For Doctors Without Borders, Telemedicine Brings Specialized Care to the Front Lines | Heather Landi | Healthcare Blogs Skip to content Skip to navigation

For Doctors Without Borders, Telemedicine Brings Specialized Care to the Front Lines

December 22, 2017
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For the past 46 years, Médecins Sans Frontières (MSF), or Doctors Without Borders, has been providing emergency medical and humanitarian aid around the world where the need is greatest, particularly to people afflicted by conflict, epidemics, disasters or exclusion from health care.

In 2016, Doctors Without Borders provided humanitarian assistance in 71 countries, providing 9.7 million outpatient consultations, performing 92,000 surgical interventions and the organization also has rescued and assisted more than 30,000 migrants and refugees at sea. Every day, the organization’s medical teams treat people displaced by conflict and extreme violence through field missions in countries such as Syria, Yemen, South Sudan, Nigeria and the Democratic Republic of Congo.

To support the medical work of doctors and nurses on-the-ground in remote areas, Doctors Without Borders leverages a telemedicine platform to provide clinicians in the field with access to medical specialists. I recently spoke with John Lawrence, M.D., a pediatric surgeon, and MSF-USA’s board of directors’ president, about the organization’s telemedicine platform and how it helps to bridge the gap between remote areas and large hospitals, linking patients with specialists around the globe. While telemedicine is not a cutting-edge technology, for doctors and nurses working in remote locations like Aweil, South Sudan with limited resources, that link to a specialist can literally help to save patients’ lives.

For the past 20 years, Lawrence has been a practicing pediatric surgeon, primarily in academic settings. He has completed eight surgical missions with MSF since 2009 in areas such as the Central African Republic, Ivory Coast, Haiti, Syria and the Democratic Republic of Congo. For the past nine months, he has been involved with the organization’s telemedicine program, providing his expertise as a specialist to doctors in the field.

The organization’s telemedicine service consists of three coordinators working 24/7 who receive alerts from field teams requesting assistance from a specialist. The coordinators then forward the request to one of the system’s 280 experts. Since 2010, more than 3,000 cases have been treated using the telemedicine service. The platform enables MSF staff to manage remote medical consultations and currently there is an average of five to ten cases received each day.

On the consulting side, Lawrence says he has found the process to be quick and seamless. “I have access to the patient’s clinical history, laboratory data, X-ray data, and sometimes, depending on the circumstances, a picture of the patient. There will also be a comment chain of other referral doctors that have been consulted on this case,” he says, noting that the general physician in the field may send a case to a pediatrician or pediatric infectious disease specialist, or send X-rays to a pediatric radiologist for input, and then request input from a pediatric surgeon.

Lawrence, who specializes in neo-natal surgery, notes one particular case he consulted on that involved an infant, whose family lived in Guinea, who was born with a severe birth defect. Based on the child’s clinical history and a photo provided, Lawrence was able to remotely diagnosis that the child was born with cloacal exstrophy, a birth defect in which much of the abdominal organs are exposed.

“It’s one of the most difficult conditions to reconstruct in all of pediatric surgery. Not every medical consultant is in the position where they’ve worked in the field and understand what the resources are like and the level of care in that setting. My response was that this was not something that could be cared for in a small, community hospital and that they needed to transfer the patient to the capital city to get the highest level of pediatric care,” Lawrence says.

In another case, physicians operating a MSF pediatric hospital in the eastern part of Lebanon, near the Syrian border, requested Lawrence’s expertise for a case involving a five-year old with a possible tumor. “The family were Syrian refugees who had just crossed the border from Lebanon and the child previously had surgery done to remove a pelvic tumor, but was experiencing symptoms that suggested it had reoccurred. The doctors in the field described the physical exam and sent X-rays and wanted my recommendation on how best to proceed,” Lawrence says. “The family had been trying in the last year or two to get care for the child, but they hadn’t been able to access care within Syria. Looking at the X-rays and knowing the capabilities of the facilities that we are running in East Lebanon, which is a good hospital, but it’s not a tertiary care hospital, it was my recommendation to refer the child to the main pediatric hospital in Beirut where the child could be treated by the appropriate oncology surgical team and receive a high standard of care.”

Lawrence believes that the telemedicine platform greatly enhances the care that physician and nurses on-the-ground can provide to patients in greatest need. “The teams we work with are exceptionally dedicated and skilled, but this allows for the full spectrum of medical or surgical specialists that you would typically have access to in a high-income setting. More often than not, our projects on-the-ground are straight-forward care, whether it’s pediatrics, gynecology or primary care, in each discipline, people are generalists with a good, broad knowledge base and can care for a wide range of common things. But, when you get into the uncommon, that’s the value of resourcing people," he says.

More broadly, Lawrence says his field work with Doctors Without Borders has been an eye-opening experience and has raised his awareness of the critical healthcare needs throughout much of the world.

“It’s been the most rewarding and most valuable part of my surgical medical career. From a patient perspective, the needs that exist for so much of the population of the world are not well addressed. In terms of how I view healthcare globally, I think it should be a basic human right, but it’s still largely a privilege. And, of course, there’s discrepancies in healthcare inside the U.S. as well, but it’s so different in the context that we work in,” he says.

Continuing he says, “Our focus is often in areas of conflict; a little over half of our projects are near or adjacent to conflict zones, so that instability often leads to deterioration of healthcare systems overall, systems that may or may not have been functioning in a pretty good state previous to the conflict or violence.” And, he adds, “From a surgical side, there is a gross maldistribution in terms of where surgical care is offered—the richest third of the population wind up getting 75 percent of the operative procedures, and the poorest third of the population only get about 3 percent of the operations. This is a void that I think we help to fill and I think what this organization offers in that regard is very valuable.”

As another takeaway, Lawrence says he has been impressed with the efficiency of the operating rooms of the Doctors Without Borders field hospitals. “They are the most efficient that I’ve ever been in. People in the U.S. are shocked to hear me say that, but there is so much more you can get done in a day there, than is possible here.”

Speaking with Lawrence about his experiences working in the field in areas like South Sudan and Syria, it brings to mind that while the U.S. healthcare system is in the midst of accelerating change and uncertainty—federal policy changes, possible cuts to Medicare, the ongoing transition from volume-based reimbursement to value-based care and payment, rapidly rising healthcare costs—there is much to appreciate and applaud about the U.S. healthcare system and the progress the industry is making to increase quality of care. And, healthcare professionals in the U.S. should perhaps appreciate that even with limited budgets they are operating with more financial resources and working in safer, more stable environments compared to many of their physician colleagues located in conflict areas throughout the world.

Moving ahead in 2018, technology and digital innovation will continue to play a large role in ongoing efforts to meet the “Triple Aim,” providing high-quality care and improving the health of populations at lower cost. And as healthcare IT leaders focus on leading-edge and next-generation technologies—whether artificial intelligence, machine learning, virtual reality, robotics and advanced analytics—it’s worth recognizing the benefits of more fundamental technologies, such as telemedicine, as highlighted by the work that Lawrence and other physicians are doing in their humanitarian and medical relief efforts around the world.

 

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Making Care Connections Happen: How Intermountain Healthcare is Moving the Needle on Virtual Care

August 14, 2018
by Rajiv Leventhal
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Treating patients locally, rather than making them travel hundreds of miles for care, was a core driver for Intermountain’s new virtual care initiative

In March, Salt Lake City, Utah-based Intermountain Healthcare announced the launch of one of the nation’s largest virtual hospital services, bringing together 35 telehealth programs and more than 500 caregivers to enable patients to receive remote medical care.

The virtual hospital, called Intermountain Connect Care Pro, provides basic medical care as well as advanced services, such as stroke evaluation, mental health counseling, intensive care, and newborn critical care. “While it doesn’t replace the need for on-site caregivers, it supplements existing staff and provides specialized services in rural communities where those types of medical care usually aren’t readily available,” officials said in the March announcement.

Michael Phillips, M.D., Intermountain’s chief of clinical and outreach services, says that a core reason why the health system went in this “virtual” direction was because its leaders saw the evolving healthcare landscape and wanted to get out in front of it. “Our thought process behind this was that the world has changed from the days where you can only take care of people who [physically] make it to you. But literally every person on the planet is pretty much within the distance of a cell tower now. So we feel people should be able to benefit from [remote] care,” says Phillips.

Offering an example of how these services work in the clinical setting, Intermountain officials brought up the instance of an infant at a southern Utah hospital who was being supported via Connect Care Pro services and received a critical care consultation that allowed the sick baby to stay in that facility instead of being transferred to a newborn intensive care unit (ICU) in Salt Lake City. This single avoided transfer would have cost over $18,000 dollars. The parents of this baby were able to remain in their community, surrounded by their support system, instead of traveling what would have amounted to 400 miles and seven hours round-trip every time they wanted to see their baby, noted officials.

Indeed, as Phillips puts it, when most rural hospitals think about big health systems, their vision is a helicopter scooping in and flying away from the rural facility with its complicated patient. “But we believe that many of those patients can be treated locally, and there are clear benefits to that. First off, it’s better for the patient—having their family separated by 200 miles to drive to a major medical center is not good for their care and doesn’t tallow for a good support system. If they can be treated locally, they should be,” he attests.

As of now, notes Phillips, Intermountain’s virtual care services—inclusive of the Connect Care Pro, which is a direct provider-to-provider service and Connect Care, which is a direct-to-consumer service—covers all of the health system’s hospitals and another nine facilities outside of the system. “We are really covering more than 30 ICUs in all, and we have a stroke service, a neonatal resuscitation service, and [other services]. Our tele-ICU services are covering a few hundred beds with this process,” Phillips explains.

Michael Phillips, M.D.

So far, some of the top results from deploying the virtual services across Intermountain have included reduced length-of-stay, decreased ER and urgent care visits, and improved mortality rates, notes Phillips. What’s more, Connect Care leaders wanted to make sure that clinicians were performing in a telehealth visit with similar antibiotic stewardship than if they were seeing the patient in person. “We don’t want the answer just to be that we talked to you on phone, so we will write you a prescription for an antibiotic; we wanted the [prescribing process] to be as rigorous as it would be in person,” he says.

Although virtual health services are certainly catching on more at health systems these days, some physicians who are used to traditional care delivery are apprehensive. At Intermountain, Phillips offers, “Providers have taken to [Connect Care] well. There is a bit of self-selection for the kinds of people who are comfortable with doing this kind of work and who are good at communicating over this medium. But I think [telehealth] will come to virtually everyone in medicine because for a lot of conditions, it’s simply a more efficient way to deliver care,” he says.

To be clear, Phillips does not believe that in-person visits will “go away” by any stretch, but that it is quite difficult to have extensive, expert coverage at every hospital and physician’s office. “But we can certainly bring that expert in with a telehealth format, virtually everywhere,” Phillips notes. “Yes, cultural changes will need to take place, and I would say that the technology is the easy part. Culture is the challenging part,” he adds.

Phillips also contends that issues around the payment portion of telehealth visits—which has sparked much discussion in healthcare and health IT circles over the years—will continue to present challenges to providers, particularly those that still operate primarily in fee-for-service environments. “We have a large at-risk population here, so the payment part might be less of an issue for us because telehealth works better in a [value]-based model than a fee-for-service one. But these are typical barriers everyone is trying to figure out. In an at-risk model, [telehealth] is efficient and if you’re not worrying about having a fee-for-service payment for each individual episode, it becomes less of a concern,” Phillips says.

In the end, Intermountain clinical and IT leaders believe that virtual care is an efficient way to provide healthcare, Phillips offers. “The technology is meant to make all the folks inside our system more productive. If you look at larger sectors in the economy, there’s only two I can think of in which the workers have not become more productive: medicine and education. And that’s about embracing technology,” he says.

Phillips believes that the cost of healthcare is largely based around how productive an organization’s workers are. Indeed, if 70 percent of the costs are “people,” there’s a need to make sure that this area is well invested so that “we can keep costs affordable for people who need to get healthcare,” he says. “You can have the best healthcare in the world but if people can’t afford it, it doesn’t do you any good. We want as many people as possible to lead healthy lives.”


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CVS Health’s MinuteClinic Launches New Telehealth Offering

August 9, 2018
by Rajiv Leventhal
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CVS’ MinuteClinic, the company’s retail medical clinic, is rolling out a new telehealth healthcare offering for patients with minor illnesses and injuries, skin conditions and other wellness needs.

The MinuteClinic video visits, a telehealth offering, will provide patients with access to healthcare services 24 hours a day, seven days a week from their mobile device, CVS officials said in an announcement this week.

In recent years, MinuteClinic has been testing telehealth as a method of increasing access to care. During the initial phase of testing, a CVS Health study found that 95 percent of patients who opted to receive a telehealth visit were highly satisfied with the quality of care they received. In the same study, 95 percent of patients were satisfied with the convenience of using the telehealth service and the overall telehealth experience. Those results led the company to develop the expanded virtual care offering being launched this week, officials proclaimed.

Working collaboratively with telehealth company Teladoc, and leveraging its technology platform, patients can receive care via a MinuteClinic video visit, initiated through the CVS Pharmacy app. Officials noted that a video visit can be used to care for patients ages two years and up who are seeking treatment for a minor illness, minor injury, or a skin condition. Each patient will complete a health questionnaire, then be matched to a board-certified health care provider licensed in their state, who will review the completed questionnaire with the patient’s medical history, and proceed with the video-enabled visit.

During a MinuteClinic Video Visit, the provider will assess the patient’s condition and determine the appropriate course of treatment, and if an in-person follow up visit with a provider is needed. A MinuteClinic Video Visit costs $59.

“We’re excited to be able to bring this innovative care option to patients,” Troyen A. Brennan, M.D., executive vice president and chief medical officer of CVS Health, said in a statement. “Through this new telehealth offering, patients

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Physicians Still Reluctant to Embrace Virtual Tech, Survey Finds

July 19, 2018
by Rajiv Leventhal
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While consumers and physicians agree that virtual healthcare holds great promise for transforming care delivery, physicians still remain reluctant to embrace the technologies, according to a new Deloitte Center for Health Solutions survey.

Physicians are specifically worried about reimbursement, privacy and other issues, according to the research, which included surveys of both consumers and providers.

The surveys found that a majority of consumers (64 percent) and physicians (66 percent) cited improved patient access as the top benefit of virtual care. About half of physicians surveyed agreed that virtual care supports the goals of patient-centricity, including improved patient satisfaction (52 percent agree) and staying connected with patients and their caregivers (45 percent agree).

However, physicians’ enthusiasm wanes when it comes to using virtual care in their practices today. While 57 percent of consumers favor video-based visits, only 14 percent of physicians surveyed have the capability today, and just 18 percent of the remainder plan to add this capability.

Lack of reimbursement, along with complex licensing requirements and high cost technologies are among the key causes of physician reluctance, the research found. However, changing reimbursement models may be a catalyst for virtual care adoption. The physician survey also found that clinicians worry about medical errors (36 percent) and data security and privacy (33 percent) associated with virtual care. 

One step in the right direction could be a very recent proposed rule from the Centers for Medicare & Medicaid Services (CMS), which included recommended changes to how physicians would be reimbursed for telehealth services. The CMS proposal has so far brought a mix of enthusiasm and concerns from groups advocating for greater usage of telehealth.

 “Changes in health care reimbursement models, combined with growing consumer demand, are driving health systems to embrace virtual care, but they are struggling to get physicians on board,”. Ken Abrams, M.D., managing director, Deloitte Consulting LLP, said in a statement. “However, getting buy-in from physicians may not be as difficult as organizations might expect: most physicians who have tried the technologies associated with virtual care feel good about them. It’s important to help physicians understand how virtual care improves care quality and lessens patient or caregiver burden.”

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