Policy

In hopes of sparking renewed commitment to applying improvement science to telehealth, we offer this Telehealth QI and QA Miniseries. Today is the second in the series.

Many people are confused about plan-do-study-act (PDSA) cycles, and I am here to set everyone straight! Dr. Don Berwick has called the PDSA the heart of the Model for Improvement. However, after many years of helping health care organizations build skill around PDSAs, it seems to be a tough nut to crack, despite its being at core of why humans are such a successful species. The more PDSAs and the faster you do PDSAs, the faster your learning and progress with improvement will be. Here are a few pointers.

How much do you love improvement science? I have been an improvement science evangelist and guru since 2007. That was the year I completed advanced training in health care improvement with Dr. Brent James at Intermountain Healthcare in Utah.

I was a practicing clinician, clinical manager, quality coordinator, practice transformation lead, IT support (and more) at a family medicine residency that was participating in the Safety Net Medical Home Initiative. Learning the power of data and the science of improvement was one of the biggest light bulb moments of my life. I often liken it to when Johnny 5 – the robot in “Short Circuit” – throws open the barn doors, seeing the outside for the first time and remarks, “Ahh – input!”. Suddenly I could ask and answer questions, using data and measurement.

Telehealth services depend on quality broadband network communications. Recent legislation, executive orders, and agency funding commitments and grants are set to make a significant impact in terms of expanding and improving telehealth services and broadband availability and reliability in the southwest region and nationally.

Telehealth has many benefits including reduced, or eliminated travel and wait times; decreased exposure to communicative diseases; easier access to healthcare professionals and therapeutic interventions; and greater flexibility. However, for many individuals with disabilities, Telehealth and it's associated benefits may be out of reach due to web inaccessibility. Benefits can become barriers because of websites’ inconsistent compatibility with screen readers, closed captions, magnifiers, speech to text software (used by individuals with limited dexterity), easy to understand instructions and hyperlinks (for individuals with cognitive disabilities), and alternative text formats.

Does it surprise you that some clinicians are NOT all that excited to continue to provide care without being in the same room with a patient? Virtual care includes care by video, telephone, email, text/chat, remote monitoring, social media, mobile apps, artificial intelligence and more! More than a decade ago, when I implemented video visits for one region of a large healthcare organization, one-to-one training was provided to approximately 1000 physicians, Advanced Practice Nurses and Physician Assistants who provided scheduled, outpatient care - primary care, medical and surgical specialties. Each of the trainees was given a webcam. One year after training was completed, only 70 of these trained clinicians had provided care by video at least once. Note that reimbursement was not an issue for these clinicians. They were and still are salaried, with incentives based on clinical outcomes and patient satisfaction.

The United States and the world have seen a dramatic increase in the use of telemedicine since the inception of the COVID-19 public health emergency due in most part to stay at home restrictions for both providers and patients. Prior to this, telemedicine was used in a wide variety of clinical and related patient care applications for at least 30 years, and had been seeing steady but not exponential growth. In many cases programs were initiated quite rapidly using readily available and often low-cost equipment and tools, unless there was already an existing program and platform in place. Further, the use of telemedicine was facilitated at the state and federal levels but widespread waivers and measures being put into place to reduce barriers that were previously in place such as changes in reimbursements, requirements regarding patient and provider locations, cross-state licensure and privacy/security requirements.

As the COVID-19 pandemic becomes increasingly under control and more states are ending their public health emergency declarations, legislatures across the southwest have sprung into action to enact bills that permanently expand telehealth services.

At the forefront of this new legislation is Arizona’s HB 2454 that Governor Doug Ducey signed into law on March 5, 2021 to provide comprehensive amendments to the state's laws governing telehealth. In Arizona and other southwest states’ new telehealth laws, entities are generally prohibited from denying coverage for telehealth services and are required to cover remotely provided services at the same rate as equivalent in-person services.

Telemedicine has for years been touted as providing access to healthcare for everyone, anywhere, anytime and it has been quite successful in doing so in many respects but disparities still exist among a number of patient populations. In particular, those who traditionally have challenges accessing healthcare due to physical challenges often experience similar or even greater challenges with telemedicine. Think about for a minute. Telemedicine is predominantly provided using audio and/or video-based telecommunications technologies. This fundamental fact of how telemedicine visits occur can actually exacerbate digital disparities.

Telemedicine is when technology is used to deliver care at a distance. A physician or some other healthcare provider is in a different location than the patient, delivering care virtually, over video or phone. Since the spread of the Covid-19 virus in 2020 telehealth and telemedicine coverage has been expanded, which was previously covered only in a limited fashion. Therefore, there has been a large increase in Medicare recipients seeing physicians using telemedicine. Many types of visits in most specialties can be handled through a virtual or telemedicine visit. This is especially important for the Medicare population, since it is mitigating their risk by not going to an office with exposure to others. In some circumstances it may still be necessary to do an in-person visit, for example to get an x-ray exam, get labs done or have a procedure done. Here are five helpful tips to help you best prepare for a Medicare telemedicine appointment.

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.