Provider and System Adoption

Updated: Apr 29, 2020

Tweetchat Summary

#TelemedNow Twitter Chat Wednesday, April 8 – 8 PM ET Introduction & Welcome: Ami Bhatt (@AmiBhattMD) – Moderator Provider and System Adoption

Q1 What #telemedicine platform are you using and what do you like or dislike about it?

A1 Notable Responses: Jagdish Patel, MD (@jpkca) we have our own cloud-based platform which is Chrome-based RTC technology but the limitation is not having smartphone-based app... everyone wants facetime equivalent solution as all rules are on sidelines including hippa #TelemedNow Helen Burstin (@helenburstin) Great point @jpkca. Now that CMS has relaxed rules, are there platforms that can accommodate simple apps like FaceTime? #TelemedNow Helene A. (@cyclene_a) That's a good question, with no answer. I'm a med student and have never been taught TeleMed platforms 😫 #Education #TeleMedNow #CovidPittClass Jackie Lee (@jacki3lee) Seconded as a med student! Wish we had more exposure. #TelemedNow Andrew Watson (@arwmd) I hear RTX is very cost effective and works well. #TelemedNow. Does it work well for you ? Ami Bhatt (@AmiBhattMD) So true, Vidyo, AmWell, Intouch, Zoom, all being used actively and have different qualities! #TelemedNow Ryan K. Louie MD, PhD (@ryanlouie) A1: @InTouchHealth at the hospital. #TelemedNow Ritu Thamman, MD (@iamritu) A1. Many different platforms out there ! Depends on your healthcare system #TelemedNow Both Epic and @InTouchHealth are great platforms.What really changes between settings is #workflow for specific use case Ritu Thamman, MD (@iamritu) A1. #TelemedNow needs to be adopted into med school curriculums - in 5 years #Telemedicine will just be #medicine Victoria Humphrey (@vshumphreyy) I've dabbled in Vidyo & good old fashioned phone calls through psychiatry Ami Bhatt (@AmiBhattMD) is a HIPAA compliant video visit system. Quick to unpack and use. Reasonable price point. Not integrated for most practices! #TelemedNow Andrew Watson (@arwmd) Telepsych is one of the great use cases. @PeterYellowlees is the national expert @AmericanTelemed swaggyt94 (@swaggyt94) Another med student here, the closest thing I've done to telemedicine was sit in during a robotic surgery Alex Stavros (@alexstvros2) Starting with integrating it into Medical School curriculums, it can become second nature to new physicians joining the workforce

Toniya Singh MD FACC (DrToniyaSingh) our biggest challenge has been to get our pts to download zoom or our present telemed platform, any suggestions on how we can get them on board, most( appropriately) dont want to come in and have trouble with technology

Q2: What keeps you or your colleagues from wanting to do #Telemedicine? How can we get more people to adopt #telemedNow? A2 Notable Responses: Evan Kirstel (@EvanKirstel) Lack of widespread #Telemedicine awareness has meant low widespread adoption Jagdish Patel, MD (@jpkca) It is funny that people hesitate using #Telemedicine but don't mind using #Hydroxychloroquine

Ritu Thamman, MD (@iamritu) #GrowingPains in adoption- make sure the camera Movie camera is ok , billing can be complex if not @CMSGov patient as not all commercial insurances are reimbursing Helen Burstin (@helenburstin) Now that payment issue being addressed (though still need parity for telephone visits), there are many myths to bust. Great article in @nejmcatalyst today by @JuddHollander offered some good advice. Jagdish Patel, MD (@jpkca) My patient population is mostly medicare above 75 and many of them have chronic problems so for them to use technology is difficult. Many time having family member connecting to tele platform is help full #TelemedNow Vivianne Oyefusi (@viv_oyefusi) Fears of telemedicine being used to push out as much productivity as possible (at the expense of physician wellness) could also be a barrier to adoption. Andrew Watson (@arwmd) Right now providers want safety and access to patients. Ritu Thamman, MD (@iamritu) Critical point. So many lives can be saved by screening patients for #Covid19 & starting prophylaxis therapy( treatment guidelines changing daily) & also care for all the other non covid patients with chronic conditions #Telemedicine Sasha Safonova (@Safonova_AS) third year medical student! I think it is also a matter of disseminating the availability and information about telemedicine to patients who may be unaware of the opportunity. Laura (@Lauraupsom) As we further incorporate and develop new systems for #telemednow we should try to keep in mind how it might be able to be designed to improve our documentation work burden to improve wellness, + pt safety too Ami Bhatt (@AmiBhattMD) How about voice recognition during televisits to autopopulate some of the record with appropriate prompts? #TelemedNow now we are having fun!!! Q3 What are the most important factors for a provider or system to consider in selecting a #telemedicine platform? A3 Notable Responses: Evan Kirstel (@EvanKirstel) A3. Flexibility. #Telemedicine platforms should be able to integrate with a variety of EHR and third-party software systems, and business processes Michelle Nickolaus (@mjnickoluas) I think realiable video and ease of integration with scheduling in EMR Helen Burstin (@helenburstin) Does it really depend on the intended use? If intended for #Covid-19 triage/management, do we need to accept less than ideal platforms since no time for a learning curve? #TelemedNow Ying Liu (@YingLiu40146323) I am an MS3. I am not familiar with the current telemed platforms. I would imagine the important factors are all the basics - convenience, reliable, security, easy access from the patient end, and variable options for the patients, etc. Ami Bhatt (@AmiBhattMD) As technology is quickly advancing, the ease of integrating new tech should be considered when choosing and marketing new platforms. Andrew Watson (@arwmd) Integration integration and then integration. #TelemedNow. Ease of ordering, ease of documentation, no additional login...... Jagdish Patel, MD (@jpkca) We can also define the variation in technology for inpatient vs outpatient #Telemedicine Jennifer Co-Vu MD FAAP FACC (@DrJenniferCo_Vu) An ideal telemedicine system should be easy, available, accessible and efficient for both providers and patients. #TelemedNow

Q4 What digital health technologies will help you provide ideal care in the community?

A4 Notable Responses: Jackie Lee (@jacki3lee) Community members can definitely get access to home bp cuffs, glucose readings, basic vitals, even urinalysis strips that can with televisits.

CoronaPandemic-pitt (@CoronapandemicP) On my list of technologies, technology that facilitates physical exam would be a game changer.

Jagdish Patel, MD (@jpkca) Wearable technology will be great addition #TelemedNow Andrew Watson (@arwmd) For physical exams there are good peripherals. @TytoCare is a great example. There are many peripherals and more to come. With remote monitoring the exam doesn’t readily apply. Tricky it seems but in reality works very well. Ami Bhatt (@AmiBhattMD) So important to get to know the companies with peripherals and help them integrate well too! Katie Fuentes (@KatielFuentes) I'm cautious about getting tech giants in on the game but more remote monitoring in every day items that are HIPPA compliant would be awesome & accessible. (eg. integreated sensors into phone to amplify heart sounds via video) Jagdish Patel, MD (@jpkca) Good source of information: breckgamel (@breckgamel) Patients with #cysticfibrosis need #homespirometry, an oximeter and #scales. Unfortunately, at this point #homespirometry is not covered by insurance for most patients. Q5 What are your favorite use cases for telemedicine/virtual video visits?

A5 Notable Responses: Andrew Watson (@arwmd) I am biased, post surgical visits. Plus we do not have to bill for them! #TelemedNow. it is so much easier for patients to see me virtually then have to drive in and see me. They are of course always welcome to come see me in clinic. Evan Kirstel (@EvanKirstel) love what @addisoncare@ElectronicCare are doing with #virtualcare

Ritu Thamman, MD (@iamritu) #CovidFeverClinic - screening clinic for those with a fever Face with thermometer #TelemedNow Jennifer Co-Vu MD FAAP FACC (@DrJenniferCo_Vu) I have two fave uses. 1. Single Ventricle clinic - esp during Interstage when babies have high risk for mortality. Parents love #Telemed ! 2. Fetal counseling, esp for second opinion cases where fetal echo already done is adequate. Rafa Ifthikhar (@rafaifthikhar) Prenatal and postpartum visits would be ideal for #telemed! These visits are extremely important for maternal & child health outcomes and often poorly attended Ritu Thamman, MD (@iamritu) Can certainly assess SOB over #Telemedicine #TelemedNow both with listening to patient speak & seeing if using video their use of accessory muscles /ability to complete a sentence Q6 Does a video visit platform need to be integrated within the EMR? A6 Notable Responses: Evan Kirstel (@EvanKirstel) No, but why not? The benefits are clear and integration is increasingly plug and play Ritu Thamman, MD (@iamritu) Ideally should be integrated but currently not as important as efficiency of workflow. Jagdish Patel, MD (@jpkca) I prefer both as separate solutions. Andrew Watson (@arwmd) It is helpful but not critical.

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