In a recent survey on telehealth, conducted by Baltimore-based healthcare research firm Sage Growth Partners (SGP) and inclusive of some 100 industry executives, about half of respondents said they have adopted telemedicine in some form, and of the non-adopters, most said that they see it as a priority. The survey findings also revealed that mobile apps and outpatient care are the “next frontier for telemedicine use.”
Indeed, hospitals across the U.S. are starting to embrace telemedicine initiatives more now—albeit at a slow space still—and in a healthcare landscape that is prioritizing cutting costs and keeping patients out of the hospital, this type of remote care has carved out a niche. At NewYork-Presbyterian Hospital, a New York City-based academic medical center, and at its affiliates, including Columbia University Irving Medical Center and Weill Cornell Medical Center, also based in New York City, leveraging telemedicine has become a priority. But as Peter Fleischut, M.D., senior vice president and chief transformation officer at NYP, contends, the institution’s digital health portfolio is inclusive of various virtual care offerings.
In 2016, NewYork-Presbyterian announced the rollout of NYP OnDemand, a new suite of digital health services that included an array of innovation initiatives, including: Digital Second Opinion, a service in which NYP specialists from both ColumbiaDoctors and Weill Cornell Medicine can offer their clinical expertise for second opinions to patients around the country through an online portal; Digital Consults, which connects patients at NYP’s regional network hospitals to NYP hospital specialists; a digital emergency and urgent care program (Express Care), in which visitors to the NewYork-Presbyterian/Weill Cornell ED have the option of a virtual visit through real-time video interactions with a clinician after having an initial triage and medical screening exam; and finally, Digital Follow-Up Appointments, which provides patients a virtual follow-up option, instead of asking patients to come back to the office in person.
Fleischut, who served as NewYork-Presbyterian’s chief innovation officer prior to being named senior vice president and chief transformation officer last May, says that NYP’s core vision was to build a comprehensive suite of telehealth services, rather than just one program. In that sense, the organization has succeeded; to date, there are more than 50 telehealth programs in all. And in total, there have been approximately 15,000 of these virtual care encounters to date, with the care being delivered by any one of 700 providers, Fleischut says.
“We have had 600 percent growth in the past year in telehealth,” he says. Taking just Express Care as an example, patients coming in could wait up to two-and-a-half hours from admission to discharge for an [ED] visit, but with Express Care, in that same window—admission to discharge—patients are seen in approximately 31 minutes. And this is with same levels of patient satisfaction and outcome,” Fleischut attests.
Peter Fleischut, M.D.
Of course, the Express Care program is meant only for patients with minor complaints, but in such cases, after ED patients go through triage—when a physician assistant or a nurse practitioner performs a medical screening exam—those who are judged to be in stable condition with no life-threatening injuries or symptoms are given the option of seeing an emergency room physician via a videoconference in a private room. Fleischut notes that even if the patient initially chooses video visits, he or she can still back out for any reason and switch to an in-person visit instead. “It really comes down to patient preference, but we find that patients prefer [the video visits] in many different [scenarios],” he says.
What’s more, NYP is also partnering with Weil Cornell and ColumbiaDoctors on a telepsych initiative. The motivation for this project, as Fleischut explains, is that in some of NYP’s hospitals—just like across the country—there simply is a shortage of qualified behavioral health specialists. As such, a patient can wait up to 24 hours to see a psychiatrist in certain hospitals. But now with the telepsych program, NYP allows for peer-to-peer visits and can connect patients to psychiatrists within an hour, says Fleischut. And that leads to reduced transfers and reduced admissions, he adds, also pointing out one recent case in which a telepsych patient was scheduled for an in-person follow-up encounter, but then called NYP and said he actually preferred doing the visit from home.
Furthermore, the same process applies with NYP neurologists; there merely aren’t enough experts available. Enter the organization’s telestroke program, which uses video conferencing and data sharing that allows for 24/7 coverage for acute stroke care with rapid evaluation by a neurologist. This can save up to 7 minutes of treatment time, or about 14 million brain cells, as approximately two million brain cells die every minute during a stroke. To this end, NYP also has a mobile stroke unit, in which ambulances are equipped with a CT scan machine to diagnose and treat the patient in the ambulance prior to coming into the hospital, Fleischut says.
Despite the success that NYP has had with this digital suite of services, Fleischut does note one specific challenge that he sees as a major obstacle right now. He gives an example of a patient who comes in, is seen by a provider, and then it’s determined that a follow-up visit is needed. In this case, that doctor has an established relationship with the patient, so if the patient goes back home, that provider can do a follow-up visit with him or her without any issue. But if the patient happens to cross state lines, that provider is no longer able to do a follow-up video visit with that patient; per telemedicine regulations, only a telephone follow-up would be permitted.
But Fleischut expressed frustration in this scenario since the technology (the video visit) is now innovative enough to the point in which it provides higher-quality care than a phone encounter. “Follow-ups are a major issue in healthcare; the non-compliance for follow-up can be as high as 40 percent. And now we have a simple way to do a high-quality follow-up, but due to regulatory challenges, it forces us into using a technology that’s not as high-quality,” he says.
Fleischut does make clear that he supports regulation that requires a doctor-patient relationship to be established before a virtual visit takes place. But in the example he gives, that relationship has already been established, and still, if the patient crosses state lines, problems arise. “Now we have the means and a technology to ensure higher compliance and higher-quality care, and what I think is the right care for the patient, but it’s a challenge—even though it’s your own patient,” he says.
Nonetheless, NYP is continuing to surge ahead in its telehealth and other virtual care initiatives. Fleischut points to a recent collaboration between NewYork-Presbyterian and Walgreens in which kiosks, located in private rooms inside some Walgreens and Duane Reade drugstores in New York, offer instant examination, diagnosis and treatment of non-life threatening illnesses and injuries though NYP OnDemand services. Here, patients can reach board-certified Weill Cornell Medicine emergency medicine physicians, who provide exams through an HD video-conference connection. At the end of the examination, if the physician writes a prescription, it can be instantly sent to the patient’s preferred pharmacy.
Fleischut opines that the next step is to ramp up remote patient monitoring (RPM) services, an innovation which he feels the industry is ready for. He also mentions the 2016 launch of NYP Ventures, a strategic investment fund that supports innovative digital healthcare companies. The venture arm of the organization just recently opened its second office in Silicon Valley. “We really don’t think about this as just telehealth,” Fleischut says. “We hone in on virtualization—and that’s everything from AI [artificial intelligence] to machine learning to robotic process automation. We feel that these are fundamental core tools that are needed in the future delivery of care.”