ATA2020 Session Summaries (Abstracts)

Abstract

Telemedicine and e-HealthVol. 26, No. 4 AbstractsFree AccessATA2020 Session Summaries (Abstracts)Published Online:16 Apr 2020https://doi.org/10.1089/tmj.2020.29036.abstractsAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Jointly provided byThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of University of Virginia School of Medicine and American Telemedicine Association. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.The University of Virginia School of Medicine designates this live activity for a maximum of 8.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.The University of Virginia School of Medicine and/or The University of Virginia School of Nursing Continuing Education, as accredited provider(s), awards 8.0 Hours of Participation (consistent with the designated number of AMA PRA Category 1 Credit(s)™ or ANCC contact hours) to participants who successfully complete this educational activity. The University of Virginia School of Medicine and/or The University of Virginia School of Nursing Continuing Education maintains a record of participation for six (6) years.Oral Presentations1. What You Should Know About Interacting with a Telehealth Resource CenterElizabeth Krupinski1 and Doris Barta21Emory University and 2National Telehealth Technology Assessment Resource CenterThe Health Resources & Services Administration Office for the Advancement of Telehealth National Consortium of Telehealth Resource Centers are comprised of 12 regional and 2 national Telehealth Resource Centers (TRCs) providing technical assistance, education, and various resources, with each having individual uniqueness, allowing them to provide a wide range of assistance targeting your regional needs. We describe our overall technical assistance model, which provides tiered levels of support ranging from free advice and information on dedicated topics of inquiry to in‐depth consultation on program design and implementation. We review data on the types of technical assistance providers to our telehealth customers, including but not limited to: number of assistance requests, types of provider and other organizations, assistance topic areas, commonly encountered questions.Method: DescriptiveClassification of Research: Technical AssistanceResult: Since inception of the TRCs, our websites have received over 1 million hits, our webinars have been attended by of 7,500 people, regional conferences have attracted over 8,000 attendees, and we have engaged in over 10,000 direct technical assistance events with those seeking to develop or expand their telehealth programs.Conclusions: The TRCs have established the National Consortium of Telehealth Resource Centers to strengthen their collaborative efforts. We have produced fact sheets, guides, templates, and other telehealth resources while improving brand recognition and strengthening relationships. The knowledge TRCs possess covers the full range of telehealth domains, reflective of their impact on the field, developing approaches to telehealth barriers from a variety of angles field.2. Long‐Distance Connections: Metrics, Outcomes and Overcoming Challenges in TelepsychiatryHossam Mahmoud, Michel Tawil, and Mohammad HaidousRegroup, TUFTS University School of MedicineAs the adoption of telepsychiatry continues to expand to meet the growing mental health needs across the country, there has been increased interest in examining the quality of telepsychiatry programs and assessing the impact of such programs. Research has attempted to examine not only clinical outcomes, but also population health measures, cost‐efficiency, access improvement and user satisfaction. This session begins by reviewing the approaches and methods that have been undertaken to evaluate the impact and outcomes of telepsychiatry programs. Next, we discuss a case study of a telepsychiatry program in rural Illinois that combines direct care with consultation services.Method: DescriptiveMethod – Other:Classification of Research: Clinical OutcomesResult: In this case study, we outline the program components, including synchronous consults, asynchronous consults, and direct patient care. We discuss the planning, implementation and outcomes of this program and compare outcome measures to those described in the literature. Specific metrics that will be reviewed include cost‐effectiveness, volume of patients served, wait list, patient satisfaction, clinician satisfaction, screening tools and clinical outcomes.Conclusions: We then examine the advantages and limitations of current approaches to telepsychiatry program evaluations, including the significant variation in metrics and indicators that are used to assess outcomes. Finally, we explore approaches to overcoming some of these challenges in program evaluations, and we review recommendations and best practices for telepsychiatry program evaluation.3. Tele‐transitions of Care: Evaluating the use of Telehealth for Triple Aim ObjectivesKimberly Noel, Catherine Messina, Wei Hou, Elinor Schoenfeld, and Gerald KellyStony Brook MedicineTelehealth has the potential to improve transitions of care, through enhanced connections among patients and their clinicians, during a vulnerable period after hospital discharge. To achieve triple aim objectives, reducing unnecessary hospital readmissions is desirable for payers and patients alike. However, poor transitions of care extends beyond the risk of increased hospital readmission rates. Poor transitions also lead to increased medical errors, poor outcomes and inappropriate resource allocation. This is a 12‐month randomized controlled trial, evaluating the use of telehealth (remote patient monitoring and video visits) versus standard transitions of care with the outcomes of over‐utilization, access to care, medication management, patient adherence and patient engagement.Method: Randomized Controlled TrialClassification of Research: Clinical OutcomesResult: Compared with the standard of care, telehealth patients were more likely to have medicine reconciliation (p = 0.013) and were 7 times more likely to adhere to medication (p = 0.03). Telehealth patients exhibited enthusiasm (p = 0.0001), and confidence that telehealth could improve their healthcare (p = 0.0001). Telehealth showed no statistical significance on emergency department (ED) utilization (p = 0.691) nor for readmissions (p = 0.31). 100% of telehealth patients found the intervention to be valuable, 98% if given the opportunity, would continue using telehealth to manage their healthcare needs, and 94% reported that the remote patient monitoring technology was useful.Conclusions: Telehealth can improve transitions of care after hospital discharge improving patient engagement and adherence to medications. This study proves the value of telehealth and it's feasibility. Although this study was unable to show the effect of Telehealth on reduced healthcare utilization, more research needs to be done in order to understand the true impact of telehealth on preventing avoidable hospital readmission and ED visits. Our study showed that patients who were readmitted had life‐threatening emergencies. We offer consideration as to whether hospital readmissions should be the desired endpoint in telehealth research.4. A Clinical trial of asynchronous telepsychiatry in primary care: clinical outcomes and implicationsPeter Yellowlees and Alvaro GonzalezUC DavisObjective Asynchronous Telepsychiatry consultations have been suggested as a potential choice in a stepped care menu of consultation approaches to be made available to patients in primary care settings. In this randomized clinical trial Asynchronous Telepsychiatry (ATP) consultations were compared with Synchronous Telepsychiatry (STP) consultations, in a heterogeneous sample of treatment seeking patients referred by their primary care physicians (PCP).Method: Randomized Controlled TrialClassification of Research: Clinical OutcomesResult: 184 participants, English and Spanish speaking, were enrolled and randomized, of whom 160 (80 ATP, 80 STP) completed baseline evaluations. Patients were treated by their PCP's in consultation with UCD psychiatrists using ATP or STP for up to two years. The clinical outcomes on psychiatrist and patient reported scales in English and Spanish speaking patients for ATP were similar to STP. Both patient groups improved over the course of the trial. Significantly greater levels of patient drop out than anticipated were experienced in both groups for numerous reasons, although less in the ATP group.Conclusions: This trial is evidence of the clinical effectiveness of ATP in primary care patients. It should lead to the introduction of this form of consultation as part of a stepped series of mental health interventions available within the primary care treatment setting, and because of its efficiency may be part of the solution to the workforce shortage of psychiatrists. Funders should support payment for ATP consultations, and research using asynchronous video in disciplines other than psychiatry should be prioritized. ClinicalTrials.gov Identifier: NCT02084979Funded by AHRQ.5. Leveraging Telehealth to Deliver Advance Care Planning Services to People Approaching End of LifeConnie DucaineVital DecisionsPatients who are dealing with complex medical situations and approaching end of life benefit from developing an advance care plan. This type of plan ensures caregivers and providers are aware of patients' preferences so these stakeholders can facilitate the appropriate level of care in the event the individuals can no longer speak for themselves. Traditionally, Advance Care Planning (ACP) activities have been initiated in a physician's office with varied results. Physicians may fail to discuss end of life care with patients/families until it's too late to substantially impact the treatment experience or allow for optimal decision‐making about future care (during inpatient episodes for medical crises). When physicians attempt ACP conversations, effectiveness may be limited by time pressure, lack of training/skills, or a focus on specific procedures rather than on patients' values and quality of life goals. Leveraging virtual modalities for ACP has resulted in the delivery of services to more than 300,000 people in the United States with a positive impact on individuals' end of life experiences. Virtual models eliminate or address many barriers (e.g., timeliness of discussion, transportation, time to travel, childcare) that often prevent seeking these services. Engagement rates for the virtual ACP intervention were 60 – 70%.Method: Survey/QualitativeClassification of Research: Patient ExperienceResult: To evaluate the patients' experiences of the ACP intervention, which is a series of telehealth sessions in which individuals explore, document and communicate their care preferences, a six question survey was administered. The survey results were tabulated by a third party. Patients and their caregivers have expressed their appreciation for, and positive experience with the virtual intervention. Survey respondents (N ∼ 2,000) have reported an overall satisfaction of 4.6 on a 5‐point Likert scale. This is equivalent to a Net Promoter Score of 59.Conclusions: The efficacy of the telehealth model with advanced illness patients demonstrated by the engagement data and patient satisfaction results negates the perspective that delicate conversations are best addressed in‐person. Program results also suggest that patient activation and engagement can be developed via telehealth model utilizing a brief intervention model.6. A Virtual Intervention to Reduce Behavioral Health Admissions from Rural EDs – Program DesignJason Roberge, Christine Zazzaro, Amy Barrett, Pooja Palmer, and Wayne SparksAtrium HealthHospital admissions are common among patients with mental illness resulting in a burden within the healthcare system. Significant morbidity exists in patients that are admitted to a psychiatric hospital from the emergency department (ED). Due to limited availability of behavioral health resources, ED providers often decide to admit patients to a psychiatric hospital. To better enhance the transition of care for patients with mental illness, Atrium Health has designed a behavioral health virtual patient navigation (BH‐VPN) program that helps coordinate services and follow‐up care, while facilitating the safe discharge of patients. Patients that present to an ED that have a telepsychiatric consult and are recommended for discharge are eligible for the service. The Behavioral Health Service line is expanding the program from urban EDs and assessing the effectiveness of the program among rural EDs.Method: Randomized Controlled TrialClassification of Research: Access to CareResult: Using a randomized clinical trial, we will assess the effectiveness of the BH‐VPN program to reduce hospital admissions among patients presenting with a behavioral crisis at a rural ED. Patients who complete a telepsychiatric consult in the ED are enrolled to either the usual care or intervention arm based on a randomization scheme. Prior to discharge, a navigator will connect with the patient virtually in the ED and offer participation in the program.Conclusions: Available evidence suggests that adoption and utilization of virtual care in tandem with wrap‐around services may reduce utilization and improve health outcomes. Here we will present the details of the program and share experiences from prior behavioral health virtual programs.7. Precision Psychotherapy with Artificial IntelligenceThomas Hull, Jeffrey Swigert, and Neil LeibowitzColumbia University, TalkspaceDigital platforms for delivering psychotherapy and other types of medicine are growing. These platforms generate a large amount of data offering the promise of more sophisticated classification and predictive models. These models allow practitioners to go beyond underspecified categories and to match treatment to patient in a more precise way. In this talk we present the results of applying text‐based machine learning to specify patient presentation that is much more specific than diagnosis alone. We also present results on factors that identify therapists who deliver better care on average. This final model combines value‐added modeling from economics with natural language processing from clinical interactions and transcripts.Method: Implementation ScienceClassification of Research: Measurement Frameworks & ToolsResult: The presented machine learning model is able to accurately categorize 85% of patients based only on their age and gender combined with as little as two paragraphs of text from a natural therapy interaction. The value‐added model identified 6 key factors that separate highly effective therapists from the rest. Of these 6, 4 are modifiable through training or through better matching of patients with providers best suited to address their needs.Conclusions: We conclude that the provision of behavioral health, a key factor in addressing modern disease burden, can be vastly improved through the use of big data and machine learning methods. The large data sets made available by telemedicine platforms offers a significant potential for improving not just access of care, but quality of care and value delivered to patients.8. Design and Implementation of a Primary Care Telemedicine Elective for Medical Students and APRNsMark Rood, Kari Gali, Leighanne Hustak, and Matthew FaimanCleveland ClinicDespite massive expansion of telemedicine, most programs listed as telemedicine sites by the AAMC are educating students via long distance learning, not training students to provide quality virtual medical care, including good webside manner, components of a video exam, and cutting‐edge innovations occurring in the rapidly changing field.In 2016 Cleveland Clinic partnered with three medical schools in Northeast Ohio creating a 2‐week elective. In 2017 the elective was opened to all of the 13 Ohio nurse practitioner schools, in 2018 aligned with ACGME competency driven education, and in 2019 began a collaboration with a college to assist in the development of a Certification in Telemedicine education track. This elective provides experiential learning in the clinical application of Primary Care Telemedicine, as well as specialty opportunities including MyChart, eHospital, Telepsychiatry, remote monitoring and others. Guided by a Virtualist mentor, they complete a scholarly project on a cutting‐edge aspect of telemedicine in their field of choice. Students are required to have completed their core clerkships in Family and Internal Medicine, Pediatrics, Psychiatry and General Surgery before applying for this rotation for the medical students. The nurse practitioner student must be in their last semester, typically completing their capstone.Method: Mixed method (observational, descriptive and survey/qualitative)Classification of Research: OtherClassification of Research: Education for future clinician experienceResult: Students are assessed in areas such as Knowledge for Practice, Interpersonal and Communication Skills, and Systems Based Practice. As we have grown we have formalized our structure with enrollment of students, involved more NP's in the instructional curriculum, enhanced the use of complimentary instructional videos, and continued our relationships with eHospital, Telestroke, Telepsychiatry, eVisit and MyChart teams. Feedback from stakeholders helped shape the program into a robust, interactive, competency based elective.Conclusions: With a shift from fee‐for‐service to value‐based care, healthcare providers are being challenged to consider delivering care through a virtual platform without any formal training. Just because providers can do this, it doesn't mean they will do it well. Integrating synchronous and asynchronous telemedicine opportunities allows students to merge the didactic learning into clinical practice, enhancing care for patients in the future. It is essential for health care systems to innovate ways to educate providers on delivering a level of virtual care that maintains consistency with the same high‐quality standards to which they are held in the non‐virtual world.9. Changing Hospital Culture through the Implementation of a TeleNeurology ProgramTejal Raichura, Anthony Noto, and David FletcherGeisingerGeisinger is a large integrated health system in central Pennsylvania and New Jersey comprised of 13 hospitals. Geisinger Medical Center (GMC) in Danville, PA is Central Pennsylvania's only quaternary‐referral, academic institution with all major medical, surgical, transplant, obstetric, neonatal, pediatric, neurosurgical, and trauma‐related specialties represented and serves as the central hub of Geisinger's telehealth network.Utilizing a hub‐and‐spoke model, the Neurosciences Institute leveraged an on‐site neurology hospitalist model to offer non‐stroke, tele‐neurology consults to 5 spoke sites (Pennsylvania only) within the Geisinger system; this is in addition to an already robust telestroke program. The intent of this program was to mitigate the need to transfer patients to the main hub, reduce the cost of the transfer, and review overall patient outcomes.Method: ObservationalClassification of Research: Access to CareClassification of Research – Other:Result: The total number of teleneurology consults completed coincided with a reduction in transfer rates from spoke hospitals to the hub; additionally, patients were able to be seen by a neurologist faster than in the previous period as the consult was often completed at the time of admission. Finally, neurology admissions started trending downward post‐intervention, however, the admissions proceeded to increase again due to a change in culture. Furthermore, the contribution margin per inpatient transfer was calculated at $10,000. Taking our average number of transfers avoided per month, we saw a reduction in costs of approximately $250,000 per month.Conclusions: The implementation of the teleneurology program has started to shift the culture of the local emergency department teams who feel more comfortable admitting the patients locally knowing a telemedicine consult is available as needed; it has also allowed the hub neurology ICU to keep their admissions instead of transferring to a Medicine ICU. As a result, the savings from avoiding transfers to a higher acuity hospital in addition to admitting patients to facilities with the most appropriate level of care for their condition has led to cost savings across the organization.10. Emergency provider tele‐medicine hours associated with decreased reported burnout symptomsAnisa Heravian, Erica Olsen, David Kessler, and Bernard ChangColumbia University Irving Medical CenterWhereas 45% of the 1 million physicians in the United States report symptoms of burnout (i.e., emotional exhaustion, depersonalization, and reduced personal accomplishment), an astonishing 70% of emergency department (ED) providers report burnout symptoms. ED overcrowding and related factors has been found to increase psychological stress in not just patients but also emergency providers, potentially increasing one's risk for the development of adverse professional and psychological outcomes such as clinician burnout. Telemedicine, may offer a unique complement to this practice environment, allowing providers to administer care in a more controlled environment without many of the other existing acute environmental stressors. We hypothesized that providers working more telemedicine hours would be associated with lower rates of clinician burnout compared to providers not working telemedicine.Method: ObservationalClassification of Research: Clinician ExperienceResult: Fifty (n = 50) emergency providers participated. Eighteen (n = 18) individuals did telemedicine shifts and 32 individuals did not do any telemedicine. Overall, no differences in sex, age or years of practice were found between providers performing tele‐medicine and those. Tele‐medicine providers performed on average 9.7 ± 4.5 hours of telehealth weekly. Individuals in the telehealth group had significantly lower scores on burnout measures (emotional exhaustion subscale) compared to the non‐telehealth group (8.4 ± 2.2 vs 11.4 ± 3.5; t = 2.64, p < 0.05). A multiple regression model, adjusted for age, years of practice and sex, found that hours of telemedicine per week significantly predicted emotional exhaustion (beta: −0.35, t = ‐2.22, p < 0.04)Conclusions: In addition to improvements in patient outcomes, telemedicine may also improve provider psychological well‐being. Future work exploring the integration of telemedicine shifts into clinical scheduling may be associated with improvements in provider well‐being and career longevity.11. A telehealth approach to reduce emergency utilization by combining AI with tailored interventionsSara Bersche Golas, Jorn op den Buijs, Mariana Simons, and Gary M. GarbergPartners Connected Health InnovationBy 2030, 73 million adults will be over the age of 65 in the United States (U.S.). Chronic disease is prevalent in this population: 80% have at least one chronic disease; 77% have at least two. Chronic disease management accounts for 75% of annual U.S. healthcare system spending. Moving toward value‐based care, organizations are identifying ways to lower healthcare costs by reducing emergency and hospital utilization. Many independently‐living older patients use a Personal Emergency Response System (PERS) to signal for help in case of incidents, e.g. falls, breathing problems. Using remotely‐collected PERS data, we developed artificial intelligence approaches to identify individual risk of emergency transport, allowing early intervention and care in lower‐cost settings. We describe a 180‐day randomized controlled trial combining risk predictions with tailored interventions, demonstrating reductions in emergency and hospital utilization.Control and intervention groups used a PERS service comprised of a wearable device with automated fall detection and 24/7 response center access. In the intervention group, PERS service data were collected and processed via predictive models to indicate imminent emergency transport risk. A study nurse triaged individuals with high‐risk scores using needs assessment questionnaires and tailored intervention recommendations (e.g. personalized remote education, primary care referral, condition‐specific telehealth).Method: Randomized Controlled TrialClassification of Research: Clinical OutcomesResult: A total of 333 patients were analyzed ‐ 173 in the control and 160 in the intervention groups. While there was no statistically significant difference between the group's demographics and clinical characteristics, the following clinical outcomes were statistically different: compared with the control group, the intervention group had 61% fewer 90‐day readmissions (p = 0.015) with corresponding triple decrease of proportion of patients with any 90‐day readmission (10.4% control vs. 3.1% intervention group, p = 0.009); 46% fewer 180‐day readmissions (p = 0.038); and 49% fewer 180‐day Emergency Medical Services (EMS) encounters (p = 0.006).Conclusions: This randomized control trial provides clinical evidence that combining actionable predictive analytics with personalized interventions can greatly reduce emergency incidents experienced by older patients in the home, thereby reducing hospital transports and readmissions. Such solutions combining predictive analytics, remote patient engagement, and telehealth facilitate the delivery of value‐based care, improve patient health outcomes, and decrease healthcare costs.12. Avoidable Emergency Department Outcomes in a Health System‐Partnered School Telemedicine ClinicCarlene A. Mayfield, Tiffany Effinger, Jennifer Villafane, Sam McGinnis, Patsy A. Fisher, Brisa Hernandez, Alisahah J. Cole, and Patty GrintonAtrium HealthFamilies living in Cleveland County, North Carolina, experience a cluster of social and economic determinants of health including high rates of poverty, unemployment, and lack of insurance coverage. Additional healthcare access barriers including transportation, system navigation, and parental work schedules, result in inappropriate utilization of the emergency department (ED) for nonemergent or primary care. Atrium Health, one of the largest integrated health systems in the region, and its facilities‐ Kings Mountain Hospital, Cleveland, Shelby Children's Clinic, and Department of Community Health‐ partnered with the County's Public Health Center and the local school system to develop School Based Telemedicine Clinics (SBTCs). Some program outcomes (i.e. reducing early school dismissal) can be tracked using school records and/or during the SBTC visit. Other outcomes, including reduction of ED utilization, requires metric specificity (i.e. isolation of nonemergent and avoidable ED visits) and the enrichment of primary program data with electronic medical record (EMR) data. Our project developed and tested a protocol to track avoidable ED utilization among SBTC patients using a scalable, semi‐automated metric available through EMRs. Avoidable ED utilization was measured using the New York University Algorithm, a validated classification system that predicts the probability of a visit being avoidable using discharge codes.Method: Secondary Data AnalysisClassification of Research: Clinical OutcomesResult: The ED records of 80 patients with an SBTC visit on October 10, 2017 through August 31, 2018 were extracted from Atrium Health EMRs, resulting in an analytic sample period of 1 year pre‐ and post‐visit. Visits with a probability ≥50% were classified as avoidable, according to standard practice. Preliminary descriptive results show an overall 13% reduction in avoidable ED visits btween the pre‐visit (88 ED visits; 47 or 53% avoidable) and post‐visit (63 ED visits; 25 or 40% avoidable) periods.Conclusions: Measuring the outcome of avoidable ED utilization using an automated algorithm is an efficient and sensitive metric to track clinical outcomes tied to SBTC project goals. Initial tests show this method is valid in our sample. Leveraging health system partnerships to access existing EMR data resources can inform quality improvement and better tracking of program outcomes. Attendees of our session will learn our protocol for accessing, testing, and applying the New York University Algorithm to examinations.13. Improving Patient Outcomes & Cost Savings by Leveraging Remote Monitoring Technology to Accelerate & Scale Care management for Medicare Advantage MembersCarla Moore Beckerle, Erin Stamm, and Robert Mattson PetersEsse HealthShifts toward improving outcomes in value‐based care systems have prioritized managing high and rising‐risk patients with chronic disease proactively and efficiently. Remote monitoring with digital and telehealth tools has been shown to lead to proactive engagement. Our organization implemented a text message‐based remote monitoring program for eight months with a single care manager and scaled to over a thousand active Medicare Advantage members at a time. Real‐time automated monitoring allowed us to restructure our CM program by focusing resources to the right members at the right time as staff operated at top‐of‐license and patients were empowered to actively manage their health. Daily targeted check‐ins provided timely patient health data, the automated feedback loop notified t