Sunday, May 9, 2021

Telehealth in the Post. Covid 19 era

The Covid 19 pandemic created many changes in health care.  Perhaps the most obvious one was the accessibility of telehealth caused by rules regarding distancing to prevent further spread of the virus.

Contrary to expectations medical offices and clinics were not overwhelmed with worried patients. Medical facilities quickly organized their office visit procedures, including personal protective equipment, careful scheduling, the use of text messaging to patients indicating when they could enter the office. Reception areas were emptied using the new format.

Online portals, and telemedicine removed the necessity for face-to-face visits unless absolutely necessary. Most practices that had adopted EHR in the past ten years were in good position to make a rapid pivot to the new norm.

CMS and private plans quickly began to reimburse for telehealth as well.  Although this may have increased reimbursements, the offsets for better care, and perhaps sicker patients more than offset this expense.  No facts have been released by insurers as yet.

UnitedHealth’s Optum To Broaden Telehealth Offerings In All 50 States

UnitedHealth Group’s Optum healthcare services unit has launched a virtual care business that is expanding telehealth across the U.S. with more specialized medical care providers and services.

UnitedHealth and Optum executives say they have already launched a product they are calling “Optum Virtual Care” that is live in all 50 U.S. states. The effort is “integrating physical care, virtual care, home care and behavioral care,” executives told analysts on a call with Wall Street analysts last week to discuss the company’s first quarter earnings and outlook for the remainder of 2021.

The move deeper into virtual care could have ramifications for smaller telehealth companies given the access to capital Optum has to expand and given UnitedHealth’s status as the nation’s largest health insurer and as a massive provider of medical care. On Monday, UnitedHealth rival Cigna’s Evernorth healthcare services business took a bigger step in the telehealth arena by closing on its acquisition of MDLive.

To compete, Walmart had to acquire telehealth business

“Walmart has had a slow roll out of physical clinics compared to other retail storefronts; they needed a partner to achieve national presence with their healthcare strategy,” Forrester Principal Analyst Arielle Trzcinski wrote in an email. “Without a comprehensive primary care and chronic care delivery model that met consumers in their homes, they would struggle to gain market share against others like Amazon Care that focus on convenience, as well as cost.”

Scottsdale, Ariz.-based MeMD was founded in 2010 by an ER physician, and offers virtual urgent care and behavioral health services. Currently, MeMD’s visits are priced at $65 for an urgent care visit and $230 for a psychiatry visit, according to its website.

At the start of the Covid-19 pandemic, the Centers for Medicare and Medicaid Services and private insurers made the timely decision to rapidly expand coverage for telehealth visits, throwing a lifeline to millions of Americans who needed ongoing medical care despite nationwide stay-at-home orders.

At the time, virtual visits done by video or by telephone were covered at the same rates as conventional, in-person office visits.

Since then, telehealth has become an indispensable part of the U.S. health care system, helping provide patients with safe access to medical care. While video visits have some advantages over telephone visits, they require access to technology, digital literacy, and broadband internet access that are far from ubiquitous. Telehealth access that includes telephone-only visits can help reduce certain health care disparities, as these low-tech visits provide access to essential health care for many whose alternative is no care at all.
A great concern is that payers will revert to old reimbursement restrictions for telemedicine visits. Those rules restricted telehealth visits to remote areas where physician access is limited.

This lifeline may be cut, as CMS has signaled it plans to end reimbursement for telephone-only visits when the public health emergency ends.

Thursday, April 8, 2021

Where are we now with the Digital Health Space ?

It has been some time since Digital Health Space began publishing. Electronic health records are in use throughout all of health care.  The process has been slow but inexorable. Let's take a look at where we are now.

The major vendors have outpaced many smaller companies, however, the smaller systems have found their own niche due to price constraints and the fact that many providers do not require very robust systems.

Large integrated health systems, including universities, and free-standing entities such as Mayo Clinic, Cleveland Clinic and others chose large robust systems.  CMS directed vendor models equipped to extract important data for outcomes and cost containment. Interoperability became common using proprietary health information exchanges built into the vendor system or by using independent Health Information Exchanges.   

In order to compete many smaller entities merged health information technology to gain financial ability to access these robust systems to compete favorably with large systems.  In some cases, these mergers grew into complete new entities.

EHRs are no longer just a digital record. The EHR is credited with creating physician burnout as physicians became clerks inputting data, which took considerable time away from patient care. Data and analytics became essential using machine learning for predictive diagnosis

The addition of machine learning, natural language processing, and language processing are decreasing physician workload. Image recognition recognizes normal and sorts abnormal or questionable images to physicians for definitive diagnosis.

Explosive growth in telehealth occurred due to the Covid 19 pandemic, in 2020. Health payors reimbursed telehealth visits. Telehealth saved the day permitting distancing for most physician visits. Texting became routine for controlling patient flow and waiting room access.  Podium and Sharp Health Care developed a texting system to improve patient communications.  Caregivers are able to seamlessly connect with all patients, from those who have recently visited a care site for the first time or long term patients who have a deep relationship with their physician. With Podium’s Review & Feedback tools, care sites are able to automatically invite the customer to leave a review via text or the messaging app of their choice. Research shows that fast, and easy-to-complete review requests are ideal, and result in more accurate feedback. This integration will save caregivers’ time as well as increase the number and quality of their online reviews on Google, Facebook, Healthgrades and other key sites.
All of this allowed the merger of genomics, proteomics, and precision medicine using genetic engineering, CRISPR, and gene splicing.  Over the counter DNA analysis became common, with varying success to study gene pools and personal Ancestry.  The cost of these tests plummeted exponentially in the past ten years.

Not all is good, however:

Within six months of implementing a new EHR system at two urgent care clinics, clinicians' cognitive workloads more than doubled, according to a study published in Applied Ergonomics.

A news release on the study said researchers examined two urgent care clinics that are part of the Urbana, Ill.-based Carle Health Systems as they transitioned to new EHR systems.

Here are six key findings:

The increase in cognitive workload lasted for more than 30 months.

After two and a half years, the clinicians' cognitive workload remained very high, and the clinic's staff found the new EHR system more difficult than the previous hybrid system that used paper and computers.

Compared to nurses, clinicians reported greater increases in cognitive workload, including higher mental demands and levels of frustration.

Researchers said the data suggested that a portion of the increased cognitive workload resulted from having to use the new EHR system while they were with patients instead of after.

Minor design flaws like slow computer response times and the nonstandard labeling of tools negatively affected the users' perception of the system's usability.

At 30 months, negative usability ratings started to trend downwards. Researchers said the negative usability ratings may have gone back down to the rate they were before the new EHR was implemented if the study had gone on longer.
EPIC and CERNER have outpaced much of the HIT marketplace, favored by integrated health systems. 

1. Small community hospitals have reported the highest satisfaction rates with EHR vendors Meditech's and Epic's platforms, according to a recent KLAS Research report.

2. Tower Health transitioned its remaining hospitals and facilities to the West Reading, Pa.-based health system's Epic EHR.

3. Newport (Wash.) Hospital and Health Services went live on a new shared Epic EHR system on March 13.

4. Epic announced plans for March 17 to open a COVID-19 vaccination clinic for its nearly 10,000 employees.

5. Buffalo, N.Y.-based Catholic Health credited its $135 million investment in Epic as a driving force behind its vaccination program, helping to distribute nearly 12,000 vaccinations to healthcare workers and others in New York's 1A category since late December.

6. Epic and health insurer Humana moved ahead with the next phase of their collaboration to improve patient and provider communication and access to health information. The companies will add support for automated prior authorizations and member insights at the point of care to their jointly developed prescription benefit tool IntelligentRx.

16 hospitals, health systems seeking Allscripts, Cerner, Epic, Meditech talent

Wednesday, March 24, 2021

AIWA | Create Websites Using Just a Keyword

AIWA, what does that stand for?  It is another abbreviation for " Artificial Intelligence Website Assistant ".

By now most people have heard of Artificial Intelligence or "AI".  It is being used with varying success in healthcare and other industries.  It is by no means simple or easy to use. For some tasks such as facial recognition, or image analysis there are off-the-shelf applications that can be adapted for radiology, identifying patients for registration on electronic health records. 

Almost all medical practices, clinics, and hospitals have websites that provide information about your practice ranging from location, telephone numbers, services, telehealth portals, insurance information, and messaging access.  Websites are designed to work on smartphones, laptops. and desktop PCs. Windows,  or macOS.

AIWA also allows for building blogs. 

There are several scenarios where this inexpensive AI program can be useful. As a clinician, your time is very limited.  Unless you are a techie that enjoys code or wants to to try building a website I do not recommend using this tool yourself.  Despite being relatively simple it will not be using your best skill set efficiently. 

In 2021 most students have been required to use and learn computer skills. One of your recently hired employees can build a website for the clinic effectively with simple guidance.

AIWA | Create Websites Using Just a Keyword explains the process.

The choices are:

1. Build the website yourself without AI

2..Build the website yourself using AIWA.
3. Assign the task to an employee with relevant skills.

4. Hire a website builder to build the website.

Perhaps you have a website that is obsolete or your website no longer meets your needs. 

Some of the choices are very expensive such as hiring a web developer, and there are other website builders and programs to build your own website. The build-it-yourself sites such a WordPress, Squarespace, or Wix are widely used. WordPress is commonly used but is not simple or straightforward.  

The way your website is built and coded determines how fast your website loads and displays. AIWA determines this as it builds your pages.  Slow loading or non-loading means a reader will become impatient and leave. your pages with engaging. The first five seconds determine if the reader will continue.  No one enjoys watching "page loading' or watching an hourglass and spinning wheel.

The cost of AIWA is very inexpensive.

Wednesday, March 17, 2021

Amazon expanding Amazon Care telemedicine program nationally

In 2019 Amazon announced it would be entering health care.  It was a bold statement, and also vague.  Was Amazon planning on forming its own medical center, hire physicians and other medical personnel? The range of possibilities was endless 

The Amazon Biosphere in downtown Seattle with Amazon employees playing broomball in 2017. Amazon Care, the company’s telehealth operation, launched last year as a service for the company’s Seattle-area employees, but there are signs it’s on the brink of a massive expansion. 

Amazon rocked mail-order pharmacies by opening "PILL PACK" from an already existing mail-order pharmacy.  Its model fits nicely with the already existing Amazon business model. It was a simple step to add medications to Amazon's already impressive search engine, which rivals Google's global search algorithm...Other than obtaining physician authorization the addition was simple.  The software was already in existence.

Amazon's Pillpack delivery systems

Amazon is rolling out its virtual medical service Amazon Care for its employees in all 50 states and Washington, D.C., this summer, with plans to expand the offering to other employers later this year, according to a March 17 news release. 

Six details: 

1. Amazon launched Amazon Care, which offers telemedicine and in-person primary care services for the company's employees and their dependents, in September 2019. Initially only available to employees in Seattle, Amazon expanded it to all its employees in Washington state last September. 

2. The retail giant is now making the service available to serve other Washington-based companies. 

3. This summer, Amazon will expand Amazon Care to other companies and Amazon employees in all 50 states; Amazon will also offer Amazon Care's in-person service in Washington, D.C., Baltimore, and additional cities in the coming months. 

4. The virtual medical clinic offers a range of urgent and primary care services, including COVID-19 and flu testing, vaccinations, preventive care, prescription requests and treatment of illness and injuries. Patients can also schedule follow-up visits in their home or office. 

5. The Amazon Care app also provides patients with various engagement tools, including scheduling follow-up visits and receiving care summaries and follow-up reminders. 

6. Amazon attributed positive feedback for its virtual medical service to its focus on patients and their changing needs, citing instances during the COVID-19 pandemic in which the company offered pediatric vaccines in families' homes and helped patients evaluate their work-from-home setups to optimize joint and muscle health, according to a company news release. 

7. PILL PACK offers a unique pack in a roll-up container, or in a usual child safety bottle.

Clearly, this is Amazon dipping its toe into the health space, with others soon to come. Amazon Health Care Amazon has an app for that as well.

Amazon Smart Phone App for iOS and Android

More articles on telehealth: 
Telehealth utilized most by wealthy, urban Americans, study says
Doctor on Demand, Grand Rounds merge to form multibillion-dollar virtual care company 
Study finds most people are willing to use telehealth for sleep concerns

Amazon expanding Amazon Care telemedicine program nationally: 6 details: Amazon is rolling out its virtual medical service Amazon Care for its employees in all 50 states and Washington, D.C., this summer, with plans to expand the offering to other employers later this year, according to a March 17 news release.