Telehealth for the internal medicine resident: A 3-year longitudinal curriculum

Telemedicine and remote patient monitoring are an increasingly prevalent form of healthcare delivery. Internal medicine residents must be adept in caring for patients utilizing this technology. This curriculum was effective in improving resident comfort and self-efficacy in providing care through telehealth and provided residents with hands-on opportunities through supervised inclusion in remote patient-monitoring services. This curriculum model could be employed and evaluated within other internal medicine residency programmes to determine the feasibility at institutions with and without advanced telehealth centres.

The full article can be downloaded below.  

Inside the 2019 Forbes Healthcare Summit

Healthcare is a $3.75 trillion dollar industry that touches every aspect of our lives. It’s also facing a number of challenges, from rising drug prices and the fragmentation of medical records to antibiotic resistance and more.

At the eighth-annual Forbes Healthcare Summit, which took place in New York City December 4-5, the brightest minds in healthcare converged to find solutions to these and other challenges facing the healthcare industry. Here, learn about key takeaways they shared on the future of healthcare for the brain, body and business.

Best Practices 

1. Eradicating the Mental Health Stigma - In an engaging discussion moderated by Dr. Mehmet Oz, media personality Charlamagne tha God, former congressman Patrick Kennedy, and NFL wide receiver Brandon Marshall discussed their own struggles with mental health and the importance of reducing the stigma around it so that people can get the help they need.
2. Replacing Antiquated Regulations with Market-Friendly Policies - Seema Verma is the administrator of Centers for Medicare & Medicaid Services, but she doesn’t think her office has all the answers in healthcare. “Government is not the solution, and government is often the problem,” she said. Her team spends a lot of time unraveling past policies that no longer apply to the way healthcare works today, she said.  Though Verma doesn’t always think government is the solution, she does think it can nudge the system toward more free-market principles—such as an increased emphasis on price transparency for medical treatments and drug prices.
3. Improving Patient Care with Better Data - Forty years after founding Epic, billionaire CEO Judy R. Faulkner shared a rare look inside the clinical database and healthcare software company. Considering the future of electronic health data, she predicts a Cambridge Analytica-esque challenge: the risk that family members’ data will be compromised by a members’ data authorization.
4. Saving Costs by Focusing on Primary Care - Moderator Moira Forbes joked with Sir Andrew Witty, President of UnitedHealth Group and CEO of Optum, about the mystery surrounding his company. “It is one of the biggest healthcare companies that no one knows anything about,” she said. Yet while many people may not know the inner workings of Optum, it touches millions of healthcare consumers across the U.S. What makes the company so profitable? A focus on efficiency without compromising patient care, Witty said.
5. Bring Technological Innovation to Emerging Markets - Partners in Health cofounder and Harvard Medical School professor Paul Farmer reflected on progress he made in 11 resource-poor countries the past 32 years, tackling widespread diseases like AIDS, tuberculosis, ebola and malaria. Asked what new technologies have been most critical in his mission, he emphasized that definitions of “technology” in healthcare should include vaccines, therapies and diagnostics—not just devices and gadgets.
6. Empowering Patients with AI and Telecommunications - How do you help patients make better health choices? Empower them to take control of their health with telemedicine, three digital health companies said. 

The full Forbes article can be viewed at this link.  

On the Digital Health Conundrum (Part I)

For a decade, digital health has been the supposed savior of the healthcare system, coming to drive healthcare into a data-first, low-cost industry worthy of the 21st century. Investors have poured over $30b into digital health since 2011 but what material change can we point to in health care costs or the experience of the average patient? Are there companies that qualify as major disruptors? To me, the answer is no. I call this the Digital Health Conundrum.

The full Medium article can be viewed at this link.  

5 Ways Technology Will Enable Value-Based Care in 2020 and Beyond

If your first thought while reading that statement was, “I’ve heard that before – and nothing actually ever changes,” your skepticism is well founded, as industry experts have been purporting significant transformation for at least a decade. However, I truly believe we’ve reached a tipping point, and that consumers will see real healthcare change in the near future. It’s a bold statement to make, but there are a few forces at work that I believe will make it true — namely, the intersection of value-based care and technological innovation. 

1. Digital Therapeutics: Engaging With Patients During Recovery 
2. Promoting Patient Wellness With Wearables 
3. Price Transparency: What’s The Cost Of My Care?
4. Healthcare, Personalized: Precision Medicine and Genetics
5. Dr. A.I. Will See You Now

The full Forbes article can be viewed at this link.  

Validation of use of billing codes for identifying telemedicine encounters in administrative data

Telemedicine is the use of telecommunication technology to remotely provide healthcare services. Evaluation of telemedicine use often relies on administrative data, but the validity of identifying telemedicine encounters in administrative data is not known. The objective of this study was to assess the accuracy of billing codes for identifying telemedicine use.

In this retrospective study of encounters within a large integrated health system from January 2016 to December 2017, we examined the accuracy of billing codes for identifying live-interactive and store-and-forward telemedicine encounters compared to manual chart review. To further examine external validity, we applied these codes and assessed patient and visit characteristics for identified live-interactive telemedicine encounters and storeand-forward telemedicine encounters in a second data set.

In manual review of 390 encounters, 75 encounters were live-interactive telemedicine and 158 were storeand-forward telemedicine. In weighted analysis, the presence of the GT modifier in the absence of the GQ modifier or CPT code 99444 yielded 100% sensitivity and 99.99% specificity for identification of live-interactive telemedicine encounters. The presence of either the GQ modifier or the CPT code 99444 had 100% sensitivity and 100% specificity for identification of store-and-forward telemedicine encounters. Applying these algorithms to a second data set (n = 5,917,555) identified telemedicine encounters with expected patient and visit characteristics.

These findings provide support for use of CPT codes to perform telemedicine research in administrative data, aiding ongoing work to understand the role of non-face-to-face care in optimizing health care delivery.

The full article can be downloaded below.  

Top 8 Predictions That Will Disrupt Healthcare in 2020

Every year, our team of futurists, analysts, and consultants at Frost & Sullivan's Transformational Healthcare Group comes together to brainstorm and predict the themes, technologies, and global forces that will define the next 12 to 18 months for the healthcare industry. We also retrospect how we did each year, and each year we are becoming more accurate in the predictions we make. For the 2019 predictions that were released in November 2018, six out of eight predictions realized as anticipated, while the two remaining predictions have not panned out exactly the way we thought.

The new vision for healthcare for 2020 and beyond will not just focus on access, quality, and affordability but also on predictive, preventive, and outcome-based care models promoting social and financial inclusion. As we are on the verge of entering a new decade of change globally, 2020 will be a reality check for long-pending national healthcare policies and regulatory reforms that must reinvigorate future strategies. China will continue to catch up to the US on some important health metrics as it strives to become the “world’s best and cheapest health system.” 

The top 8 predictions for 2020 are as follows:

1. SDOH analytics platform gains traction during 2020
2. AI develops more use cases and faces more ethical challenges, beginning with radiology
3. Annuity-based model to catapult gene therapy commercialization
4. Continued VC funding mega-rounds make 2020 a banner year for Digital Health Unicorns’ IPO exits
5. Interoperability by pure-play solution vendors will gain ground against standalone systems
6. Telehealth will gain mainstream adoption in the overall mix of healthcare services and will expand beyond the current focus on chronic conditions
7. Precision medicine-led approaches will pave the way for next-gen health data analytics solutions
8. 2020 will be a year of ‘Retailization’ for the healthcare industry, promoting the ‘Comparison Shopping’ consumer mindset

The full Forbes article can be viewed at this link.  

Impact of Pharmacist Involvement on Telehealth Transitional Care Management (TCM) for High Medication Risk Patients

This pilot study sought to evaluate the impact of pharmacist involvement in the preexisting telehealth transitional care management (TCM) program at Atrium Health on the quality and safety of the medication discharge process for high medication risk patients. Eligible participants were those 18 years of age or older with moderate-to-high risk for hospital readmission who were contacted by a TCM Nurse, identified as high medication risk patients, and referred to the TCM Pharmacist from September 2018 through February 2019. The TCM Pharmacist contacted patients by phone, completed a comprehensive medication review, identified medication list discrepancies (MLDs) and medication-related problems (MRPs), and made interventions or recommendations to primary care providers. Primary endpoints included the number and types of MLDs identified, number and types of MRPs identified, and the rate of unplanned 30-day hospital readmissions. Seventy-six patients were enrolled, and 78 MLDs and 108 MRPs were identified. Of the identified MRPs, 74.1% were resolved. A relative risk reduction of 36.8% was achieved for 30-day hospital readmissions for those with high medication risk contacted by the TCM Pharmacist compared to those only contacted by the TCM Nurse. Overall, TCM Pharmacists identified and resolved 80 medication-related problems, improved access to medication therapy, provided comprehensive medication counseling, and bridged gaps in care following hospital discharge.

The full article can be downloaded below.  

On-Demand Telemedicine as a Disruptive Health Technology: Qualitative Study Exploring Emerging Business Models and Strategies Among Early Adopter Organizations in the United States

On-demand telemedicine is a potentially disruptive innovation currently in the early adopter stage of technology adoption and diffusion. On-demand telemedicine must cross into the early majority stage to truly be a positive disruption that will increase accessibility and affordability for health care consumers. Our findings provide guidance for adopter organizations as they seek to deploy viable business models and successful strategies to smooth the transition to early majority status. We present important insights for both early adopters and potential early majority organizations to better harness the disruptive potential of on-demand telemedicine.

The full article can be viewed at this link.   

Artificial Intelligence Could Help Solve America's Impending Mental Health Crisis

Five years from now, the U.S.’ already overburdened mental health system may be short as many as 15,600 psychiatrists as the growth in demand for their services outpaces supply, according to a 2017 report from the National Council for Behavioral Health. But some proponents say that, by then, an unlikely tool—artificial intelligence—may be ready to help mental health practitioners mitigate the impact of the deficit.

The full TIME article can be viewed at this link.  

Prevalence and Factors Associated with Family Physicians Providing E-Visits

The use of telemedicine has grown in recent years. As a subset of telemedicine, e-visits typically involve the evaluation and management of a patient by a physician or other clinician through a Web-based or electronic communication system. The national prevalence of e-visits by primary care physicians is unclear as is what factors influence adoption. The purpose of this study was to examine the prevalence of family physicians providing e-visits and associated factors.

A national, cross-sectional practice demographic questionnaire for 7580 practicing family physicians was utilized. Bivariate statistics were calculated and logistic regression was conducted examining both physician level and practice level factors associated with offering e-visits.

The overall prevalence of offering e-visits was 9.3% (n 702). Compared with private practice physicians, other physicians were more likely to offer e-visits if their primary practice was an academic health center/faculty practice (odds ratio [OR], 1.73; 95% CI, 1.03 to 2.91), managed care/health maintenance organization (HMO) practice (OR, 9.79; 95% CI, 7.05 to 13.58), hospital-/health system– owned medical practice (not including managed care or HMO) (OR, 2.50; 95% CI, 1.83 to 3.41), workplace clinic (OR, 2.28; 95% CI, 1.43 to 3.63), or federal (military, Veterans Administration [VA]/Department of Defense) (OR, 4.49; 95% CI, 2.93 to 6.89). Physicians with no official ownership stake (OR, 0.44; 95% CI, 0.28 to 0.68) or other ownership arrangement (OR, 0.29; 95% CI, 0.12 to 0.71) had lower odds of offering e-visits compared with sole owners.

Fewer than 10% of family physicians provided e-visits. Physicians in HMO and VA settings (ie, capitated vs noncapitated models) were more likely to provide e-visits, which suggests that reimbursement may be a major barrier.

The full article can be downloaded below.