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Market Report: Telehealth Vendors Need to Improve Integration with EMRs

October 11, 2017
by Heather Landi
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Within the telehealth vendor market, American Well and Avizia are currently the most widely adopted, yet very few virtual care vendors have delivered on their promises of integration, according to a new market report from Orem, Utah-based KLAS Research.

KLAS’s market report, “Telehealth Virtual Care Platforms 2017,” examines which vendors are supporting healthcare organizations’ abilities to expand virtual care.

With regard to how healthcare organizations are using telehealth platforms, KLAS identified three primary visit types—scheduled/patient-focused visits, on-demand/consumer-focused visits and tele-specialty consultations.

Healthcare organizations have found that virtual care platforms (VCPs) reduce delivery costs, increase access to new patients, and allow organizations to deliver better care. While these platforms are just one aspect of the rapidly evolving telehealth market, a number of vendors now offer virtual care platforms supporting diverse visit types and use cases. Some have only a handful of live organizations today, but all are growing, according to the KLAS report.

Working with the College of Healthcare Information Management Executives (CHIME), KLAS reached out to healthcare organizations facilitating live video visits on virtual care platforms to provide an early look at who is helping organizations expand telehealth services today.

Currently, American Well and Avizia are the most widely adopted virtual care platforms. To date, American Well, Avizia, and VSee are the only vendors KLAS has validated as being used for all three key visit types mentioned above.

The KLAS report notes that most telehealth vendors originally built their solution for one specific visit type, rather than as an all-encompassing platform, and few are capable of supporting the expansion organizations are looking for. “InTouch Health, swyMed, and Avizia began with hardware to support the secure, reliable communication needed for provider-to-provider consultations; American Well and Carena offer provider network services to support on-demand/consumer-focused visits,” the KLAS researchers wrote in the report.

It was announced this week that Avizia acquired virtual care provider Carena.

KLAS researchers also note that for many organizations, telehealth is a new endeavor with an uncertain return on investment. “Those hoping for leadership and strategic guidance from their VCP vendor often find that guidance is limited to implementing existing product functionality. Vendors are generally supportive when called upon, but customers want a more proactive approach,” the KLAS researchers wrote, based on their interviews with healthcare organizations. “This is especially problematic when vendors support complex telehealth programs, as is the case with American Well, Avizia, and VSee.”

What’s more, the KLAS report states that Epic customers describe a “one-size-fits-all approach that leaves strategy largely up to customers.” Vendors with the highest ratings for guidance, such as InTouch Health, TruClinic, and Zipnosis, tend to offer less complex solutions for which provider expectations for guidance are typically tied to operational support, the KLAS report states.

In a survey of healthcare organizations conducted by KLAS and CHIME, which Healthcare Informatics covered here, the survey findings indicated that healthcare organizations cite integration as an ongoing concern when using telehealth platforms. Apart from Epic, vendors have not delivered on promises of integration, the KLAS report states. “Provider organizations want to be able to access electronic medical record (EMR) data from within their VCP, but interfaces are missing, and many organizations are frustrated with what it costs to achieve any sort of integration. A large number feel that integration costs are too high and that most vendors are missing standard interfaces,” the KLAS researchers wrote.

What’s more, unidirectional EMR integration is possible for some, but organizations say it is generally insufficient to meet their workflow needs. “A single respondent from American Well and two from Avizia have achieved bidirectional integration; however, these customers say this was achieved through extensive effort by their own organizations,” the KLAS report states.

KLAS also notes that several EMR vendors have developed or are developing telehealth capabilities, but only Epic had enough live organizations to meet the minimum sample threshold for inclusion in the report. As the market continues to grow, it is expected that many other EMR vendors' solutions will be represented in future KLAS reports.

Looking at KLAS overall scores for telehealth vendors, American Well, “a large and earlier developer of telehealth and virtual care platforms, with a comprehensive offering,” scored 79.8. “Customers praise their platform as functional and easy to use. American Well has grown rapidly, and a few customers feel they do not get the support they expect,” the report states.

InTouch Health, which is used solely for tele-specialty consultations and is praised for telestroke expertise, scored 89.8.  “Their reliability and strong customer support drive high satisfaction. The vendor is expanding to support other visit types,” according to the report.

The additional seven vendors KLAS included in the report had less than 15 unique respondents, which the organization refers to as “Below Konfidence.”

Avizia scored 88.3; Epic, the only EMR vendor in the report, scored 84.2; swyMed scored 87.7; TruClinic, a newer entrant to the telehealth space, scored 91.7 and Zipnosis scored 89.6. Carena and VSee had insufficient data, according to the report.

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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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