ACP – addressing the digital divide

“We need to advance health equity in a sustainable way – not with charity care and not performative health equity”, said Dr. Alister Martin, ED physician and CEO of A Healthier Democracy in the closing keynote at the annual NEHIMSS chapter conference last week. One of the many initiatives of A Healthier Democracy is Link Health which focuses on connecting patients to the Affordable Connectivity Program (ACP) to close the digital divide.

Listening to Dr. Martin last Thursday, I decided to use this week’s blog post to amplify this important initiative and help raise awareness among health IT leaders about the ACP and its importance for healthcare. As they say, timing is everything. June 14-22 is the ACP White House Week of Action and June 16 is the ACP Healthcare Day of Action.

Here’s some background on the ACP taken from the Link Health website:

COVID-19 Accelerated A Massive Shift To Telehealth.

The COVID-19 pandemic ushered in widespread acceptance of telehealth and other digital innovations in medicine and dramatically increased the use of telehealth as an intervention to reach patients.  A recent HHS study shows a 63-fold increase in Medicare telehealth utilization and 32-fold increase in behavioral health care through telehealth triggered by the pandemic.

Access To Broadband Internet Is A Social Determinant Of Health.

Despite widespread internet usage in the United States, 15–24% of Americans lack broadband internet connection, a foundational requirement for telehealth and the bevy of other services that underpin the social determinants of health. In fact, access to broadband internet has been considered a “super” social determinant of health (SDoH).

The Affordable Connectivity Program Expands Broadband Access But Needs Help From Healthcare.

The Bipartisan Infrastructure Law created the Affordable Connectivity Program which provides a subsidy of up to $30/month for lower-income households ($75/month for households on tribal lands) on participating internet service plans and a one-time $100 subsidy for a connected device. 51.6 million households are eligible for the ACP, yet only 25% have enrolled. 38 million more households are potentially missing out on money to pay their internet bill. Importantly, only 13% of patients with Medicaid have signed up for the ACP.

Link Health is partnering with the White House, Civic Nation, and leading healthcare organizations on the ACP Week of Action to leverage the health sector to connect patients to the ACP and close the digital divide. There are resources at this site if you are ready to be part of the action and amplify the message through your organization and in your community. Continue reading

How do patients rate telehealth a year later?

Since March 2020, telehealth volume has increased at rates we would never have anticipated. As Dr. Rasu Shrestha, EVP & Chief Strategy & Transformation Officer at Atrium Health, said during a panel at the recent CHIME21 Spring Forum, “It was an overnight success 30 years in the making”. Indeed, when there were no other choices, clinicians and patients were quick to adapt.

But what do patients really think of telehealth a year later? The COVID-19 Healthcare Coalition recently published the Telehealth Impact: Patient Survey Analysis. The aims of their research were to determine:

  • How well did telehealth serve the clinical needs of patients during the COVID-19 pandemic?
  • For what reasons did patients seek care through telehealth?
  • What were the strengths and weaknesses of telehealth related to quality of care?
  • What are patients’ expectations for the use of telehealth after the pandemic?

The 20-question survey was open to persons 18 years or older who had at least one telehealth encounter between March 1, 2020, and January 30, 2021.Survey responders included 2,007 persons from across the U.S. who received telehealth during the pandemic.

The findings were highlighted in an mHealth Intelligence article “COVID-19 Telehealth Delivery Reaps High Patient Satisfaction”, by Hannah Nelson on April 15, 2021. The results are very encouraging for the future of telehealth. Continue reading

Hospitals too are part of a safe reopening

This past weekend was the unofficial beginning of summer. After 2+ months of stay at home orders and a few weeks of phased reopening depending on the state you live in, the images of large crowds packed in close and without masks at a pool in Missouri, on the boardwalk in New Jersey and at a race track in North Carolina were concerning. As I hope many others chose to do, we stayed home and had a family visit on our patio at a social distance.

We are hearing stories of super spreaders from Mother’s Day two weeks ago resulting in upticks of COVID-19 cases in many states. We see stories of a hair salon in Missouri where two stylists who were ill exposed over 140 customers. We see stories of no available ICU beds in Montgomery, Alabama where cases have reportedly doubled since that state reopened two weeks ago.

On Friday, the President ordered churches to reopen and threatened to override governors who refused to do so. Fortunately, many faith leaders acted responsibly and outlined plans for continued online or outdoor services until they are certain that they can safely reopen their doors to congregants.

News reports say the virus is still spreading at epidemic levels in 24 states and is not contained. This pandemic is not over. And it may be a long time before it is. So how do we begin to recover and safely reopen? Continue reading

Knocking on the digital front door

Health systems are learning many lessons during this pandemic that they will need to carry forward into the recovery and “new normal” phases. One of them may be the need for an integrated digital health strategy, and more specifically a patient focused “digital front door”. The almost overnight shift from in-person ambulatory visits to virtual visits during this pandemic highlighted the need for a more integrated approach for many health systems.

An integrated strategy for a patient centered digital front door has many components including the core website, the patient portal linked to the electronic health record, improved access and scheduling capabilities, call centers, and care delivery through virtual visits. The goal is to meet patients where they are and guide them along the right care pathway with efficient, consistent, and easy processes in the background.

However, these multiple components and functions are often led and directed in an uncoordinated manner by different senior leaders within the organization. The core website is typically owned and directed by Marketing and Communications with technical support from IT. The patient portal is often managed by the ambulatory team in IT partnering with the Chief Medical Information Officer, Ambulatory Services, and Marketing. Improved patient access and scheduling initiatives are often directed by Ambulatory Services or in an academic medical center by the Physician Practice Group leadership. The call center may be managed by Marketing or Ambulatory Services leadership. And telehealth may be provided by a specialized team either connected to or part of IT but be directed by physician leadership.

A successful patient centered digital health strategy needs to involve all these components in a coordinated, comprehensive manner. In some respects, who leads this strategic initiative does not matter. What does matter is that there is buy-in and collaboration from all leaders involved with a common overarching goal to meet patients where they are at and provide an easy, consistent experience to access services. Continue reading

Looking ahead – the “new normal” post COVID-19

It’s hard to think about anything good coming out of this pandemic. Every story of a life lost is heartbreaking. Like you, I have shed many tears in the past month as I read and heard their stories.

And yet, it is encouraging to consider some of the positive changes we may see when we get to the other side of this crisis and are living and working in the “new normal”. We don’t yet know when that new normal time will come. But there are changes in healthcare and how we work that will hopefully be long lasting. I’m not talking about the overall healthcare system or macro societal and economic changes – I’ll leave that to others.

From a health IT lens, here’s my take on some of the positive changes:

Telehealth – There is no question that this crisis has led to a huge increase in telehealth and new use cases. Some organizations are seeing 50+ times the number of telehealth visits compared to before. With regulations relaxed and no alternative, telehealth is being used in many different scenarios. Training, broad deployment and adoption has accelerated as clinic visits are cancelled and telehealth becomes the primary means to connect with your physician. And on the frontlines of COVID-19 hospital care, leveraging it with inpatients to protect staff and reduce the amount of PPE used has also become common. We’ve reached the tipping point for telehealth and I expect we’ll see it continue to grow in the future. A recent article in NEJM Catalyst by Judd E. Hollander, MD, and Frank D. Sites, MHA, BSN, RN, titled “The Transition from Reimagining to Recreating Health Care Is Now”, covers how organizations need to look at expanded telehealth use post COVID-19.

Rapid deployment – From an IT perspective, supporting the effort to stand up a field hospital or alternate care site such as the 1000 bed Boston Hope Medical Center is like a “greenfield” hospital compared to rolling out a new EHR and the associated infrastructure at an existing hospital. What lessons can be learned and applied from these rapid deployments when it comes to getting all hospitals in a healthcare system on a common platform? Does it have to take years?

Interoperability – I use this term loosely here. New York considers all hospitals statewide as one system to share resources and staff. The Hospital for Special Surgery (HSS) in New York City quickly transitioned from an orthopedic only hospital to take other surgical cases and COVID-19 patients, credentialing physicians and providing access to systems. While state and regional Health Information Exchanges (HIEs) have varied in their successes over the years and physician credentialing is one of the slowest and most tedious administrative processes in healthcare, it gives me hope to see how effectively and quickly hospitals are working together in a time of crisis.

Workflow changes – With EHR systems it can often take weeks or months to identify requirements, reach consensus, make the changes, test, train, and implement. Those changes are now measured in hours or days if it’s needed for COVID-19. IT teams and their clinical partners should ask what processes can be streamlined when we are in the new normal. Continue reading

8 tips for telehealth success

Telehealth or connected health as some call it, takes different forms depending on the provider organization and their strategy. The primary driver may be extending geographic reach by providing canstockphoto40754495telehealth services to rural areas. Or it may be largely a focus on consumer engagement.

Regardless, there are common themes for successful initiatives. Based on my experience in several healthcare systems in recent years, I offer these tips for success:

Strategy is key – The organization must first determine what the key drivers are for the initiative. Is it to extend reach or provide an easier patient experience or a combination?

Tactics and specific programs will follow – Once the strategy is clear, which specific clinical services and offerings are needed the most will become clear.

Physician leadership is needed – If the focus is on extending reach of certain clinical services, physicians are at the center and must provide overall direction. For consumer-focused services, ambulatory services or strategic planning leadership may play a more central role.

Operational issues and decisions must be considered early on – There are legal and billing factors along with workflow issues for clinicians and staff to work out before any implementation. Continue reading