In a COVID-19 hotspot, a physicians group deploys a free triage and telehealth tool | Healthcare IT News

 Olympia, Washington-based Physicians of Southwest Washington is taking advantage of a health IT vendor’s free tech in an effort to gain efficiencies in coronavirus triaging and to see patients remotely.



Physicians of Southwest Washington has been implementing health IT vendor Innovaccer’s COVID-19 Management System, a tool the vendor has been offering provider organizations free to help manage and care for patients during the pandemic. The state of Washington is one of the areas in the U.S, hit worst by COVID-19.

The system is designed to enable provider organizations to drive self-assessments by individuals, educate high- and medium-risk individuals on next steps, help individuals navigate to care, offer telemedicine and virtual-triaging capabilities to doctors, and track and trace high-risk populations.

Before and after
Tamra Ruymann, Chief of Digital Health at Physicians of Southwest Washington, first explains how her caregiver colleagues are treating patients now, and then how they will treat them with the aid of this form of triage and telehealth IT once they begin deploying it in the immediate future.

“One of our larger independent clinics has nine clinicians; this clinic currently is performing triage with patients when they call in for an appointment,” she explained. “They are providing parking-lot visits, in-office visits and telehealth visits using a popular audio/video platform that can be used with iPhones, Androids and computers. This triage is being done through a paper questionnaire that the front desk employees are completing with each call.”


"Using the system will allow this nine-clinician clinic to reduce the time of assessment, as well as the human error in risk calculation that is possible, and remove the paper-based workflow."
Tamra Ruymann, Physicians of Southwest Washington

Once triage is completed, employees have protocols in place that allow them to schedule the most appropriate visit type for each patient.

“This same questionnaire is the survey that is provided in the first step of the COVID-19 Management System,” Ruymann said. “The assistant, however, has an algorithm that allows for a low-, medium- or high-risk assignment for COVID-19, and can be used to help with visit-type determination. Using the system will allow this nine-clinician clinic to reduce the time of assessment, as well as the human error in risk calculation that is possible, and remove the paper-based workflow.”

Dealing with low-risk patients
Additionally, the front desk can use the system to generate informational links from the CDC that enable low-risk patients to be informed about how the virus spreads, how they can protect themselves and others and the importance of monitoring symptoms for worsening, she added. If a patient initially is deemed low-risk, the electronic survey can be sent to the patient via text message with a recommendation to take it daily so clinical staff can monitor the patient for worsening, she said.

“In another of our clinics, the only physician is working offsite and providing all care currently through telehealth or telephone visits for his patient population,” Ruymann explained.

“The determining factor for the type of visit is the technology available to the patient and their understanding or ability to use the technology. This requires time just to explain how to utilize the available audio/video systems, which can be abandoned due to lengthy processes for set-up.”

For this clinic, office staff currently are directing all patients with COVID-19 concerns or questions to the physician for communication, which requires a response from him for every call.

“The COVID-19 Management System could be used to send the assessment directly to the patients with smartphones for completion and risk assessment, and allow the physician to reach out to the medium- and high-risk patients, and move the outreach for the low-risk patients to the office staff,” she said.

Telehealth that is easy to use
Neither of the two clinics was set up with a telehealth platform. The COVID-19 Management System, she said, has incorporated a telehealth platform with simpler technology; the system involves the sort of audio/video capability included on a typical smartphone that will reduce the time to assist patients in app set-up.

Physicians of Southwest Washington already was a user of the Innovaccer healthcare IT platform. Its population health management department was provided two COVID-19 dashboards. These dashboards provide details on both confirmed and highly likely cases, as well as high-risk patient identification.

“Using this information, our care management team is working to implement remote patient-monitoring tools for the confirmed cases that are recovering in the home,” Ruymann explained. “Monitoring patients regularly using pulse oximeters and thermometers, along with outreach, will allow for the identification of patient-status changes requiring care-setting modifications and release of those who have fully recovered.”

With the high-risk patients, the care team is performing outreach to those most vulnerable and helping with items like medication, grocery and pet food delivery, she added. The provider organization can identify patients with multiple comorbidities and assist with everyday necessities in order to allow them the ability to remain at home, thereby reducing their risk of exposure, she concluded.

For information on the free COVID-19 management system, click here.










In a COVID-19 hotspot, a physicians group deploys a free triage and telehealth tool | Healthcare IT News:

Medi-Cal NewsFlash: COVID-19 Guidance for Telehealth and Virtual/Telephonic Communications

If you have Medi-Cal you can get telehealth services more than privately insured patients. but how many have broadband internet?

COVID-19 Guidance for Telehealth and Virtual/Telephonic Communications

• 
  Section I: Current Medi-Cal Policy for Enrolled Medi-Cal Providers: As outlined in the Medi-Cal Provider Manual (Medicine: Telehealth) and/or posted to the Medi-Cal Rates Information Page:
• Traditional telehealth modalities, i.e., synchronous two-way interactive, audio-visual communication and asynchronous store and forward, inclusive of e-consults
• Other virtual/telephonic communication modalities
• Section II: Current Medi-Cal Policy for FQHCs, RHCs, Tribal 638 Clinics: As outlined in various sections of the Medi-Cal Provider Manual (Federally Qualified Health Centers/Rural Health Clinics, and Indian Health Services Memorandum of Agreement 638 Clinics), and/or posted to the Medi-Cal Rates Information Page:
• Traditional telehealth modalities, i.e., synchronous two-way interactive, audio-visual communication and asynchronous store and forward.
• Other virtual/telephonic communication modalities
• Section III: DHCS’ Section 1135 Waiver Request Related to the Novel Coronavirus Disease (COVID-19), Submitted March 16, 2020
• Additional flexibilities and options relative to traditional telehealth modalities, i.e., synchronous two-way, audio-visual communication and asynchronous store and forward, inclusive of e-consults
• Additional flexibilities and options relative to other virtual/telephonic communication modalities

The majority of the Guidance has to do with arcane billing rulings and procedures such as CPT codes. The relative items include the need for telecommunications due to quarantine and isolation concerns.

SECTION I: CURRENT MEDI-CAL POLICY FOR ENROLLED MEDI-CAL PROVIDERS

Traditional Telehealth - Overview
For enrolled Medi-Cal providers, including but not limited to physicians, nurses, mental health practitioners, substance use disorder practitioners, dentists, etc., the below policy applies. Please note that this does not apply to FQHCs, RHCs, and Tribal 638 Clinics, for which the policy is described below.

• Medi-Cal providers may bill DHCS or their managed care plan as appropriate for any covered Medi-Cal benefits or services using the appropriate procedure codes, i.e., Current Procedural Terminology (CPT) or Health Care Procedures Coding System (HCPS) codes, as defined by the American Medical Association (AMA) in the most current version of the billing manual that are appropriate to be provided via a telehealth modality. The CPT or HCPCS code(s) must be billed using Place of Service Code “02” as well as the appropriate telehealth modifier, as follows:
• Synchronous, interactive audio and telecommunications systems: Modifier 95
• Asynchronous store and forward telecommunications systems: Modifier GQ
Please note that DHCS will use the telehealth modifiers to identify that the Medi-Cal covered benefit or service was provided via a telehealth modality for tracking and reporting purposes relative to COVID-19. As a result, DHCS requests that all providers ensure the appropriate modifier is included on all submitted claims.

Originating Site and Transmission Fee
The originating site facility fee is reimbursable only to the originating site when billed with HCPCS code Q3014 (telehealth originating site facility fee). Transmission costs incurred from providing telehealth services via audio/video communication is reimbursable when billed with HCPCS code T1014 (telehealth transmission, per minute, professional services bill separately).

Restrictions for billing originating site fee and transmission costs are as follows:

• HCPCS code Q3014 – Billable by originating site; once per day; same patient, same provider.
• HCPCS code T1014 – Originating site and distant site; maximum of 90 minutes per day (1 unit = 1 minute), same patient, same provider
• Originating site fees and transmission costs are not available for telephonic services.

SECTION III: DHCS’ SECTION 1135 WAIVER REQUEST RELATED TO COVID-19

Overview
DHCS has requested additional flexibilities in terms of the available modalities for delivering Medi-Cal covered benefits and services, as part of its Section 1135 Waiver. DHCS recognizes that in addition to traditional telehealth/telemedicine modalities (i.e., synchronous two-way interactive, audio-visual communication, and/or asynchronous store and forward/e-consults), as outlined in existing Medi-Cal coverage policy, there are extraordinary circumstances under which both face-to-face visits as well as traditional telehealth modalities are not an option.

Under these limited and extraordinary instances (such as COVID-19), DHCS recognizes the need for Medi-Cal providers – including but not limited to physicians, nurses, mental health practitioners, substances use disorder practitioners, FQHCs, RHCs, and Tribal 638 Clinics – to utilize other methods such as telehealth and virtual/telephonic communication to provide medically necessary health care services.

Unless otherwise agreed to by the MCP and provider, DHCS and Managed Care Plans (MCPs) must reimburse Medi-Cal providers at the same rate, whether a service is provided in-person or through telehealth, if the service is the same regardless of the modality of delivery, as determined by the provider’s description of the service on the claim. DHCS and Managed Care Plans (MCPs) must provide the same amount of reimbursement for a service rendered via telephone or virtual communication, as they would if the service is rendered via video, provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the member.

Other Virtual/Telephonic Communications
Medi-Cal providers, – including but not limited to physicians, nurses, mental health practitioners, substances use disorder practitioners, FQHCs, RHCs, and Tribal 638 Clinics, will provide and bill for visits consistent with in person visits using the appropriate and regular CPT or HCPCS codes that would correspond to the visit being done in-person, and include POS 02 and Modifier 95. The virtual/telephonic visit must meet all requirements of the billed CPT or HCPCS code and must meet the following conditions:

• There are documented circumstances involved that prevent the visit from being conducted face-to-face, such as the patient is quarantined at home, local or state guidelines direct that the patient remain at home, the patient lives remotely and does not have access to the internet or the internet does not support Health Insurance Portability and Accountability Act (HIPAA) compliance, etc.
• The treating health care practitioner is intending for the virtual/telephone encounter to take the place of a face-to-face visit, and documents this in the patient’s medical record.
• The treating health care practitioner believes that the Medi-Cal covered service or benefit being provided are medically necessary.
• The Medi-Cal covered service or benefit being provided is clinically appropriate to be delivered via virtual/telephonic communication, and does not require the physical presence of the patient.
• The treating health care practitioner satisfies all of the procedural and technical components of the Medi-Cal covered service or benefit being provided except for the face-to-face component, which would include but not be limited to:
• a detailed patient history
• a complete description of what Medi-Cal covered benefit or service was provided
• an assessment/examination of the issues being raised by the patient
• medical decision-making by the health care practitioner of low, moderate, or high complexity, as applicable, which should include items such as pertinent diagnosis(es) at the conclusion of the visit, and any recommendations for diagnostic studies, follow-up or treatments, including prescriptions

Sufficient documentation must be in the medical record that satisfies the requirements of the specific CPT or HCPCs code utilized. The provider can then bill DHCS or the managed care plan as appropriate. 

NewsFlash: COVID-19 Guidance for Telehealth and Virtual/Telephonic Communications: 

Containing Coronavirus with Telehealth - TMT Pledge | Telehealth and Medicine Today

Telehealth and Medicine Today (TMT) peer-review journal, has pioneered the concept of social and economic impact in the sector – now, it reaches across the globe identifying gaps in care and health systems where telemedicine can help. It can help governments provide quality care, near and far, to all citizens, at an affordable cost. Today, at the dawn of a new decade, healthcare can truly be democratized and scaled for health citizens around the globe.
At this time, we urge leadership at health systems, providers, policy representatives, government officials, and aid organizations around the world, to unite in service and assistance. 

TMT pledges to operate as a conduit to those in need of educational resources, information, access to telemedicine services, expert advisers, and leaders in enterprise, where possible. We know telehealth and telemedicine can deliver healthcare and services where there are none - in remote and rural areas - where preparedness and operations strategies do not exist.

Telehealth can play a critical role in diagnosing COVID-19 since a person can carry and transmit COVID-19 without showing symptoms. The virus can remain infectious on inanimate surfaces at room temperature for up to 9 days and is spread primarily via respiratory droplets. There is some evidence that people declared “recovered” can be re-infected.

 Telehealth can also help contain or limit COVID-19 outbreaks by:

• Help providers diagnose faster and monitor discharged patients
• Alleviating the workload and stress of overworked providers
• Can be used to monitor quarantined patients reducing the risk to unnecessary exposure

Covid-19 has catalyzed an opportunity to scale the awareness and use of telemedicine by government, citizen, and sector. It will. In the interim, let’s keep all citizens informed and healthy, in an effort to contain it.

###

About Telehealth and Medicine Today
Telehealth and Medicine Today (TMT), is an open access online, international peer-review journal where multidisciplinary thought leaders, practitioners, and stakeholders converge to address strategic, medical, technical, legal, policy, economic, and social aspects of a new health and technology sector. TMT assists building knowledge and consensus for deploying and scaling delivery services to achieve sustainable outcomes for affordable, accessible, and quality care for health consumers around the world, by implementing pragmatic approaches addressing issues such as interoperability, quality and safety of evolving technologies, business processes, and economic systems, to drive the global telehealth and the remote care revolution in value-based care. The journal is published by Partners in Digital Health and is endorsed by the American Telemedicine Association (ATA), IEEE-SA, and the International Society for Telemedicine and eHealth (ISfTeH).
https://telehealthandmedicinetoday.com/index.php/journal

( Press Release Image: https://photos.webwire.com/prmedia/54628/256146/256146-1.jpg )

5 predictions for 2020 in digital transformation and digital health

Healthcare’s digital transformation: 5 predictions for 2020

2020 will see a slow but steady advance in the digital transformation of healthcare. Such things as interoperability, electronic health records, mobile health, remote monitoring and telemedicine are well underway and becoming the norm or standard of care. We have seen the beginning of big data and analytics used to predict and study health outcomes.

However, the overall pace of digital innovation remains slow relative to other sectors of the economy. Large health care systems are adapting to the new environment.  Mayo Clinic Platform is now a new enterprise for the Mayo Clinic. John Halamka, M.D., has been named president of the Mayo Clinic Platform. The platform will elevate Mayo Clinic to a global leadership position within digital health care. He will join Mayo Clinic on Jan. 1, 2020. Hamlaka is an innovator and leader in Health Information Technology.

Article attribution:  
Paddy Padmanabhan, CEO of Damo Consulting

1. 2020 won’t be a breakout year for digital health startups

Healthcare’s digital transformation is underway, and many health systems are investing significant amounts in upgrading infrastructure and driving productivity through collaboration tools. Digital front doors are in vogue, and almost every health system is investing in creating superior experiences for patient access and engagement.

However, my firm’s research indicates that the average health system is relying heavily on its EHR system as the primary platform for digital initiatives. Notwithstanding the high levels of VC funding and the heightened expectations from a handful of much-awaited IPO’s, the marketplace fundamentals for digital health companies have not changed much during the year.

Except for a handful of leading health systems, most healthcare providers do not have a dedicated digital function or even a dedicated budget for digital health initiatives. Most health systems lack mature programs and processes for evaluating and onboarding digital health innovations. This makes it a challenging competitive environment for digital health startups. Also, the challenges of long sales cycles, short-term ROI expectations, and data interoperability remain pretty much the same as last year.

2. Cloud migration will accelerate, boosted by data and analytics partnerships

Most healthcare CIO’s are bullish on the cloud today. They have come to accept SaaS solutions in the digital health ecosystem and are progressively migrating enterprise workloads to the cloud. Cloud partnerships for data integration and advanced analytics received a boost when Google signed a significant data partnership deal with Mayo Clinic. The Mayo partnership is also the first instance of a major health system migrating its EHR platform to the cloud.

However, privacy concerns will mount as data sharing agreements proliferate. Google’s partnership with Ascension Health faced a backlash due to a whistleblower complaint alleging unauthorized access to patient data, triggering a federal probe. A data outage at diabetes management company Dexcom was blamed on failure with its cloud computing service. Notwithstanding such incidents, cloud migration will continue its onward march in the coming year.

3. Voice recognition technology will make the most significant gains in digital health next year

Any technology that can reduce physician workloads is bound to get attention today. Voice-enabled technology has the potential to significantly ease the burden on physician workloads by taking on mundane administrative tasks such as scribing and documentation. Voice-recognition will possibly make the biggest gains in digital health in the coming year.

Amazon and Microsoft have both made significant progress with voice-recognition software during the year. The former has launched various healthcare “skills” on its Alexa voice-recognition platform, and the latter has gone the partnership route with Nuance Communications to voice-enable EHR platforms for administrative tasks as well as for clinical intelligence. Leading health systems have started reporting significant productivity gains from ambient clinical computing, driven by voice recognition software. The only downside is that voice recognition is a maturing technology with significant error rates. Presumably, the technology will improve with increased usage.

4. AI will gain ground, but growth will be more in administrative than in clinical functions

I had predicted last year that artificial intelligence (AI) will make progress but will struggle with an adoption gap. AI has indeed made progress, and there are several emerging areas where the technology is showing promise, especially in population health risk assessment and interventions. However, algorithmic bias has been a constant concern about AI, especially in clinical use cases. Reports that Optum’s AI algorithm for population health management was found to contain racial bias have raised skepticism for “black box algorithms.” The bright spot for AI is that there is plenty of opportunities to make an impact on administrative functions such as revenue cycle management.

5. Data sources and uses will continue to expand while interoperability challenges will recede into the background

The CMS clarified earlier this year that patients are the rightful owners of data. A proposed HHS ruling will open up access to patient data while penalizing data blocking. Big tech firms pledged during the year to work together to promote interoperability. In response to market forces, healthcare continues to make steady progress with interoperability. FHIR standards and API-led connectivity are slowly becoming the norm in application development.

The uses of emerging data sources such as genomics data, social determinants of health, and patient-generated data continue to rise in population health management and new digital health solutions. Health systems will increasingly get into the data monetization business, in consortiums with other health systems, or through strategic partnerships.

Among other emerging technologies, blockchain has fallen off the radar, despite being all the rage a couple of years ago. Several new technologies are worth watching. AR/VR applications are gaining ground in a range of medical procedures, as well as in educational applications. 5G networks hold promise in transforming communications within hospitals as well as in remote care models with faster data transfer to and from IoT devices. We are in the early stages of quantum computing and DNA data storage.

Short of a “black swan” event, 2020 will see a slow but steady advance in the digital transformation of healthcare. Lack of alignment among different stakeholders will continue to impact the pace of digital transformation initiatives in the coming year. Many health systems are stuck in a “two-canoe” syndrome, eager to adopt digital innovation that encourages efficiencies in care delivery but hesitant to give up the fee-for-service reimbursement model that encourages increased consumption of care.

The industry is in the transition to a capitated model of care, however, the progress has stalled in the past couple of years. The good news for innovators is that the diffusion of digital technologies in health care is happening. Just don’t expect any dramatic twist in the plot next year.

5 predictions for 2020 in digital transformation and digital health: In this article, Paddy Padmanabhan shares his views on the predictions for digital transformation in healthcare and digital health in 2020.