed with the
comprehensive nature of the system. We need to bring that kind of modeling to other chronic diseases as well.
Lisa Levitt (@llevitt800) RPM is great opportunity to get patients more interested in their own health. Provide real data
to see impact of certain lifestyle events and choices (what happens when I eat that food, don't get enough sleep, forget
to take my medication etc.) #TelemedNow
populations with #SDoH issues. Can also bring coaching (diet, cooking, fitness) & role models into underserved
Jagdish Patel (@jpkca) Benefits of Offering CCM Services in Your Practice
-Improved care for patients, improved patient satisfaction
-Increased payment for the practice for the coordinated CCM services provided.
Andrew Watson (@arwmd) #RPM is such a key area. https://bit.ly/2N8xBqI Outcomes from @UPMC @hysimhan
@AHauspurg RPM showing engagement of postpartum patients, remote #HTN management, management of a
potential chronic illness.
Salim Saiyed (@SalimCMIO) we build our next generation #telemednow platforms, this will be key. it has to go beyond
audio-video platforms. measuring & tracking outcomes will let us mature at much faster pace.
Ritu Thamman (@iamritu) design features, including a focus on culture, literacy, & numeracy will
˄Language preference data is also critical & frequently not mandated
˄repetitive gentle reminders (based on the nudge theory) behavioral economics will also
˄pt engagement #TelemedNow
Salim Saiyed (@SalimCMIO) by make it fun & engaging for patients
- by gamification so its entertaining
- #rpm doesn't have to be bunch of clicks or buttons a patient pushes
- points & rewards to constantly nudge patients to better behavior change
Ceci Connolly (@CeciConnolly) Keys to patient engagement: make it easy and meet their needs. If RPM is a way to do
that then patients will interact with the platform and their providers.