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The 2017 Healthcare Informatics Innovator Awards: Innovation in Clinician Workflow Co-Winner: Avizia

February 14, 2017
by Kayt Sukel
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For more than a decade, Healthcare Informatics has honored those at the forefront of healthcare IT innovation with its Innovator Awards Program. As read in our January issue this year, the Healthcare Informatics Innovator Awards Program again recognized leadership teams from patient care organizations that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance. The Program also distinguishes vendor solution providers that have helped their clients shine in enhancing clinician workflow, exchanging data, or cutting down costs.

Indeed, this year the Innovator Awards program included two tracks for innovation recognition—one for healthcare provider organizations and one for technology solution providers, allowing both sides of the health IT spectrum to submit their examples of transformation. All vendor submissions were given to a selection of Healthcare Informatics expert editorial board members for careful review. The list of all provider and vendor winners in this year’s program could be seen right here.

Over the next few days, Healthcare Informatics will give readers the stories of the four vendor winners in the three above-mentioned categories. These technology solution providers are truly blazing the trail for innovation in the health IT vendor market, and we are proud to honor those whose combination of expertise and innovation are shaping the future of healthcare systems.

The 2017 co-winner in the category of Clinician Workflow is Avizia, a Reston, Va.-based company that offers a comprehensive telemedicine platform. Founder and CEO of Avizia, Mike Baird, spoke with Healthcare Informatics about the importance of embracing complexity in healthcare—and how that can translate into a seamless experience for the doctor and the patient.

Tell me about Avizia’s vision for clinician workflow in healthcare.

Mike Baird:  We at Avizia are focused on delivering an end-to-end telehealth experience, making it easier for hospitals to allow any provider to connect with any patient in any place.  That’s our goal—and to do it, we need to really look at and improve the flows of healthcare for patients.

Let’s face it, healthcare isn’t getting any less complex.  In many respects, healthcare is still stuck in the 1980s.  Doctors still use pagers and paper forms. Our mission is to help move them to the digital age—we want to make it seamless for doctors to deal with their workflows. For us, that translates into trying to figure out how to take the normal workflows and processes doctors do in healthcare on any given day and make them applicable in the digital world. That means having things like virtual waiting rooms, being able to easily access patient data, being able to gather the diagnostic information from different sources, and trying to mirror that in a virtual consult. That’s the core of what we do at Avizia. 

Mike Baird

How do you see the competitive marketplace in the clinician workflow area?

Telehealth, obviously, is a very exciting area these days.  You hear about it all the time in the news. It is something that can solve a whole host of problems for providers and patients. But the vast majority of players in the telehealth space have focused on a very narrow niche of the market, that being direct-to-consumer. It’s understandable.  It’s easier than other types of care. There are a lot of great companies out there that provide an app of some sort that allow you to talk to your doctor from home and address what we call low-acuity use cases.  You can call up your doctor and say, “I have a sore throat,” or “I have a runny nose,” and get medical advice.  It’s a fantastic offering.  But where Avizia is different is that we focus almost solely on healthcare systems and the way that they deliver care.  That means we have to focus on a different level of telehealth than many other companies in the space.  It’s high-stakes telemedicine.  We work on strokes and behavioral health offerings. We’re working on telehealth solutions in pediatrics and other specialty care.  It’s a different mission, working right in the heart of the healthcare system—and one that differentiates us from the majority of players in the marketplace. We believe there is great value in ways to better deliver specialty care, ensuring that everyone, regardless of where they happen to be, has access to qualified specialists. And we believe there is value in providing that in a very patient-centric way.

To what do you attribute Avizia’s success?

We do our best to put our customers first—which, in our care, is the patient.  We are always working to figure out new ways to make telehealth a seamless experience.  We are successful because we embrace the complexity of healthcare instead of trying to ignore it.  And it’s important.  If you are going to solve healthcare problems from inside of the hospital, you have to jump in with both feet.  You have to accept that you are going to have to interact with electronic health records (EHRs), different systems, different devices and scopes, and the different infrastructures.  You have to deal with challenges like, “Is there wireless available in this hospital or not?” or “What PACS system are you using?” or “What about your e-prescription platform?”  Because you’ll have to integrate into those systems to get the job done. 

There’s so much complexity in healthcare and hospitals need partners that can help them figure out these new needs and experiences. We need to find new ways to increase the reach of care, lower the cost, and improve the overall quality of care. We see tremendous change in healthcare policy that make it difficult sometimes for health systems to figure out the best way to deliver care. We see our job as partnering closely with healthcare institutions to help them solve for that.

Our product ensures that a patient in a rural area can have access to a qualified neurologist and have their life saved in the case of a stroke emergency. Our product allows a worried parent to use their phone to do a consult from the comfort of home when their child has a fever.  Our system works across very different service lines. 

Providing care for a stroke is very different from something that dermatology does. So, by embracing all that complexity, we are able to deliver a product that lets the hospital have the simplicity of working with a single vendor, to scale in an efficient way, and revolutionize the way they deliver healthcare.  And that allows the idea of a telehealth or virtual medicine experience to feel very much the same as if you were walking in to see the doctor for an in-patient visit. That’s really what differentiates us.

What is your vision for the future—both in terms of challenges and opportunities—when it comes to clinician workflow?

Our job is to drive innovation in the marketplace.  We view that as our responsibility. So there are a lot of different challenges and opportunities. One big one for us is to work closely with different EHR vendors to try to make our solution as integrated as possible with the workflows in the hospital.  If we are going to try to mirror an in-person experience in the digital world, that means we have to fit in very tightly with how that in-person experience is evolving—we need to know the way doctors are doing their jobs when it comes to any use case. 

Another challenge is trying to deliver products that are the right cost. We try very hard to deliver high quality healthcare in an efficient manner, and we do our best to innovate in such a way that we can deliver a product that is extremely advanced from a technical standpoint yet at the right price point so that hospitals can have more access to their patients.

The complexity, of course, remains a challenge. We work with a lot of different systems and devices and it’s not always easy to integrate all of them into one platform. But it’s also a challenge to try to convince the industry as a whole to deliver care in a different way. Luckily, consumer demand is driving telehealth very strongly, particularly millennials. And, frankly, every patient is looking for better care. Together, they are all pushing for new technologies that can help drive that.

But when we talk about future and opportunities, we also should mention the importance of not just covering episodic care but addressing chronic care needs. People need to see specialists. Certainly, there are times you need to do that in person. But, for high quality care, whether it’s a patient with diabetes, obesity issues, someone in an oncology setting or what have you, chronic care is a growing issue in our country. And if we are going to truly be patient-centric, we need to provide tools that enable healthcare providers to work around the life of the patient, as opposed to the systems of the healthcare center. It’s a great opportunity for Avizia to figure out ways that any provider can talk to any patient anywhere—and really bring healthcare into the 21st century.


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KLAS: EHR Integration, Enterprise Scalability Key Challenges Facing Telehealth Vendors

December 11, 2018
by Heather Landi, Associate Editor
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Healthcare organizations report high satisfaction with their telehealth virtual care platforms (VCPs), however there are significant differences in how broad the various platforms are and in the quality of the vendors’ service. What’s more, integration with electronic health record (EHR) systems is a key challenge facing every telehealth vendor, according to a KLAS report.

In its report, “Telehealth Virtual Care Platforms 2019: Which Telehealth Vendors Have the Scalability Customers Need?,” KLAS evaluates some of the top telehealth companies including American Well, MDLive and Epic, and analyzes what capabilities will set vendors apart as more healthcare organizations adopt virtual health technology solutions.

Most virtual care platform vendors receive positive performance ratings, but the depth and breadth of their capabilities vary, and this can impact scalability for organizations looking to grow, according to KLAS. No two vendors are alike in their capabilities, offering different combinations of functionality and experience.

Of the companies KLAS evaluated, the most common type of visit varied—most of American Well’s visits were on-demand urgent care, while the majority of Epic’s visits were associated with virtual clinic visits.

A key factor of scalability is the ability to support multiple visit types, KLAS researchers note. While multiple vendors offer support for all three visit types (on-demand or urgent care, virtual clinic visits and telespecialty consultations) no single vendor has a large proportion of customers using all three (only 12 respondents across all vendors said they were doing so).

American Well, a market share and mindshare leader, and MDLIVE, two of the vendors used most frequently for multiple visit types, receive generally positive—but lower than average—performance scores. Vendors more specialized in specific visit types or component layers (e.g., Vidyo and Zipnosis) have high scores but narrower expectations from customers.

No one vendor meets all needs equally well, but several are reaching for “all-purpose” status with internal development and/or recent acquisitions (American Well acquired Avizia; InTouch acquired TruClinic), according to the report.

KLAS’ analysis also uncovered a general trend of poor integration. In most cases, the addition of a virtual care platform also means the introduction of a second EHR into the clinician workflow.

“Although integration between EMRs is generally understood to be important for care quality, patient safety, efficiency, and productivity, few interviewed VCP customers have full bidirectional transfer in place. Most say that they are too early in their virtual care programs to pursue integration or that it simply costs too much,” KLAS researchers wrote.

Only American Well, Epic, and MDLIVE have more than half of interviewed customers currently on an integrated path, KLAS found. Epic has placed virtual care capabilities directly into their top-rated MyChart patient portal, which many patients already use. Epic integration means clinicians are able to stay within their existing workflow environment as well.

Many provider organizations are in the early phases of their virtual care programs where showing an ROI is an important milestone and one that organizations want to achieve as soon as possible, KLAS notes. “A key promise from vendors is that their technology and accumulated expertise will result in a fast start and continuous acceleration. When this comes at significant cost or progress is slower than expected, provider organizations can experience disappointment,” the KLAS researchers wrote.

When it comes to getting their money’s worth and achieving desired outcomes, Epic and InTouch are rated highest among fully rated vendors, and swyMed and Vidyo perform well among their smaller groups of respondents, KLAS researchers note.

“For each vendor, the current value proposition is somewhat narrow but well understood: Epic’s use is limited to existing patients of Epic EMR customers; InTouch is used primarily for consults; swyMed is used by respondents primarily for mobile, first responder needs; Vidyo delivers video-conferencing tools,

which are typically combined with other VCP solutions. SnapMD is seen as a low-cost option, but some customers say the impact has been limited. Commentary from VSee customers suggests a similar experience,” KLAS researchers wrote in the report.

Many healthcare organizations are early on in their virtual care journeys, and their ability to achieve desired results depends on guidance from vendors. According to KLAS’ analysis, swyMed and InTouch receive the most praise for taking initiative in proactively guiding customers and also in quickly responding to support problems.

While respondents praise American Well’s platform scalability, some customers blame the vendor’s “exponentialgrowth for staffing shortages that have led to implementation holdups and backlogged service requests. Some SnapMD customers say hard-to-beat pricing comes with a support model that is spare in terms of providing tailored guidance, according to the KLAS report.

Most vendors offer two additional options that can help accelerate customers’ expansion and growth—supplemental services, including added-cost advisory and outsourced services, and tools that automate patient-facing tasks that traditionally require additional staff. I

KLAS found that few customers mentioned these options in top-of-mind conversations. “Respondents who spoke of their vendor’s supplemental services most often referred to marketing support or strategic planning services from vendors American Well, MDLIVE, or Zipnosis. Those who referred to task automation report patient-self-service capabilities around check-in, scheduling, surveys, and/or patient flow from InTouch Health (TruClinic), Epic, MDLIVE, or Zipnosis,” the KLAS researchers wrote.

 

 

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Study: Neonatal Telehealth Reduces Hospital Transfers, Saves Money

December 11, 2018
by Heather Landi, Associate Editor
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Neonatal video-assisted resuscitation reduces transfers from hospitals without newborn intensive care units and provides significant cost savings, according to study published in the November issue of Health Affairs.

The study authors, led by Jordan Albritton of Intermountain Healthcare, examined a newborn telehealth program implemented at eight Intermountain Healthcare community hospitals in November 2014–December 2015 and the impact on the transfer of newborns from those eight hospitals to level 3 newborn intensive care units.

Studies show that 10 percent of newborns require assistance breathing at birth, and 1 percent require extensive resuscitation. At Intermountain Healthcare, approximately 1–2 percent of all babies born in suburban and rural hospitals are transferred to newborn intensive care units (NICUs) for higher-level care, according to the study.

In response to the need to improve outcomes for complex newborn patients, an innovative telehealth program was established at Intermountain Healthcare in 2013 to provide synchronous, video-assisted resuscitation (VAR), bringing a neonatologist to the bedside. As a result, access to specialized neonatal services in rural and suburban settings is no longer limited to telephone calls or the arrival of a neonatal transport team, the study authors wrote.

While telehealth can facilitate video connections between neonatologists at tertiary care centers and providers at smaller hospitals, there is little empirical evidence about the benefits of telehealth programs for neonatal resuscitation, according to the study authors.

Although Intermountain Healthcare began using telehealth technologies in 2013, the current VAR program was implemented in the period November 2014–December 2015. Today, neonatologists from four level 3 NICUs provide VAR support for nineteen referring hospitals.

As part of the study, the researchers evaluated eight hospitals that contained either well-baby (level 1) or special care (level 2) nurseries staffed by physicians, advanced practice clinicians, nurses, respiratory therapists, and other health care professionals. T

The study found that video-assisted resuscitation was associated with a reduction of 0.70 transfers per facility-month and a 29.4 percent reduction in a newborn’s odds of being transferred. Annually, this resulted in 67.2 fewer transfers and an estimated cost savings of $1.2 million per year.

The study authors conclude that reducing transfers keeps families closer to home, increases community hospital revenue, and reduces risk associated with transfers.

“This program helps keep newborns in level 1 or 2 nurseries, which in turn allows families to stay closer to home, improves social support, and increases the revenue of community hospitals while reducing costs and risks associated with transfers,” the study authors wrote. “Payers should consider reimbursement for pediatric subspecialty telehealth consults for neonates in level 1 and 2 nurseries. Through improvements in care quality and cost savings, this service would likely pay for itself many times over.

However, the authors also note that lack of reimbursement for telehealth services limits widespread implementation.

“Policy changes are necessary to align payment incentives and promote the use of telehealth services,” the study authors wrote.

Related Insights For: Telehealth

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Can Telehealth Slow the Traffic Between Nursing Homes, Emergency Departments?

December 6, 2018
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The RUSH Act seeks to reduce the 1.3 million transfers from skilled nursing facilities to emergency rooms each year

There are 1.3 million transfers from skilled nursing facilities (SNFs) to emergency rooms each year, and CMS estimates that two-thirds of those are avoidable. The result is as much as $40 billion in unnecessary spending. Could telehealth be part of the solution?

That question led Timothy Peck, M.D., formerly chief resident in the Emergency Department at Beth Israel Deaconess/Harvard, to co-found a startup company, Call9, and become an advocate for legislation, the RUSH (Reducing Unnecessary Senior Hospitalizations) Act of 2018, to support reimbursement for connecting emergency physicians and SNFs.

Peck has spent considerable time studying the issue. “I didn’t know much about nursing homes when I started,” he said.  “I went and lived in one for three months. I wound up sleeping on a cot in a conference room.”

Peck was trying to understand nursing home finances and operations and why the patients are being transferred. They usually have things like urinary tract infections or pneumonia, which could be treated in the outpatient setting, but the SNFs aren’t equipped with the right tools to be able to treat these patients. Those patients come in without their families and 43 percent have dementia, he said. “Most become delirious upon transfer. We don’t have much information about them so we order every test under the rainbow, driving up the bill unnecessarily. We put them in hallways. They get bedsores. We inevitably admit these patients for an average of $15,000 to $20,000 per admission.”

The two-thirds of transfers that are avoidable represent about $40 billion in unnecessary spending for something that harms patients,” he said. “We are spending money on hurting patients.”

Peck zeroed in on three operational issues:

• First, on average, nurse to patient ratios in nursing homes are 1 to 36. If one patient becomes acutely ill and spikes a fever, that nurse does not have time to take care of that patient when they have 35 other patients to take care of. Also, most nursing home nurses are trained to handle chronic care, not emergency or acute care. It is a mismatch of skills, not a people problem in any way, he said.  

• Second, diagnostic equipment is sparse, and EKGs and lab tests take 24 hours to 48 hours to come back. That doesn’t work well for acute care.

• Third, physicians are not present in nursing homes. “When I was living in that nursing home and walking the halls weekends and nights, I never once saw another physician. Long-term care patients are seen once a month by their primary care doctors.”

Peck described the Call9 service: They embed 24x7 a paramedic or EMT or a nurse with emergency experience in the SNF. They go to the patient’s bedside and connect to a remote emergency physician who is available 24x7 and working from home. They can see a patient in nursing home A with a paramedic by the bedside and then jump to nursing home B and see a patient there with a first responder with them. “It makes the physician a scalable resource,” Peck said. “Believe it or not, they are our least expensive resource because they get scaled.”

Call9 has full integration with the three most commonly used EHRs in the SNF world. The solution also deploys a suite of mobile diagnostics and can return lab test results in a few minutes. It offers real-time telemetry and real-time ultrasound.

After treating a few thousand Medicare Advantage patients, he said the model has shown that it can save payers more than $8 million per nursing home per year. That allowed Call9 to get involved with Medicare shared savings value-based contracts with several payers nationally. But he notes that 60 percent of patients in nursing homes are Medicare patients. “We took that data to CMS and showed it to them,” Peck said. “The Ways and Means Committee in the House of Representatives got ahold of the data and got excited and started writing the Rush Act.”  He stressed that Call9 is not the only organization creating a program like this. There are others working on similar solutions.

Peck said CMS is interested in using telehealth in this way, he said. “But they don’t have any way to change payment mechanisms in a quick manner. They would have to ask CMMI to run demos, which takes years. But Congress could pass new legislation.” He described the RUSH Act as creating a value-based shared savings arrangement with Medicare where 50 percent of the savings goes back to Medicare, and 37.5 percent goes to a company like Call9 or a physician group or medical staffing group that administers the program and 12.5 percent goes to the nursing home, aligning all stakeholders, he said. “The bill has been introduced by a bipartisan group, because it is a nonpartisan issue.” With time running out in this session, he said, the bill still has strong support among Democrats set to take over House leadership in 2019.

Besides bipartisan sponsors in Congress, the bill also has support from patient advocacy groups such as the Alzheimer’s Association, Michael J. Fox Foundation for Parkinson’s Research, American Heart Association, the National Alliance on Mental Illness, and the American Telemedicine Association. “They are saying that the patients need it; the taxpayers benefit; why are we not doing this?” Peck said.

As someone who has seen family members and friends make that repeated, disruptive round trip from nursing home to emergency room, I concur.  

 

 

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