A Virtual Care Blueprint

How Digital Health Technologies Can Improve Health Outcomes, Patient Experience, and Cost Effectiveness

Robert Longyear

• Verlag: Productivity Press
• Jahr: 2021
• ISBN:
  9781000417296
• Auflage: 1
• Thema: Betriebswirtschaft
• Thema: Informationsmanagement

The Covid-19 pandemic prompted healthcare systems around the globe to quickly explore and subsequently adopt digital health technologies and virtual care models that had been slowly growing in mainstream acceptance throughout the decade prior. In particular, telemedicine use skyrocketed as healthcare organizations and governments needed to provide access to infection risk-free health services. Telemedicine has been around in its current form for nearly two decades but grew significantly in utilization after the rapid acceleration of internet and smartphone adoption in the 2010s, and again in 2020 due to Covid-19.

Beyond traditional audio-visual telemedicine modalities, newer, more advanced models of tech-enabled clinical services have begun to gain popularity. Fueled by ubiquitous modern telecommunication technologies (e.g., the Smartphone), a growing dissatisfaction with healthcare services among patients, and increasing chronic disease epidemics in developed countries, models like remote patient monitoring (RPM) and other hybrid virtual care models have entered the clinical toolbox. RPM-based care models can fill the gaps of transactional telemedicine in order to deliver longitudinal care appropriate for patients with chronic conditions. Despite the apparent recent acceleration of interest in and adoption of RPM-based virtual care models, substantial research exists on RPM covering patient reported outcomes, clinical effectiveness, and economic factors.

In A Virtual Care Blueprint: How Digital Health Technologies Can Improve Health Outcomes, Patient Experience, and Cost-Effectiveness, Robert L. Longyear III explores the science, frontline clinical perspectives, and potential impact of RPM-based virtual care programs. Seeking to provide evidence-based information on RPM and virtual care in a market flooded with marketing materials, Longyear provides healthcare leaders, clinicians, and policymakers a clear outline of these increasingly important care models for a modern healthcare delivery system.

1

Introduction

I walked into the bathroom of Union Market in Washington, D.C., around mid-February 2020. With the recent reports of a SARS-like virus circulating in China, I was wary of going to a place with such a large number of people. I made my way into line at the bathroom and waited—as one does. Shortly after getting into line, I noticed an employee of Union Market enter and move toward the sinks to look in the mirror. He coughed a few times and looked visibly sick as he proceeded to wash his face in the sink.

I quickly left the bathroom, found some hand sanitizer, and motioned to my friend outside that we should leave to go somewhere less crowded and not indoors. A few days later, the first confirmed cases of the virus, now named Sars-CoV-2, began to appear in the United States and other countries around the world. It took a matter of weeks for the virus, and its disease Covid-19, to reach the level of a pandemic.

As a respiratory disease, Covid-19 spreads rapidly between persons. To combat the exponential spread, public health authorities across the globe recommended societal lockdowns, social distancing, and mask mandates. With the lockdowns came paradoxical effects for healthcare systems around the world and in the United States. Some service lines that provide elective or non-emergency care saw forced shutdowns, while others like intensive care units and emergency departments were flooded with patients experiencing a wide variety of cardiopulmonary symptoms and distress.

Given the infection risk, healthcare organizations, clinics, and medical offices represented unsafe locations, and thus healthcare visit volumes¹ decreased rapidly (~60% reduction) at the beginning of the pandemic in the United States and globally. In-person services became unsafe—thus the health system, at large, turned to modern technologies to maintain connection with patients.

It’s been called a revolution, an unprecedented boost, a windfall, an accelerator, ten years of progress in a month, and Covid-19. For healthcare’s slow move to digital, the pandemic accelerated adoption and exposure to what could be the future. Call it what you want—telehealth, telemedicine, virtual care, digital health—whatever it’s called, the Covid-19 pandemic forced regulators and healthcare organizations to quickly mobilize technologies to continue providing needed care to patients as in-person services became unsafe.

To quote then Centers for Medicare and Medicaid Services Administrator Seema Verma, with regard to this topic, “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

Patients needed care and providers needed revenue to continue operating. Thus, in the midst of a pandemic, the immediate solution sat firmly in the provision of services remotely and via digital technologies—and that’s exactly what happened.

The reports all tell the same story. Electronic medical record (EMR) company eClinicalWorks reported an increase from 100,000 minutes of televisits on March 16, 2020, to 1.5 million by April 6, 2020, through their Healow telehealth brand. Similarly, data² from Epic Systems, another large EMR vendor, was published by Fox et al.(2020) showing a 300-fold increase in telehealth visits. In mid-April, the first peak of the virus in the US, telehealth visits represented 69% of all visits among health systems using Epic according to the data published by Fox et al.

Telehealth had been on the rise in the US, and globally, since the early 2000s. But a number of barriers to adoption made the growth of this care delivery modality slow. In 2020, Covid-19 forced health systems, regulators, governments, physicians, and patients to adopt.

As I lived through this event while writing this book on the topic, I was fortunate to have a front row seat to the growth, the challenges, and the opportunities now presented in the world of telehealth. At the same time, the period was marked by tremendous uncertainty, fear, and enormous loss. While a windfall for the digital health industry, Covid-19 wreaked havoc on all facets of society and on the lives of individuals. Intensive care units (ICUs) were filled to the brim with patients in respiratory failure. General Motors and other large companies began manufacturing ventilators. People lost their jobs. Hundreds of thousands lost their lives to a complex respiratory virus. And the population experienced incredible stress from fear of infection, grief, and an uncertain future.

In the midst of the early pandemic, I thought back to my life a few years prior. In March of 2017, my family was in the throes of the toughest year of our collective lives. My mom, a leukemia survivor of eight years, was hospitalized as her condition entered a state known as blast crisis where cancerous blood cells multiplied uncontrollably in her body. She was very sick and immunocompromised, and we were doing our best to support her on the journey. She spent months in and out of hospitals, clinics, and in our home-hospital room.

My first exposure to the world of digital health was during this time of great need. After months of inpatient care, chemotherapy, and a week-long ICU stay due to a treatment-induced heart condition, she was discharged home in mid-April to begin outpatient care. In an instant, we lost the 24/7 monitoring and access to a high level of hospital care. Set adrift on our own, we were forced to navigate a complex, comorbid care journey with limited face-to-face interaction with healthcare providers.

During the first peak of Covid-19 infections, I was tremendously thankful that we did not have to endure the tribulations of a complex leukemia care journey at the same time as a pandemic, where an infection would have added further complication to an already precarious clinical situation. At the same time, I felt the pain and the fear of those patients and family members fighting their own conditions during this time. With major disruption to inpatient and outpatient services and the risk of infection, adequate patient care was impossible.

Despite the widespread availability of digital tools, remote care technologies, telehealth, and other solutions in the market for years prior, our systems around the world were largely unprepared to manage patients when they were not physically located in a brick-and-mortar facility.

Realizing the immediate need and accelerating planned five-year digital transformation plans, health systems were forced to implement and adopt technologies. With new technologies being implemented in months rather than years, the digital health industry and virtual care models entered the mainstream.

But with great power and recognition also comes great responsibility for digital health companies, healthcare organizations, and policymakers moving forward. The power of virtual care and digital technologies in healthcare has not yet been realized. Beyond extending care remotely, these technologies have the potential to dramatically improve the effectiveness and experience for patients with chronic diseases like diabetes, hypertension, cancer, and depression.

**

My journey into and passion for virtual care stems from my time as a caregiver for my mom during a particularly chaotic, complex, and traumatic journey through the US healthcare system. I was 20 years old, had just finished my emergency medical technician (EMT) training, and was in the middle of studying healthcare management and policy at Georgetown University. Everything I have done since then has been driven by a deep desire to build a better healthcare future for patients with chronic illnesses. The story begins at a local hospital in Atlanta, Georgia.

I pulled the car around to the patient discharge pickup location at Northside Hospital. Sitting outside in her wheelchair, in the shade under the awning, was my mom and a few members of our family. I parked the car and walked around the side to help her stand and move into the back seat carefully.

This was the first time in my life that I had to help my mom physically move anywhere. She was a marathon runner, a fifth-grade teacher, and a Tough Mudder. But, after nearly two months in the hospital, the former athlete and daily manager of 30 twelve-year-olds had lost weight and mobility and needed a wheelchair to move any distance greater than five or six feet.

Moving her was awkward at first but became more routine as she and I both began to accept the new dynamic between mother and son. The interpersonal part of the support in her movement was far more of a challenge than the technique for me, as I had recently completed my training as an EMT and was well versed in moving patients—nonetheless, they certainly do not teach caring for and coping with a very sick parent in EMT class.

After helping her get into the car, we began the hour-long journey home through rush hour traffic in Atlanta. For a newly discharged patient with leukemia, it was a challenging journey—and one we would be making frequently in the months after her first discharge from the bone marrow transplant floor.

She moved into the downstairs guest bedroom where a durable medical equipment provider had installed a hospital bed that we thought might make her caregiving and positioning easier now that she was back home. Instead of having 24-hour monitoring and supportive care provided by highly trained nurses and techs in the hospital, she was home and her care was now our responsibility. In the health system world, we call this period in a patient’s journey the post-acute period.

According to the Medicare Payment Advisory Commission (MEDPAC), the definition of post-acute care is as follows:

Post-acute care (PAC) includes rehabilitation or palliative services that [patients] receive after, or in some cases instead of, a stay in an acute care hospital. Depending on the intensity of care the patient requires, treatment may include a stay in a facility, ongoing outpatient therapy, or care provided at home.

MEDPAC is an organization that has been commissioned by the US Congress to monitor and analyze Medicare spending to recommend policies and needed changes to the Medicare Program.

The post-acute care area is one of the most expensive and crucial areas of innovation in healthcare. That’s because it is a time of transition where previously critically ill patients are no longer being monitored by highly trained clinical staff. These transition points where the patient goes home are places where there is tremendous risk to health.

In this situation, my mom was in the hospital after intensive treatment for her chronic myeloid leukemia (CML). For the eight years prior to this hospitalization, she lived a relatively normal life aside from taking two pills a day, experiencing the side effects of those pills, and knowing that she was living with a dangerous disease.

In the years after her initial diagnosis, she was sent home with care plan instructions and a schedule to return for blood work on a semi-frequent basis. Her leukemia, in this situation, was in a chronic phase of the disease. Due to some phenomenal biomedical research on CML, the disease is managed with a unique class of small-molecule drug called tyrosine kinase inhibitors.

During this time, my mom was responsible for managing and ensuring that she followed her oncologist’s instructions related to her condition. When not between the four walls of her physician’s office, she was the sole responsible party for her own health and navigating her care journey.

Prior to her condition’s precipitous decline that lead to this particular hospitalization, she lived those eight years with little official health support other than occasional oncologist visits. She, like other patients with a chronic disease, was left to her own devices between those office visits.

This model of care is consistent across many other chronic, or life...

Inhaltsverzeichnis

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• Foreword
• Preface
• Acknowledgments
• Author
• Chapter 1 Introduction
• Chapter 2 Digital Health—A New Industry
• Chapter 3 The Smartphone and the Internet
• Chapter 4 Refocusing Our Collective Efforts: Addressing Health Risk Factors
• Chapter 5 Bridging and Adjusting the Setting of Care
• Chapter 6 Telemedicine: The Genesis of Virtual Care
• Chapter 7 Telemedicine: The Evidence
• Chapter 8 The Patient Relationship: The Softer Side of Virtual Care
• Chapter 9 Data Collection in Healthcare: An Overview
• Chapter 10 Wearables and Predictive Analytics
• Chapter 11 Remote-Patient Monitoring
• Chapter 12 RPM-Driven Virtual Care: Frontline Perspectives
• Chapter 13 Remote-Patient Monitoring Outcomes
• Chapter 14 Digging Deeper: RPM Outcomes by Condition
• Chapter 15 Payment and Policy
• Chapter 16 Digital Therapeutics
• Chapter 17 Furthering the Field and Adoption
• Chapter 18 Our Moral Responsibility and a Compass
• Chapter 19 Conclusion
• Index