Is Telemedicine Here to Stay?

Introduction & Welcome: Jamey Edwards (@jameyedwards) - Moderator

Is telemedicine here to stay?

Q1: As #telemedicine becomes further integrated into the daily care continuum, what opportunities for improvement

exist to make it an even better overall solution?

A1 Notable Responses:

Ceci Connolly (@CeciConnolly) Industry needs to make sure tools are accessible/easy to use and integrating tools into

interoperable EHR tools. Both give patients more control & make process easier—big wins for consumers.


Andrew Watson (@arwmd) I really think it is an operational model. @CeciConnolly and I heard @Prov_Health discuss

their operational model and “aggregated demand” to lay on top of it. Very interesting. @connectedmed @_ACHP

Make it easy to use and also patients to use. @JulieReisetter agree!!

Ritu Thamman (@iamritu) #Access to -Broadband/internet

-devices/syncing their wearables

-participation in research studies & health literacy

-help to set up & manage technologies/tech literacy

-no language barrier

Aditi Joshi (@draditijoshi) good evening all! better connectivity, more access to devices/apps that use telehealth,

improved language, use of #ai, better evidence based guidelines specific to telehealth and validated educational

competencies #telemednow

Andrew Watson (@arwmd) Aditi, are you saying connectivity being the issue, or patients unable to set up the device?

They are slightly different. #TelemedNow

Helen Burstin (@HelenBurstin) Huge opportunity for #telehealth is connectivity for all. - Too many vulnerable patients

still cannot access video. Time to support #universalbroadband legislation! -Too many video visits have to switch to

phone. Tech solutions should be simple to use! #TelemedNow

ACHP (@_ACHP) Tools should be interoperable, easy, accessible and work with existing systems. Convenience is a major

driver for #telehealth usage, so let's make it as convenient as possible. #TelemedNow

Connie Hwang (@hwangc01) We're probably seeing regression to new mean on #telemednow usage. Well-written blog

in @Health_Affairs back in Aug discusses how we're moving on from "Telehealth-by-Desperation" to slowly building true

confidence w/ the modality. @LoriUscherPines @_ACHP

Vince Kuraitis (@VinceKuraitis) blocking & tackling. Press Ganey analysis of pt satisf. surveys: When 3 key drivers were in

place LIKELIHOOD TO RECOMMEND = 96.3% 1) Video visit staff worked together to care for you 2) Ease of talking with

care provider over video 3) Video connection

Source: #TelemedNow

Salim Saiyed (@SalimCMIO)

√ focus on #patients, survey & improve the issues

√ build clinical protocols to direct patients to #telemednow

√ enhance outreach to #patients that have not used it

√ concentrated efforts on adoption of tech

Mo Elshazly (@mbelshazly) Integrate Objective data through physical exam and remote monitoring devices. Integrate in-

person and telehealth schedules. EHR integration

Stevland Sonnier (@StevlandS) Outreach: what can #telehealth do for you, the patient or provider? The possibilities are

enormous with telehealth. Concerted efforts like integrating RPM into care can improve everyday life & prevent hospital

re-admits, but we need to inform patients about these options.

Andrew Watson (@arwmd) Helen raises a good point,I am guilty as charged. I do convert some to phone calls, I just

don’t have the time to try to figure out the. #TelemedNow Today I asked my AA to call all patients three days prior to

clinic to make sure they have the app downloaded

Ceci Connolly (@CeciConolly) May seem basic but everyone must have easy access to #telehealth. Includes affordable

devices, robust infrastructure (broadband/5G) and digital literacy.

Eve Bloomgarden (@evebmd) Necessary for telemedicine and for the education of our children right now. This is an

urgent issue that deserves even more attention. #TelemedNow

Ritu Thamman (@iamritu) Allow the #Broadband Community Act to pass & close the loopholes that allow incumbent ISP

to block internet for communities that want to form their own networks rather than wait for the ISP #TelemedNow

@AjitPaiFCC @FCC

ACHP (@_ACHP) There's a reason we keep saying: #broadband is essential to effective #telehealth.

Jessica Spencer Castner (@DrCastner) Key concepts in telehealth as an opportunity to reduce access disparities, not

widen them #TelemedNow

Helen Burstin (@HelenBurstin) I hear this all the time from docs in practice. How can we effectively use our healthcare

workforce to assess patient connectivity and readiness for video visits? Let's assess connectivity as #SDOH


Matt Sakumoto (@MattSakumoto) Moving from disease prevention to health promotion - asynchronous (and patient-

tailored) diet plans, zip code specific exercise options (@_NowPow_), etc #TelemedNow

Jennifer Co-Vu (@DrJenniferCo_Vu) My MAs call ahead to make sure they take patients’:

- Temperature

- O2 Sat (home pulse ox)

- Heart rate (home pulse ox)

We also prefer to use smartphone so they can flip camera to show the baby/child for virtual physical exam!


Q2 Do you have any experiences where you have experienced a #TelemedicineFail? How could it have been avoided?

A2 Notable Responses:

Vince Kuraitis (@VinceKuraitis) Evidence: a #telemedicine visit can be a satisfactory SUBSTITUTE for an ER visit. A 2018

study found that that among patients who had contemplated an ER visit, 74% had their concerns resolved. American

Journal of Emergency Medicine #TelemedNow

Salim Saiyed (@SalimCMIO) We now have hundreds of thousands of #telemednow experience

√ most of its related to tech literacy - need to focus on outreach

√ the initial workflows might require optimization to make it easier for #clinicians

#patients expectations can be different for #TelemedNow

Ceci Connolly (@CeciConnolly) Personally? Minor tech hiccups - poor connection, lousy visual or sound and then frantic

to fix quickly. Drs and patients need time to adapt, learn

Andrew Watson (@arwmd) Many times the phone is broken or the app is not downloaded. Sometimes, I am late. I think

it will take us 1 to 2 years to train “society” how to use it. I remember early laparoscopic surgery having to explain it,

now almost all people understand it. #TelemedNow

Eve Bloomgarden (@evebmd) how much time do you have ? So many instances of waiting for a connection , video

freezing , converting to phone only etc #TelemedNow

Salim Saiyed (@SalimCMIO) Study reveals inequalities in telehealth usage across demographic groups

we really need to focus on these groups to make it better across

Andrew Watson (@arwmd) Vince, Interesting to see those stats prior to Covid. And, now that remote monitoring is

more capable, it makes you wonder if all ER discharges should not go on monitoring for some period of time.

@VivifyHealth @PittRCR Ps. LOL at “recovering lawyer”. #TelemedNow

Salim Saiyed (@SalimCMIO) and most times the #patients are not aware the docs are late, & its easy to lose attention

Andrew Watson (@arwmd) Salim, have you seen many technology glitches or other challenges on your side? I know you

are you are an Epic shop. #TelemedNow

Ritu Thamman (@iamritu) Need to keep teaching & sharing physical exam pearls via gifs & short videos ie difficulty

breathing should be easy to spot on #TelemedNow

Aditi Joshi (@draditijoshi) Depends on what is meant by 'failure' as w/out definition hard to say. Poor outcomes or

needing higher level of care? Inperson visit can be a failure if could have been done virtually, esp now when need less

exposure. #telemednow

Helen Burstin (@HelenBurstin) Totally agree @draditijoshi. There are "failure" with all care. Telehealth may have more

"failure” due to tech issues and digital divide, but same clinical issues related to limited interoperability #TelemedNow

Jennifer Co-Vu (@DrJenniferCo_Vu) I had an encounter when Pt’s computer audio wasn’t working. Solution: I called

their phone for audio and used computer for video. #Telemedicinefailsave #Telemednow

Matt Sakumoto (@MattSakmoto) Knowing when to bail is an important skill set for #Telemednow Both knowing when

to clinically triage to higher level of care - or make the jump to phone call @zoom_us and @doximity have great options

for in-app)

Stevland Sonnier (@StevlandS) Had an appointment a while back where the provider was looking at their screen and not

facing me. Easy to fix and understandable as they were just getting underway. But teaching providers #webside

ettiquette is helpful!

Matt Sakumoto (@MattSakmoto) To be fair, providers with their backs to the patient tending to the EHR is true in clinic

as well! #TelemedNow

Matt Sakumoto (@MattSakmoto) But with good webside manner we can literally flip the script and provide great

patient-focused care #TelemedNow

Jessica Spencer Castner (@DrCastner) Excellent point. Excessive documentation burdens are a productivity & staffing

drain that can place clinicians in unnecessary moral dilemmas—for both in person & telehealth care delivery. The Ethics

of Time: Care for Your Patient or Nurse Your Charts


Stacy Hurt (@stacy_hurt) Yes. I gave up after calling 3 times for a #telehealth appointment

Thankfully @jstclair1 and @RasuShrestha intervened on my exhausted patient/caregiver behalf. The biggest

#TelemedFail is when it isn’t available or offered #TelemedNow

Q3 With a $4.5bn fraud recently reported, how do we ensure that #TelemedNow is used in a compliant fashion and

not taken advantage of?

A3 Notable Responses:

Jessica Spencer Castner (@DrCastner) With more telehealth use & datapoints, payers can use & refine existing #AI

algorithms for fraud detection #TelemedNow

Andrew Watson (@arwmd) Helen and I were discussing us earlier, I wonder how it’s best to defined that point when you

pick up the phone. Just like a patient handoff. Or call in a code on the floor. #TelemedNow

Salim Saiyed (@SalimCMIO)

√It is on #payors to track & route out any fraud

√ there will always be bad actors, recognize it, & find them so they can be easily stopped

#telemednow remains and is safe way to receive care !

Ceci Connolly (@CeciConnolly) Important role for payers - hope all other upright citizens in #health sector aid in effort


Andrew Watson (@arwmd) @jameyedwards #TelemedNow do you know of any automated checkpoints you can put in

the technology to prevent fraud? How much of this is in identification issue versus an E prescribing issue?

Helen Burstin (@HelenBurstin) Like most healthcare fraud, it's concentrated in small # healthcare profs (~300) that took

advantage of #telehealth. To reduce fraud, we need to make the right thing the easy thing to do (e.g., e-consent)


Ritu Thamman (@iamritu) legislate interoperability: if patient is in charge of their data, & “healthcare systems must

compete for that patient’s business, interoperability becomes a much more attractive business proposition.”


Matt Sakumoto (@MattSakumoto) Fascinating - I never thought of #interop as a fraud deterrent, but it totally makes

sense! #TelemedNow

Jamey Edwards (@JameyEdwards) As #Telemedicine is digital, should be easier to track any anomalies and catch them

before they become and issue. Need billing technology and policy to catch up with care delivery infrastructure. :)

Andrew Watson (@arwmd) Jamey, do you think #AI will help here at all? #TelemedNow

Jamey Edwards (@JameyEdwards) I do. #AI filtering of the data and comparing to where payments should be can

definitely help find issues that require "intervention" that out of the realm of normal practice.

Helen Burstin (@HelenBurstin) Great point, @jameyedwards. Digital fingerprints can be very useful to detect fraud

Stevland Sonnier (@StevlandS) Use a telehealth compliance checklist to ensure dotting of i's and crossing of T's.

@FoleyandLardner has a sample framework and other resources to help guide telehealth practitioners.

Helen Burstin (@HelenBurstin) If you look at the recent fraud cases, very specific link to Rx unnecessary DME and

opioids. Safeguards will need to be put in place #TelemedNow

Andrew Watson (@arwmd) Helen, there has to be some sort of #AI detection that can track the outbound flow of DME

and medications from various providers. #TelemedNow I have a wireless camera on the side of my house that can detect

faces and email me. Batteries last for a year. So, ........

Matt Sakumoto (@MattSakumoto) Bringing my #DigitalEquity hat, we also want to make sure the #AI fraud detectors

don't preferentially disadvantage certain clinics and patients. #TelemedNow

Q4 Privacy & security remain broader market issues for #healthcare & other industries. What can we do to make sure

#TelemedNow can be used with even greater confidence?

A4 Notable Responses:

Ritu Thamman (@iamritu) conduct an effective #TelemedNow risk assessment

1. validate the minimum necessary resources installed to its attack surface (actual risk)

2.measure exploitable attack surface so that vulnerabilities that aren’t exploitable can be de-prioritized

Salim Saiyed (@SalimCMIO) Is the issue though with #telemednow platforms or really fraudulent billing?

Ritu Thamman (@iamritu) Platforms & Apps #TelemedNow

Kevin Fowler (@gratefull080504) Is there evidence to support that apps are used consistently? #TelemedNow

Helen Burstin (@HelenBurstin) Engage & educate clinicians AND patients on key actions to protect privacy/security, like

use of trusted platforms, authentication, HIPAA (beyond pandemic). Let's share toolkits and training videos. No need to

reinvent the wheel! #TelemedNow

Helen Burstin (@HelenBurstin) Time for a shared #TelemedNow resource center? New resource today from

@TJCommission on #telehealth.


Ginny Whitman (@GinWhitman) Such an essential component and only a few months away #july2021 #Interoperability


Stevland Sonnier (@StevlandS) The recent report by @NCQA @AmericanTelemed and @ConnectwCare provides key

recommendations for program integrity. Congress can direct funds towards agencies like HHS that can use AI and other

tools to improve fraud,waste, and abuse detection.


Salim Saiyed (@SalimCMIO)

- tracking claims across the states, systems, #providers

- comparing patterns & following through with special designated #telemednow anti-fraud resources

- systems that do correctly, should be transparent w/ their processes

Rasu Shrestha (@RasuShrestha) Keyword here is confidence. That’s the currency of trust. Solution? Spare no expense on

the tech aspects of privacy & security. BUT let the patient dictate the use cases. Inform, empower and enable.

Q5 Does #TelemedNow have more/less risk of failure vs an in-person visit? Why?

A5 Notable Responses:

Helen Burstin (@HelenBurstin) Not really more/less failure. Different kinds of failure. In-person visits have "failures"

related to long waits, more no-shows, expensive parking, etc. Telehealth "failures" related to tech issues, digital divide,

lack of training. All fixable! #TelemedNow

Vince Kuraitis (@VinceKuraitis) False dichotomy.

Jamey Edwards (@JameyEdwards) totally agree. this is about matching need with appropriate modality. For some things

in-person is most appropriate and others the telemedicine will be. Regardless, #telemedicine can be the

#DigitalFrontdoor for #healthcare and help people wayfind more efficiently.

Vince Kuraitis (@VinceKuraitis) Long run: #TelemedNow will be proven to be better for some patients/conditions. In-

person visits will be proven to be better for some patients/conditions. Hybrid health and care.

Salim Saiyed (@SalimCMIO) with any tech or process, initially it did have more failures. As #patients & #physicians

adopted, improved workflows, it is about the same. We need better predictors on failures or risk score, to proactively

intervene for #telemednow

Aditi Joshi (@draditijoshi) Same as before what is failure?! It depends on what you want your outcomes to be and your

goals. So having to go to your doctor when not necessary is a #fail #telemednow

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