#TelemedNow w National Patient Advocate Foundation

#TelemedNow Twitter Chat Wednesday, March 17 – 8 PM ET Introduction & Welcome: Stacy Hurt (@stacy_hurt) & National Patient Advocate Foundation (@NPAF_tweets) – Moderators “Patient Advocacy”

Q1: Do #patients and caregivers actually like #telehealth? Why or why not?

A1 Notable Responses: Ritu Thamman (@iamritu) Those that have tried it have liked it & esp promising that it crosses racial boundaries AA are most likely to report using telehealth because of the COVID-19 pandemic, particularly when they perceive the pandemic as a minor health threat Nathaniel Lacktman (@lacktman) Yes. Convenience. Immediacy. Leverage. Aditi Joshi (@draditijoshi) let’s hope so. But it has to be setup for success, the access, ability to get the care they need, tech, easy follow up, information exchange, and, as the necessary base, the patient/caregiver feels connected to the clinician Patient Empowerment Network (@power4patients) I’d like to think patients and caregivers do like telehealth although it is still an adjustment for many. Telehealth creates an opportunity for easier access to care and can save time in regards to transportation. #TelemedNow -Nykema Helen Burstin (@HelenBurstin) More from @JDPower survey of best practices for #TelemedNow that mirror good care in-person: spend enough time, issue resolved, follow up after visit, issue resolved!… Andrew Watson (@arwmd) Yes, yes and yes #TelemedNow. Patient truly appreciate it. Less travel. Great quality. Care at home. My satisfaction is always above 95%. Have done 620 consults personally. Helen Burstin (@HelenBurstin) Patients like #TelemedNow convenience (travel, time) and pts perceive docs as more attentive online (!), but dislike scheduling and tech. Stacy Hurt (@stacy_hurt) YES WE DO! #Telehealth in no way replaces face to face visits, but it is an invaluable, flexible, supplemental option. More must be done to educate on which type of visits can be done virtually #TelemedNow Ceci Connolly (@CeciConnolly) Hear this constantly from patients - no long drives, traffic, sick people in waiting room, old magazines. Safe, affordable Janice Tufte (@Hassanah2017) Mixed responses depending on who you talk with. Many PFC have appreciated the ease of care, less travel and time saved- others found it a challenge to communicate and were uncomfortable #TelemedNow Evan Kirstel (@EvanKirstel) The convenience and utility of engaging my doctor or nurse on my term Diverse Health Hub (@DHealthHub) I think patients and caregivers are adjusting and genuinely enjoying the ease of telehealth. Listen to care partner Susan and CLL patient Bob Bottega’s thoughts on how telehealth has improved their quality of life. Ceci Connolly (@CeciConnolly) Survey after survey shows consumers are happy with #telehealth. In the early days of COVID, polling we did with @amcporg found 89% of users were satisfied w/ televisits. #TelemedNow NPAF (@NPAF_tweets) Patients & caregivers like #telehealth and want more! In our most recent surveys, 80% of patients reported satisfaction with their telehealth visit - and 40% of them categorized themselves as "extremely satisfied" #telemednow Ginny Whitman (@GinWhitman) Absolutely and for so many reason! It’s success is that #telemednow looks a little different for everyone! Personal. Tailored. Secure. Dr. Salim Saiyed (@dr_salim_MD) yes they certainly like #telemednow Mostly cause of safe, less travel & save time There are certainly challenges, but benefits outweigh all the challenges Tricia Guay (@TBG_ACHP) As I patient, I like having #telehealth as an option. As a caregiver, wishing I had had this option for my Mom. Being able to join the appt virtually with her would have provided so many answers especially when I lived away from her. #TelemedNow @_ACHP Andrew Watson (@arwmd) and at home Evan. When folks are sick they don’t want to travel, you want to stay on your couch. Hence home #Telemedicine is humane. #TelemedNow @NPAF_tweets And @NatQualityForum @NCQA we value your input. Shereese Maynard (@ShereeseMayMba) Patients and caregivers buy into innovation that considers their needs foundationally, not as the subtext to the innovation. Telehealth offers convenience & coordination but falls short on decision making. #TelemedNow Caitlin Donovan (@ByCaitlinD) Agreed! There are so many family members who would love to be there in-person to advocate for their loved ones during appointments and #telehealth makes it possible. It's one of the most frequent questions I'm asked - especially during #covid19. #telemednow Judd Hollander (@JuddHollander) Lets recognize that not all patients like the same thing. There is a right time and place for different care delivery models that varies based upon patient preference. Do you agree? Ami Bhatt (@AmiBhattMD) Absolutely agreed. Blended care is the only way to go. There will be certain cases were virtual care is better, and there will be times when either the provider or patient prefers in person. That is ALL OK .. acceptance is the key to telemedicine success #TelemedNow Ritu Thamman (@iamritu) Agree & we need better roadmap with concrete examples to guide people about when to call VS sched an appointment VS go to urgi care, or wait: better triage algorithms- for care continuum Q2: How can we best incorporate case management and social needs navigation tools into #telehealth visits for a more complete patient assessment? #TelemedNow A2 Notable Responses: Ceci Connolly (@CeciConnolly) Our community health plans have found #telehealth BOOSTS care management. @AboutKP leverages telehealth for consults, @UPMC boosts care management w/ remote monitoring & @CDPHP found digital integration gives consumers more insight/power into own care. @_ACHP #TelemedNow Ritu Thamman (@iamritu) #TelemedNow IT help apps or digital navigators to help pts onboard Phone a digital friend- or a third party that logs into your computer and helps a pt check in or download an app etc or “share a screen” Pre visit check list/pt preparation by students/Mas Andrew Watson (@arwmd) A large part of case management should involve 3 way calls and dovetail in remote monitoring. This is all long term / longitudinal care. Janice Tufte (@Hassanah2017) #PatientPortals offering pre-appointment questionnaire that collects social needs information that will be followed up with during visit with next steps. b)PHQ9 + Social Needs = :) c) Utilize the waiting time on virtual calls to offer surveys on social needs- #TelemedNow Dr. Salim Saiyed (@dr_salim_MD) goes back to proactive planning - give access & training to #telemednow platform to case managers, social workers - plan joint #telemednow visit w/ #doctors or back to back - Ease of referral both push & pull from #patients - importantly try to streamline the workflow

NPAF (@NPAF_tweets) We've been using telephonic case management for decades and find we can adeptly address accessibility issues and others barriers. #Telemednow shouldn't just be about the camera - it should be about finding the right tools and people to get people the care they need. -AB Diverse Health Hub (@DHealthhub) Assessing a patient's needs beforehand, scheduling needs, a dedicated telehealth employee to assist patients with any questions they may have about telehealth, are they able to navigate this tool with help, figuring out what they need will help greatly. Stacy Hurt (@Stacy_hurt) I forsee a multi-step #telehealth visit with different members of a care team to get a more holistic view of a patient’s support system. Support can play a big role in chance of success for treatment. #TelemedNow Shereese Maynard (@ShereeseMayMba) The easiest way to incorporate case management into telehealth is to ask patients "how are you doing?" And mean it. The innovation doesn't have empathy; that's the job of the person using the innovation. NPAF (@NPAF_tweets) Patients miss seeing the rest of the care team when they have a #telehealth visit. In the future, we'd like to see pre-appt screenings, visits with financial counselors and other professionals who can help with social determinants of health. -AB #telemednow Ceci Connolly (@CeciConnolly) Can understand that; often PA or social worker is most beloved member of care team. Think there are ways to maintain those connections Helen Burstin (@HelenBurstin) Telehealth can pull social services and case management into the visit. Less phone tag, more direct interaction. Three-way calls should make life easier for the patient, the clinician, AND especially their caregivers! Eve Bloomgarden (@evebmd) we do this all the time for patients with diabetes - start with uploading the data, then appt with diabetes educator, then with physician and we communicate in real time and triage together. Can always bring someone in to office if needed. Aditi Joshi (@draditijoshi) improved care coordination because there is easier access not just for patients, but for clinicians, social services and other necessary parts of a care team. Imagine consulting SW and have them login and help within a certain time. The ED can’t always boast that. Greg Weidner (@DrWeidner) think beyond the “visit” as the unit of value and shift mindset and delivery model to continuous, collaborative relationships #telemednow Matt Sakumoto (@MattSakumoto) A standard #SDOH screener should be done on every pt (telehealth or in-person) but being able to send links to community resources like @UniteUsHQ @AuntBertha pre-post visit is a good way to use digital tools to connect pts #TelemedNow Ami Bhatt (@AmiBhattMD) Pre-visit work has been essential in provider adoption #TelemedNow Blake McKinney (@BlakeMcKinneyMD) Significant satisfaction and effectiveness happening with multi-disciplinary care team/navigation/pharmacy/financial/mental health counseling via asynchronous chat Ami Bhatt (@AmiBhattMD) This is right. We need to move from episodic to continuous care, not only for logistics and billing, but most importantly because we will be able to help our patients earlier in the course of prevention and disease. #telemednow Andrew Watson (@arwmd) And may impact disparities. Q3: What burdens of patient care has #telehealth effectively addressed? How can we avoid shifting new burdens to #patients? A3 Notable Responses: ACHP (@_ACHP) So glad that you brought up behavioral health, Janice. #Telehealth has been such a boon; helps bypass provider shortage, tamp down concerns about stigma and gives consumers a safe, comfortable place to get one of the most difficult kinds of care. #TelemedNow Janice Tufte (@Hassanah2017) #BehavioralHealth and past due appointment back log- #telehealth was a positive game changer during COVID19 Let #Patients chose how they want to receive care offer a variety of clinic visit opportunities #TelemedNow JK Han (@netta_doc) It has helped bridge the *literal* distance from patient to care. For many of our patients, this has meant no more 4 hour bus rides to and from a 15 min appointment. We are finally starting to meet patients where they are at. Ceci Connolly (@CeciConnolly) #telehealth is convenient, saves time & money, and VA research backs it up. Particularly important for rural populations, who don’t have easy access to clinicians. #TelemedNow Stacy Hurt (@stacy_hurt) Transporting my #IDD son to the doctor is nearly impossible for one person. And he has zero cognitive understanding of waiting, an additional challenge. A way to be seen remotely makes my life as his #caregiver easier. #TelemedNow Patient Empowerment Network (@power4patients) In one of our previous Activity Guides, we took a deep dive into telemedicine. We know continued education will be key in addressing telehealth issues. Check out this complete breakdown of telemedicine with Dr. Joe Kvedar: #TelemedNow NPAF (@NPAF_tweets) For 25 years, transportation has been one of the most common issues the case managers see at PAF. Telehealth eliminates this barrier so completely that it can even jump borders by allowing patients who are homebound to see the provider of their choice #telemednow -AB Diverse Health Hub (@DHealthHub) Telehealth has managed to ease the financial burden for many patients. Dr. Burnham from @cityofhope explains how telehealth can mitigate financial toxicity for #prostatecancer patients. Watch here: Nathaniel Lacktman (@Lacktman) Access to world class experts, regardless of geography. #telemednow Diverse Health Hub (@DHealthHub) As a #SickleCell patient, it's been really helpful to use telehealth. It's eased the burden of driving for me so I do not have to deal with pain, driving long distance to my doctor appointments. -Jemela Shereese Maynard (@ShereeseMayMba) Access, wait times, cost issues; it's all mitigated under telehealth Andrew Watson (@arwmd) And connectivity with broadband for underserved communities. Ami Bhatt (@AmiBhattMD) #telemednow success - access to experts - so much time/costs $$ - better patient education - make medicine a partnership not paternalistic anymore (you don’t come to me, we come together) Helen Burstin (@HelenBurstin) Telehealth should reduce burden on caregivers who may not have to take off work to go to doctor's visits. But let's ask them about caregiver burden! #TelemedNow Tricia Guay (@TBG_ACHP) Yes! Completely agree. Not just taking off work. What about family who lives out of town who can’t completely count on the loved one to remember everything the doctor says. I think this would also help the clinician. #TelemedNow Manju George (@manjuggm) Second opinion visits maybe great over #telehealth, if all the records can be shared over email & the pateint could email specific questions, which then the provider could answer at the virtual visit. If needed, a second in-person visit could be arranged Ami Bhatt (@AmiBhattMD) Amazing that getting records from other hospitals is still one of the biggest pain points of medical care in this country. Ginny Whitman (@GinWhitman) July 1 2021! We just need to make it til then! Health plans are working SO HARD right now to make this data exchange easier for patients Stacey Tinianov (@coffeemommy) Ah yes, the irony of discussing #Telehealth & eradicating the #digitaldivide for healthcare when healthcare insists on relying on fax machines to 'share' data. Meeting the patients where they are, without the data that everyone needs, would be a failure. #TeleMedNow

Q4: How is #telehealth failing to be all it can to serve #patients? What improvements can be made? A4 Notable Responses: Nathaniel Lacktman (@Lacktman) Better ways to tie #telehealth with a brick & mortar (or at-home care) experience. Better integration with RPM tech. #telemednow Janice Tufte (@Hassanah2017) I believe a # of patients felt that #telehealth is substandard to in person care. The more patients have opportunities to utilize telehealth the more comfortable they will become with it. Sincere questions about a patients wellbeing is a benefit and appreciated #TelemedNow Diverse Health Hub (@DHealthHub) Certain populations may not have access to telehealth dealing with Wi-Fi issues or lack of access to updated devices. There's also a concerning gap in digital health literacy. We can empower various communities through digital health equity: #TelemedNow Greg Weidner (@DrWeidner) Thoughtfully design models of care to build on the progress of the past year and deploy the right care from the right care team member via the right channel at the right time. Sometimes IRL, sometimes #telehealth (including RPM, asynch, learning, activation) Andrew Watson (@arwmd) Several ways we can improve #TelemedNow 3 way calls Video and RPM combined AI and transcripts like what @AbridgeHQ @ShivdevRao do. Dr. Salim Saiyed (@dr_salim_MD) good article from @RANDCorporation #telemednow grew most in wealthy + metro areas, leaving behind poor & rural 48 visits per 10,000 people rich area, 15 per 10,000 people in high-poverty areas Ceci Connolly (@CeciConnolly) need to be careful how we talk about this, because #telehealth isn’t really failing. Given policy and infrastructure constraints, it’s a fantastic way to deliver care. But there are ways we can improve it. #TelemedNow FIRST: Congress needs to make it clear U.S. is committed to #telehealth. We need to expand tele-provider pool and encourage investment in new tools; that only happens if it’s clear federal commitment to virtual care isn’t going to disappear with the virus. #TelemedNow 2nd: Equity is a major issue in health care, but #telehealth could help. We’ll need real investment in infrastructure. Lack of access to broadband/5G is a big hurdle, plus educ, ease of use #TelemedNow Helen Burstin (@HelenBurstin) Expect more "fails" with care provided by 3rd party #telehealth provider who doesn't know your clinical history v #telehealth provided as part of a continuum with usual provider. Do patients agree? JK Han (@netta_doc) The UX/UI on various platforms still need improvement. Holy grail for all platforms would be one button push for connectivity, easier ability to share info electronically (PDFs, images, med records), connectivity with #DigitalHealth devices. Ritu Thamman (@iamritu) Need access to internet Patients should have digital health equity there are barriers for women, older pts, pts whose first language isn’t English, & those with the lowest income so may #digital divide Manju George (@manjuggm) Patients can be asked what they prefer Imp to allow flexibility Some days you may want to meet a real person Ask & find out if they are OK with talking over the phone if Zoom runs into issues & verify phone #. This way, you can see over Zoom &hear over the phone Helen Burstin (@HelenBurstin) Completely agree @manjuggm. Patients and clinicians need the flexibility to use #telehealth when most appropriate to meet their needs and confirm it works for them Patient Empowerment Network (@power4patients) We MUST bridge the gap in digital health literacy. We have launched our Digitally Empowered™ course ( helping you become more tech-savvy so you can find info and support to empower you/your loved ones. #TelemedNow NPAF (@NPAF_tweets) Too often, patients feel all their needs aren't being addressed. We need to make sure that we're addressing the patient, not just the disease. #Telemednow Caitlin Donovan (@ByCaitlinD) Millions of Americans still don't have broadband access. When you look at gov data, the standard for "access" is so low as to almost be negligible, so official numbers are undercounted. We won't have truly equitable access to #telemednow until we address broadband access Andrew Watson (@arwmd) And JM this quickly gets into #interop. Ami Bhatt (@AmiBhattMD) #Telehealth gaps - access to video - failure to pay for value - lack of multicenter research - digital literacy education - inadequate workflows Ceci Connolly (@CeciConnolly) Good list, areas we all must work on to ensure #telehealth success broadly serving all David Lee Scher (@dlschermd) Telehealth needs to part of a continuum of care, supplementing consultations, patient portal data, and caregiver needs. Encounters should be able to be recorded. Reimbursement needs to be standardized across payers and states. #telemednow Caitlin Donovan (@ByCaitlinD) When my mom was seeing the cardiologist via #telehealth, he wanted her to buy a new Apple Watch for tracking - that's out of reach for most of us! Insurance is already behind on device coverage, so we all need to keep an eye on what happens as telehealth expands. #telemednow JK Han (@netta_doc) The inadequate workflows!! This became the #1 perceived barrier to #DigitalHealth in our recently published paper in @CVDH_journal… Ceci Connolly (@CeciConnolly) This is right. We need to move from episodic to continuous care, not only for logistics and billing, but most importantly because we will be able to help our patients earlier in the course of prevention and disease. #telemednow Q5: How can #patients work together with their clinical team members to maximize a telehealth visit? A5 Notable Responses: Helen Burstin (@HelenBurstin) Maximizing #TelemedNow visit similar to prep for any visit: Clinical team should share resources for #SDM. Patients should build questions. Patient Empowerment Network (@power4patients) As patients/caregivers you have to remember that YOU are the best advocate in the room. Learn how to make the most of your telehealth visit with this simple guide ( from our Thyroid Cancer Network Manager, Carly Flumer @carlyflumer#TelemedNow Stacy Hurt (@stacy_hurt) Like any dr visit, come prepared and organized ready to discuss your chief complaint with timeline. List of questions/medications are vital. Minimize distractions best as possible. #TelemedNow @NPAF_tweets Diverse Health Hub (@DHealthHub) : A phone call with a team member beforehand to address any symptoms, concerns they may need to discuss would be helpful. Work with the team by having a blood pressure cuff, thermometer, etc., other necessary tools for patient assessment, nearby and ready to use. #TelemedNow Caitlin Donovan (@ByCaitlinD) My favorite bit of advice before any appointment is to write down your questions ahead of time, with a big star next to the most important question you want answered. Say it once, say it twice! You can also email your provider ahead of time with those questions. #Telemednow Imua Project (@imuaroject) That's great advice to prioritize your most important questions and ask those first (in case time doesn't permit getting to all of your questions). Stacy Hurt (@stacy_hurt) Like any dr visit, come prepared and organized ready to discuss your chief complaint with timeline. List of questions/medications are vital. Minimize distractions best as possible. #TelemedNow

Ritu Thamman (@iamritu) submit their RPM data before visit so it’s all loaded into digital chart , have patient ask questions upfront to guide enough time to answer them, have pt prepare for physical exam ie wear a t shirt/open neck to check for JVD - take off shoes/socks to check for edema #TelemedNow NPAF (@NPAF_tweets) Telehealth is a great vehicle for making clear, detailed & goal-concordant plans for the delivery of services that support all the decisions we make along the way-AB #telemednow Dr. Salim Saiyed (@dr_salim_MD) - Helpful to have someone near you - okay to take notes - be prepared for an exam - be in quiet space - most importantly engage & enjoy during #telemednow visit Shereese Maynard (@ShereeseMayMba) Be open and honest with your doctor. White down any changes since the ladt visit. This us especially important for women Manju George (@manjuggm) Same as you would prepare for an in-person visit. List of ?s, plan of action till next visit Good to ensure they can call over the phone, if Zoom doesn't work the best Have a caregiver around who could answer ?s if needed --- Docs need licenses to practice.. Q6 Share your story! Submit the first name or initials of a patient/caregiver who is dependent on #telehealth remaining in place post-pandemic and why #TelemedNow Notable Responses: Ami Bhatt (@AmiBhattMD) Me. No joke. Adults with congenital heart disease live Miles away from the few ACHD centers in the country, and many are lost to follow up because of distance, time, cost, memories, health related anxiety and more. As their caregiver #TelemedNow is essential. @ACHA_Heart Helen Burstin (@HelenBurstin) The phrase "like any doctor visit" was said a lot tonight. Let's use this opportunity to reinvent care that works for patients - not just digitize broken processes! Andrew Watson (@arwmd) As an adult with ACHD I would really value #RPM. Said as a patient. Like others I use the @Apple iWatch and @AliveCor Stacy Hurt (@stacy_hurt) Stacy & Emmett H need telehealth to help minimize risk of germ exposure & make management of our overwhelming concurrent health and caregiving issues more manageable Ritu Thamman (@iamritu) DL pt of mine with end stage CHF & cannot travel to see me I still can hear his accent clearly ( he’s from Liverpool England) & #TelemedNow enough to keep him going at age 88 & out of the hospital Dr. Salim Saiyed (@dr_salim_MD) the list is too long, the family friend w/ MS mostly to remain safe, & a handful of MS specialist in the country #telemednow Diverse Health Hub (@DHealthHub) JW, Me! many times I'm fatigued or having daily #Chronic & #SickleCell pain and I just can't get around & of course being #HighRisk, germs are a nono! I'd love #Telehealth to stick around forever, for myself & many other patients who have the same issues. -Jemela Imua Project (@Imuaproject) Some blood conditions require so many labs, transfusions, and treatments on a weekly basis that having more #telehealth options for MD office appts would have improved quality of life greatly. #TelemedNow Ceci Connolly (@CeciConnolly) Reflecting on final question. If only my mother would have had #telehealth option for 14 years of caring for my father with #Alzheimers THAT would have been a gamechanger CME Information For #TelemedNow CME - the website to set up an account, register your cell and / or claim CME : If you registered your cell text the code to 412-312-4424 Tonight’s code for 1h of category 1 CME: DENQAN

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