The 2018 SEARCH (Society for Education and the Advancement of Research in Connected Health) meeting was the first held by this group of dedicated telehealth researchers since the Society was formed earlier this year. The meeting was jointly organized and hosted by SEARCH, the West Health Institute and the National Consortium of Telehealth Resource Centers (NCTRC). It was held at the West Health facilities in San Diego, CA October 24th and 25th. About 150 people attended from a wide variety of backgrounds and there were 47 presenters, all with a passion for proving (or disproving) the benefits of connected health through the conduct of rigorous investigations.
The program wasn’t simply talks and panels, but things were spiced up with research-flashes and education bursts. For the former, those presenters with posters were given 2 minutes (not a second more!) to summarize the content and impact of their research in order to draw people to the posters during the poster session. It worked! The poster session was lively and although there was food and drink it seemed as if the posters were the main draw.
There was a People’s Choice Poster Award and it went to a presentation titled “Referral Redesign: Store and Forward (SAF) Dermatology in Mississippi” by Julio Cespedes Jr., MBA andKourtland Adams, MSN from the University of Mississippi Medical Center. The poster described how the UMMC Center for Telehealth leveraged its EHR to bring a low cost, asynchronous solution for dermatological access to the UMMC health system and external community providers. The providers were trained how to capture dermatological images with accompanying history and relevant clinical information and route to a UMMC Dermatologist to render a clinical diagnosis and recommendation. These recommendations were then routed back to providers for management of patient conditions. They showed that SAF is effective for almost 80% of encounters and how their complete referral redesign leverages SAF in a triage approach where live, in-person time is primarily used for complex cases.
The education bursts were designed to provide brief didactic overviews of some key research fundamentals. Although clearly aimed towards those with less research experience, the topics were such that everyone could benefit as not everyone uses the same methodologies or research techniques. I gave the first blast, focusing on diagnostic accuracy – everything from sensitivity and specificity to ROC analysis. Not quite a semester’s worth of material but to some it must have seemed so! Kathy Wibberly, PHD from the University of Virginia and Mid-Atlantic TRC gave an overview of survey development. This generated lots of discussion not only on format but content – do we really need more survey studies on patient and provider satisfaction? Probably not – but if you must at least design one properly! The final burst was provided by Judd Hollander, MD from Thomas Jefferson University on getting published and selecting the right journal. This talk provided some excellent advice not only about paper sections and what they should/should not include, but also some sage advice on when to start writing – as early as possible!
The winner of the best oral presentation went to Stephanie Crosson, MD, MPH, Hadley Sauers-Ford, MPH, Shelby Chen, BS, Victoria Tran, BS, Nicole Glaser, MD and James Marcin, MD, MPH from UC Davis Health for the talk “Use of Home-Based Telemedicine to Improve Care Delivery in Pediatric Patients with Poorly Controlled Type 1 Diabetes”. The study assessed the feasibility and impact of home-based telemedicine as a care modality in a 1-year prospective trial of telemedicine visits for pediatric patients with T1Diabetes and poor glycemic control. The patients receive home-based telemedicine visits with a pediatric endocrinologist every 4 weeks (HbA1c >12), 6 weeks (HbA1c 10-12), or 8 weeks (HbA1c 8-10) between regularly scheduled clinic visits. Data are uploaded from the device(s) prior to each visit and visits are conducted using VidyoDesktop. Not only were patients satisfied with the system and felt that it helped them better manage their diabetes, there was a statistically and clinically significant drop in HbA1c levels!
The two keynote speakers are well-known to the telehealth world. Peter Yellowlees, MD is a Professor of Psychiatry at UC Davis, Immediate Past President of the American Telemedicine Association and a long-time advocate of telehealth through his long career spanning programs in Australia, the UK and the US. His talk on “What should researchers in virtual care be examining now and what areas and approaches to research will be needed in the future?”. Michael Adcock, MS, RN is the Director of Telehealth Services at the University of Mississippi Medical Center and has been involved in telehealth in a variety of clinical and administrative positions. His talk focused on “Worst to first: how Mississippi improved care for vulnerable seniors”.
These talks opened the two mornings and brought up a theme that ended up permeating the entire 2 days – culture change. Talk after talk noted at some point that we really are for the most part past the technology issues and even basic acceptance of and desire to utilize telehealth in any variety of clinical and education scenarios. Even the traditional key barriers (legal, regulatory and reimbursement) were mentioned (often) but not quite with the same levels of frustration as in the past as we are slowly making progress on all fronts in these areas.
What is really needed to make connected health work is the connected part. Not the technology connection, not the Internet. The connection between telehealth and traditional practice. We need to better integrate telehealth into our existing practices – either by figuring out how to fit it seamlessly into the existing infrastructure and workflow or by effective disruption and creating something new. Either approach is hard and fraught with challenges, but it can be done. The key to getting it done – culture change.
Culture change itself is hard and fraught with challenges as well. However, there are two key things (at least) that help drive effective and efficient culture change – education and training. This isn’t just teaching people how to turn on the telemedicine equipment and look into the camera. We need to educate users about the 5 W’s – who can benefit from telehealth, what will it take to make telehealth seamless, where do we need to change to make it seamless, why is telehealth a useful complement to traditional ways of serving our patients, and when is the use of telehealth most appropriate. I know I might be preaching to the choir, but training and education should not be limited to the immediate users – it needs to span the healthcare enterprise - institutionally, as well as at the state and federal levels, plus patients, caregivers and the general public who may not need care now, but at some point in time they will and they should be aware of connected health options and opportunities.
SEARCH will return in 2019 for another round of exciting and impactful connected health research presentations. Check our website (https://searchsociety.org/) periodically for updates about location and dates!