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The Telemedicine Hype Curve



#TelemedNow Twitter Chat Wednesday, July 8 – 8 PM ET Introduction & Welcome: Jamey Edwards (@jameyedwards) – Moderator The Telemedicine Hype Curve

Q1 After peaking a few weeks ago, usage of #telemedicine seems to be declining. What do you think is driving the decline? A1 Notable Responses: Ceci Connolly (@CeciConnolly) A recent @commonwealthfnd report touches on this: in late May we saw small rebound of in-person visits and stall in #telehealth usage. While this crisis has highlighted value of #telemedicine, can’t count on it to drive adoption. #telemednow Helen Burstin (@HelenBurstin) In a word: uncertainty. For clinicians -- will telemedicine payment stay in place? Will my patients continue to want to use #telehealth if they can come in person? #TelemedNow Andrew Watson (@arwmd) I used to think it was all cultural change, #TelemedNow. But lately there have been so many issues with technology and broadband access that this exposes a flawed business assumption. that assumption - we had technology and bandwidth. Interesting…. Jim St. Clair (@jstcliar1) lack of organizational commitment. Matt Sakumoto (@MattSakumoto) Pent up demand - lots of deferred in-person care so the % virtual care was bound to decline. Absolute #'s still much higher than baseline. Andrew Watson (@arwmd) https://www.bloomberg.com/news/articles/2020-02-19/where-the-u-s-underestimates-the-digital-divide Salim Saiyed (@SalimCMIO) Several factors X no clear guidance on permanent reimbursement X staff are feeling burned out on the effort for #telemednow set up √ pent up demand for in person #physician visit √ people are tired of being cooped up Ceci Connolly (@CeciConnolly) I hate to say this, but too many providers & hospitals are urging patients back to brick & mortar where there are opportunities for more fees. #coronavirus infection risk is real & med community shld lead on Ritu Thamman (@RituThamman) ˄ #TelemedNow means less $$ per visit. http://catalyst.nejm.org/doi/full/10.10… ˄ need active listening, empathic communication,& not seeming rushed ˄ Workflows have to be adjustment to virtual care & remote staffing. ˄ need Prompt response to pts' telephone & online-portal messagesKey JK Han MD (@netta_doc) * Poor infrastructure / support to continue * Institutions encouraging in-person visits * Uncertainty re: financial reimbursement Ryan K. Louie (@ryanlouie) I wonder if there's any effect from universities moving to all online and people wondering if tuition should be discounted. It might spill over to people thinking somehow that #telemedicine should be discounted compared to an in-person visit. #TelemedNow #parity Rasu Shrestha (@RasuShrestha) #Telemedicine shouldn't just be treated like a bandaid. It's a vital organ, and needs to be used and incentivized as such. Eve Bloomgarden (@evebmd) decline driven by administrators demanding reactivation of clinic. Employed physicians told they must do in person even when not best option for patient care. This is why usage declining. Unfortunately patient and physician satisfaction also going down w mandate #telemednow

Q1 POLL: What is driving #Telemedicine's currently decline from recent peaks? Q2 Clearly #COVID19 has been a catalyst for #telehealth’s adoption & served as the #innovation trigger (@gartner #HypeCycle) but as we move to the #newnormal, what do we need to do to for #Telemedicine’s “Trough of Disillusionment” to be more shallow? A2 Notable Responses: Helen Burstin (@HelenBurstin) Yes, access is increased for many who wouldn't not have had it, but we need to balance with need for in person care when appropriate. Patients need surgeries, screening tests, vaccines! #telemednow Janice Tufte (@Hassanah2017) Complementary to in person visits Jim St. Clair (@jstclair1) Just hold your arm up to the screen... Matt Sakumoto (@MattSakumoto) I wonder if there's any effect from universities moving to all online and people wondering if tuition should be discounted. It might spill over to people thinking somehow that #telemedicine should be discounted compared to an in-person visit. #TelemedNow #parity Janice Tufte (@Hassanah2017) The sharing of #TelePatients and #Clinicians unique success stories far and wide into cyberspace to spread the good news! #OneDropAtaTime #SpoonfulofMedicine Ceci Connolly (@CeciConnolly) Building a simple, consistent experience that lets users view and manage own data and care won’t be easy. But if we’re serious about making #telehealth a cornerstone of 21st Cent care, it’s the experience we have to deliver. Andrew Watson (@arwmd) @HelenBurstin pointed out in an earlier tweet, the provider financing is fundamental here. A second Covid peak could also change this equation dramatically. Helen Burstin (@HelenBurstin) Don't think #telehealth is in trough. Given meteroic rise at start#COVID19. likely now on somewhat shaky upward slope of enlightenment. With trough - tech fails, implementation fail to deliver On slope: benefits getting more clear, more pilots, some caution Salim Saiyed (@SalimCMIO) besides all the great points - √ hiring #virtualist i.e dedicated #physicians √ More staff training √ dedicated patient #telemednow help centers or call centers Pete Metzgar (@PeteMetzgar) Getting the word out, ease of use, more pilots, education the community. Choosing the right technology for everyday devices that make it easy. I don’t believe we are in a trough. Matt Sakumoto (@MattSakumoto) High touch can be high emotional connection too - not just physical touch. I sometimes focus better during telehealth since I'm not triangulating computer, desk, patient, exam table like I would in clinic #TelemedNow Ceci Connolly (@CeciConnolly) Our research w/ @AMCPorg shows high satisfaction w/ #telehealth: So focus should be on getting drs & consumers to TRY it. Let’s make it as easy as possible. Can we integrate/mirror tools people are already using in daily life in an interoperable-friendly way? Jamey Edwards (@JameyEdwards) #websidemanner and #empathy can be delivered via #telemednow. #palliativecare and other emotionally weighted encounters have been successful via #telehealth. Just need better training to build connection remotely. thoughts? Matt Sakumoto (@MattSakumoto) I don't even think THAT much extra training even needs to happen for tele-empathy. Just need expanded access and protected time and reimbursement. #TelemedNow Nick Adkins (@nickisnpdx) what if it wasn’t about the money? Andrew Watson (@arwmd) At some most basic level it will always be, fortunately I see almost 100% of MDs / nurses / care givers to be focused on patient care. #TelemedNow . That is what drives us forward, the care of our patients / members. A tricky topic indeed. Chad Ellimoottil (@chadellimoottil) I’m a huge fan of telehealth, but our field needs to stop relying on satisfaction as a metric of success. Patients will generally say that they are “satisfied” with any healthcare they receive, whether or not it’s true. We need better measures of experience. #Telemednow Sam Lippolis (@samiamlip) Trough of disillusionment can also be because providers are givers that thrive in high touch environment. How do we help more providers see that #telemednow can be high touch and it's not to replace in person. It's to get the right person and complexity in person. Jamey Edwards (@jameyedwards) training and #meded. reversion is because that is how MD's have been trained that "hands on body" is required. New physical exam could be remote using local hands :) Requires shift in mindset and education. Helen Burstin (@HelenBurstin) While we to make virtual care > part of med ed and residency training, we also need more virtual physical exam tools that can reassure clinicians that they won't miss things with #telehealth Matt Sakumoto (@MattSakumoto) If you have any societies actively studying this I'd love to connect! Been thinking about safe ways to deploy the new Virtual Physical Exam since our shift to telehealth #digitalBates Andrew Watson (@arwmd) Can you clarify your virtual exam piece ? #TelemedNow Very interested. Matt Sakumoto (@MattSakumoto) Used Ansary paper as a starting point, and then expanding to develop triage and diagnosis of Respiratory eval, The red eye, Abd pain, etc https://journals.sagepub.com/doi/abs/10.1177/1357633X19878330 Q3 Are there lessons we can learn from other industries that we can apply in #healthcare to ensure we don’t backslide to Digital Regression instead of continuing Transformation? A3 Notable Responses: Michael Archuleta (@Michael81082) Incorporating IT as a core component to the orgs strategy is not a tech makeover, but a business revolution! Your org needs to see IT as innovators and profit drivers! IT can no longer be considered a COST CENTER, but a STRATEGIC REVENUE CONTRIBUTOR! Michael Archuleta (@Michael81082) Start seeing your IT team as your INNOVATION TEAM! Ceci Connolly (@CeciConnolly) Banking & finance is obvious parallel. When I check my balance or pay bills online it’s not “e-banking”; it’s just banking. That industry focused on making it easy, reassuring users it was secure and integrating into way customers engaged. #telemedNow Helen Burstin (@HelenBurstin) Agree. The e-component was completely woven into the banking system. It's what needs to happen in healthcare. Ultimately, "virtual care" should just be "care.” Helen Burstin (@HelenBurstin) One example of a tech inside healthcare that stuck is e-prescribing. Why did it work? Important lessons for #TelemedNow? Clear benefit to patients, clinicians and pharmacists; $ Incentives for use; ease of use https://surescripts.com/images/default-source/company-initiatives/e-evolution-r10.png?sfvrsn=e5237eca_0 Salim Saiyed (@SalimCMIO) first step is #healthcare needs to be open up & learn from other industries Ritu Thamman (@iamritu) How about a self-contained #telemedicine station to assist addressing rural health care challenges #TelemedNow https://bit.ly/2Z8Twoh Need to be like service industry simple & never be asking for double documentation Salim Saiyed (@SalimCMIO) √ Need to make this exciting for patients √ Need to move beyond the basic audio-video for most #telemednow - think #zoom or #teams backgrounds, chat function, sharing links, etc √ aggressive investment in digital front door to make this simple for patients Pete Metzgar (@Petemetzgar) @redbox @netflix @Airbnb @Uber Here are 4 companies that #transformed the way we live life. Simple ideas changed the way we as people now use their services. #techcompanies can learn from solving the potential problems to fast forward adoption and #newnormal. Salim Saiyed (@SalimCMIO) Parterning with #community in #rural areas is key . They can help be #Liason and bring patients to #telemednow

the barriers are beyond just #ruralbroadband or #tech device

Q4 If closed systems like @VeteransHealth & @aboutKP have been able to move more than 50% of their visits to #Telemedicine, what is holding back the rest of the market?

A4 Notable Responses: Pete Metzgar (@Petemetzgar) 1. Reimbursement 2. Grants and Govt funding 3. Word of Mouth 4. Educating our communities Janice Tufte (@Hassanah2017) Underdeveloped common sense where #telehealth could be scaled #Health leaders,policy makers & politicos alike, all on board w accompanying strong #publichealth support #COVID19=SelfRisingBread VS #AncientSourDoughStarter #telemednow Ritu Thamman (@iamritu) no Payment parity ˄ employer sponsored( more folks out of work yet need telehealth ˄ related to billing (facility fee not collected during #telemedNow ˄ patients expect to “see” their doctors IRL :telehealth still feels substandard part of healthcare access Maram Museitif (@MaramMPH) At our (Federally Qualified Health Clinics) FQHC’s since the pandemic we had 70% of our visits via telehealth. Previsouly, those visits were not being reimbursed for I believe #Covid19 will move the needle. Ryan Louie (@ryanlouie) Could it be that alot of hospitals and clinics had to scramble to setup and deploy #telemedicine as compared to others who have had infrastructure in place already pre-#COVID19? Ceci Connolly (@CeciConnolly) Talked about this a little bit last q, but @aboutKP’s success was about culture shift. Integration made it easier, but only worked because integration rests on strong, trusting relationships between docs and payer side. Andrew Watson (@arwmd) The main feature that drives these two is the internal risk bearing / sharing. #TelemedNow Like many others including @UPMCnews @Intermountain that internal IDFS model is so important. VA and KP have more inherent overlap. Helen Burstin (@HelenBurstin) These systems also planned for #telehealth over many years. They didn't flip the switch with #COVID19. VA also saves money with #telehealth > $1 billion/year on transportation of veterans to and from hospitals #TelemedNow Jamey Edwards (@jameyedwards) #nailedit https://pubmed.ncbi.nlm.nih.gov/26305666/ Matt Sakumoto (@MattSakumoto) Yup! Savings in one arena have to be realized by the whole system. This level of integration, especially with payers is key. Is this the time to bring up bundled payments? #telemednow Maram Museitif (@MaramMPH) At our (Federally Qualified Health Clinics) FQHC’s since the pandemic we had 70% of our visits via telehealth. Previsouly, those visits were not being reimbursed for I believe #Covid19 will move the needle. #TelemedNow Jose Espinoza (@jose_l_espinoza) Are you also doing walk up #covid testing and converting folks to new patients if they weren’t originally part of FQHC? Maram Museitif (@MaramMPH) Due to the high cases in Travis County we are only testing symptomatic people. We also offer free Medical Access Plan for low income individuals who are in need of care. #TelemedNow Ceci Connolly (@CeciConnolly) While harder, those relationships can exist in any model. In fact, @CDPHP is having strong success implementing #telehealth in Albany, despite being entirely network. This is about shifting culture, methodology and perspective… and that means bldg trust. #telemednow Ritu Thamman (@iamritu) Bundled payments have been difficult in past because there’s a slippery slope where we start losing key reimbursement components ie in cardiology affected cardiac rehab which is greatly underutilized #TelemedNow Sue Woods (@SueWoods) #VA has spent years creating foundational digital health services, and aligning them - portal, mobile, telehealth, remote monitoring, automated texting.. And they’re still pioneering.. @VeteransHealth

Q5 Why have other countries been more successful in rolling out monitoring & #telehealth solutions to their populations vs. the US?

A5 Notable Responses: Sam Lippolis (@samiamlip) Nationalized Healthcare Systems that need to focus on wellness versus sickness. None fee for service Community health workers that triage up based on severity. Jim St. Clair (@jstclair1) I think it all goes back to so many countries not having a) multiple influencers on billing (single payer) and b) structural and societal limits on cost/expense/"profit". More effective solutions like #telemednow become natural. Andrew Watson (@arwmd) We don't talk enough about all the leadership by @OTNtelemedicine Ontario Telemedicine Network. Now Ontario health. With Ed Brown and his team this was and still likely is the lead example of telemedicine at the global level. Ed an @AmericanTelemed past pres. #telemedNow Janice Tufte (@Hassanah2017) Leadership who respected their #Clinicians and #Patients requests for change, care that saves time, complementary virtual visits supported by policy makers, change makers and stakeholders. #TelemedNow Jorge Rodriguez (@translatedmed) Broadband infrastructure and device access have been key. Compared to countries like S. Korea, we need more resources aimed and digital equity. Pete Metzgar (@Petemetzgar) #UniversalHealthcare Ritu Thamman (@iamritu) their #TelemedNow May not be employer sponsored -not related to billing -pt expectations: patients may expect #telehealth to be a standard part of healthcare access in other countries -different business models Lots of $$$ being spent in (Flag of United States) on wearables which may ˄ costs RE Lewiss (@RELewiss) We talked a bit about #Telemedicine in France and Sweden in a recent podcast episode: https://podcasts.apple.com/us/podcast/covid19-chat-dr-eric-topol-colleagues-on-opensafely/id1510254235?i=1000475756706 Salim Saiyed (@SalimCMIO) This is interesting insight on as use of wearables increase, it will inadvertently increase cost, and not necessarily improve outcomes! Ceci Connolly (@CeciConnolly) Sadly economics. Fee-for-service medicine drives US to more expensive, revenue-generating services. In-person typically triggers extra tests, procedures = more $ Q6 Can you think of #TelemedNow edge use cases that we haven’t heard of yet that can have a broader impact? A6 Notable Responses: Janice Tufte (@Hassanah2017) Assessing #SDoH factors, "Is there enough Food in the House?" "Are you able to make rent?" Could you share with me more about that fall ?" Matt Sakumoto (@MattSakumoto) I saw a great use for pre-op Virtual Reality program at @CedarsSinai to prep patients and surgeons. #TelemedNow Helen Burstin (@HelenBurstin) An edgy use case that hasn't gotten as much attention is the vast opportunity to innovate and improve home care and long term care. Major concerns surfaced during #COVID19 #TelemedNow could be important driver. Ritu Thamman (@iamritu) -Need to redesign clinical trials within telemedicine -need to prove whether or not the telemedicine actually increases our capacity to care for those patients that we really need to be seeing Squared vs those that don't necessarily need to be seen face to face Pete Metzgar (@PeteMetzgar) I have to believe that wearables are going to be a huge influence while adding horsepower(fastnfuriousWinking face) to the more enhancement use of telemedicine with millennials and progressive thinkers pushing on GenXrs and others to evolve healthcare even further! Salim Saiyed (@SalimCMIO) definitely need more #research in #Telemednow But can we learning while doing ? Salim Saiyed (@SalimCMIO) I think the edge is to take #telemednow to next level- √ #captions √ on screen #emojis to display #empathy, hugs, etc. √ closing the last mile #digitaldivide Andrew Watson (@arwmd) A big one and key one is pre-procedural exams / visits that would avoid a FTF unnecessary visit.

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