mHealth

Utah has a population of over 3 million people spread across 82,144 square miles. Rural communities make up a little more than 10% of Utah's population. The details of Utah’s population raise a challenging question for healthcare: How to provide quality and timely care to the 10% of the population living in rural communities? At Intermountain Healthcare, telehealth is a crucial part of our solution. The Intermountain telehealth journey began when clinical leadership recognized that Park City Hospital was transferring many critically ill patients to Salt Lake City. The distance is not far, but potentially unnecessary transfers were taking place on mountain roads, during bad weather conditions typical of high-elevation, mountainous regions.

Snow birds. Not the kind that fly (certainly not now with COVID) but the human kind. For those of you who never heard the term before, snow birds are typically retirees who travel south in the winter to states like Arizona, New Mexico and Florida to get away from the snow and cold up north than go back up north in the summer when the heat hits the south. What does this have to do with telemedicine? A lot actually and not just with snow birds. We are a mobile population. People don’t stay in one place their entire lives anymore – we move around, we travel but when we move from one place to another we don’t get to leave our health conditions behind us. They stay with us and sometimes we just get sick when we travel. Being creatures of habit, however, most people like to have consistency in their health providers. We like to think that our PCP and specialists that we see know us and our problems, that we have a relationship. Back to the snow birds – if my cardiologist lives in Chicago and I see her during the summer I want to see her during the winter as well when I’m relaxing by the pool in Tucson staying warm. Problem is she’s back in Chicago shoveling snow so how can I see her? Telemedicine of course but it’s not that easy.

Empanelment. Do you know what it is? Probably not if you’re not “in” primary care. You may know the patient side of empanelment, though. If you have a primary care provider (PCP), it usually means you have been empaneled to that provider. Empanelment is a foundational component of primary care and is essential in population health management. In 2019, the People-Centered Integrated Care collaborative, participants from 10 countries developed an overview of empanelment and a comprehensive definition:

When it comes to platforms and technology for virtual care, when do you buy and when should you build? Building is certain to cost more up front, but it offers the option of lower costs of ongoing support. In addition, if you build it, you own it and can do what you like without interference. Buying it leverages the experience and expertise of vendors, while alleviating programming and some internal support needs. When it comes to creating a telemedicine offering, the struggle is real. There are countless vendors and options. Large companies have merged into larger major market brands. Many companies, including startups, do one or a few things very well as targeted solutions. Getting information on product decisions can be difficult as vendors do not always provide actual use cases. They often leave that up to the customer to define then say how their system could fulfill those needs. Searching for something like ‘TeleICU’ returns more articles and vendors than one could reasonably read.

I spend many hours every week in meetings regarding telehealth. I lead one on proving the value of telehealth. I participate in others focused on mental health, pediatrics, ocular care, the business of telehealth, the associated technology, etc. etc. etc. Over time I’ve realized that, in most cases, the focus is totally on video visits. Having spent many years leading virtual care for Kaiser Permanente in Colorado, in my humble opinion, telehealth encompasses MUCH MORE than video visits. My definition of telehealth is any care process that does not have the clinician and the patient in the same room at the same time. This includes care provided via secure text, e-mail, telephone, video, remote patient monitoring, social media, mobile apps, even sources of information for self-care.

I don’t think I need to say why everyone was more than ready to say goodbye to 2020. Even New Year’s Eve was probably the most subdued we’ve ever had. It was sad to watch the ball drop in NYC without a soul in site, but we stayed up anyway by watching old Abbot and Costello skits from the Colgate Hour – amazing what you can find these days and it’s hard not to laugh at “Who’s on First” no matter how many times they do it. What’s to look forward to in 2021? Infinite possibilities! New Year’s offers the opportunity to envision all sorts of new and exciting things ahead and to reset the course of our lives and events. I have high expectations for 2021, saying goodbye to the trials of yesterday while holding firmly to the triumphs and lessons learned last year. The road ahead is wide open and our gas tanks are full – drive on everyone to new adventures!

The Southwest Telehealth Resource Center (SWTRC) and the Arizona Telemedicine Program (ATP) had the pleasure of working with the United Way of Weld County, CO to provide a webinar to their membership on November 6, 2020. “Effectively Engaging Families in Telehealth” was a very informative and addressed one of the most asked questions about telehealth, how does a provider build an intrapersonal relationship through a screen? Janet Major, Associate Director for Education & Facilities for SWTRC/ATP and Dr. Elizabeth Krupinski, Co-Director, STWRC addressed this question with the central message being that physicians and their support staff need to prepare for each telehealth visit. If a provider is prepared, the visit should go smoothly and an intrapersonal relationship can be established just like an in person visit.

How can we make sure telehealth processes are making a difference that matters? Having led virtual care for Kaiser Permanente Colorado, what matters most to me is that we are finding ways to make care less expensive and/or with better clinical outcomes.

We have some proof that telehealth improves clinical outcomes. Video visits significantly decrease no-shows for mental health care. Remote patient monitoring significantly increases patient engagement in managing chronic disease. Most trust that no-shows and patient engagement are good surrogates for improved outcomes. However, the evidence that telehealth processes lead to decreased cost and/or improved clinical outcomes is less clear.

We pause each November to give thanks. This year, more than ever, it is important to give thanks. For many of us, we are thankful that everyone now knows what telemedicine is and are actively using it even though many of us have been supporting telemedicine and telehealth for well over 20 years. We asked a few friends and colleagues in the Southwest region “What are you thankful for?” and below are their responses. We hope that you too will be thankful. “I am extraordinarily thankful, now more than ever, for both my health and my financial stability. I am also thankful that there has been a burning platform for, and therefore a tremendously increased use of telehealth processes, by both clinicians and consumers. Finally, I am thankful to be able to significantly increase my contribution to the improvement of the US healthcare system as a result of the increased interest in telehealth processes.”

COVID-19 has overstayed it welcome for most of us. Everyone’s lives, across the nation and world, have changed drastically in the last nine months. While COVID-19 has impacted everyone, everyone’s experiences have been different. This summer, I had the privilege to speak to Carol Lewis about Yavapai county, Arizona’s experience and how rural centers are handing the pandemic. But even rural centers experience the effects of the pandemic differently from each other. To explore different experiences across the southwest, I reached out to The Wayne Community Health Center in the rural town of Bicknell, Utah. Bicknell is one of the 10 communities that make up Wayne County. Wayne county contains about 2,475 square miles (105 miles long and 23 miles wide) in south central Utah, 97% of which is federal and state land. The population of Wayne county is about 2700 and there is only one medical doctor in the county to serve them. Of 2700 people in Wayne county approximately 81% of them have health insurance. The demographic of the population is mostly Caucasian (91%), with the median age and income being 41 years and $45K respectively.