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How Telehealth Can Improve Chronic Disease Management and Outcomes


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

https://foley.com/en/insights/publications/2017/03/new-resources-for-telehealth-chronic-care-

manageme#:~:text=CCM%20is%20another%20way%20health,ultimately%20reduce%20overall%20patient%20costs.

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

#chronicillness

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

Lisa Levitt (@llevitt800) #chronicillness is everyday life. Symptoms don't wait for office visits! Finally #TelemedNow


allows 360 view of patient experience, medical care ongoing connection, real-time #healtheducation, facilitates 2-way

data exchange, plus patient coordination with #familycaregivers

Salim Saiyed (@SalimCMIO) Patients are more #engaged in their #healthcare. We had one patient do a #telemednow

visit while walking outside, which is a great showcase to their #physician they were making active #lifestyle changes. I

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

training, to build a daily culture of security habits. #Infosec cybersecurity and #privacy are all key elements of patient

care. #TelemedNow

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

#TelemedNow

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

better outcomes

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

divide

- Language barrier

- Not comfortablew technology

-Poverty: lack of access to technology or embarrassment about showing their living conditions” (a pt’s story...)

- Illiteracy


Q2 How can we prospectively evaluate the benefits of improved quality, access and outcomes related to use of

#TelemedNow?

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

doesn’t have broadband or a smartphone. #DigitalDivide #HealthEquity #TelemedNow

Jamey Edwards (@jameyedwards) Need to find measurements targeted at quadruple bottomline:

˅Avg Cost per Encounter & Overall System Level Acuity.

˄#NetPromoterScore for #healthcare should improve. Downwards arrow#Physicianburnout

˅#Medicalerrors, unnecessary care and #defensivemedicine

Irma (@IrmaRaste) @jameyedwards is “quadruple bottomline” here = quadruple aim? That’s one of our goals at

@ACHT_USA @DrDaveLevien

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

unimportant.

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

despite #race, ethnicity or SES #TelemedNow

Andrew Watson (@arwmd) #telemedicine has questions unanswered, esp re #CHF + #RPM - #TelemedNow. But this is

the art and science of how we look at the new frontier Flexed biceps

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739893/


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

#telemednow costs less so insurance should reimburse less. We cannot afford a #TelemedNow pay cut.

Catherine Olexa-Meadors (@msolexa) #TelemedNOW being used by @AledadeACO practices for #TCM Services last few

months. Great provider and patient feedback about improving access for vulnerable pop while keeping them safe @

home.


June Ho-Kim (@junehokim) Nice primer on global #telehealth for maintaining access to routine/essential services during

#COVID19 from @ImprovingPHC @AriadneLab #TelemedNow

https://improvingphc.org/sites/default/files/Telehealth%20Services_PDF.pdf

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.

#ItsHipToBeSquare...healthy.

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

needed, including #virtualcare. #telemednow

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

#TelemedNow

Jim St.Clair (@jstclair1) This focus of the EHRs the central point for all information and workflow has got to stop

somewhere #TelemedNow


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.

Need #healthcaredata heirarchy of relevance so clinical risk stand out clearly. Avoid #alertfatigue #TelemedNow look

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.

https://www.onlinejacc.org/content/early/2020/05/28/j.jacc.2020.05.002?versioned=true

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:

Jamey Edwards (@jameyedwards) Aggregating #healthcare's #bigdata has remained challenging. Need to make data

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.

#TelemedNow

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

Ceci Connolly (@CeciConnolly) This is why #interoperability is a key issue: #healthdata is only useful if right people can

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 ?

#TelemedNow

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

participate, communicate #ChronicConditions and surrounding concerns with their Clinicians #telemedNow

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!

Jamey Edwards (@jameyedwards) #Telemedicine #RPM can be an empowerment tool if designed correctly. Feedback

from remote devices ca n help guide #patient's decision making, but information needs to be digestible. @Livongo has

clearly built successful use case around this for #diabetes. #TelemedNow

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.

#TelemedNow

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

Jamey Edwards (@jameyedwards) #Telemedicine can help level the cost of #healthcare & make it more accessible for

populations with #SDoH issues. Can also bring coaching (diet, cooking, fitness) & role models into underserved

communities. #disparities #socialdeterminants #healthequity

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) #obsetrics #pregnacy is a great #rpm #telemednow use case

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

˄engagement

˄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.

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