Providers

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:

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.”

I have spent the last year training as an infectious diseases pharmacist at Banner University Medical Center-Tucson. A large part of this has been participating in weekly HIV office visits at the Petersen HIV Clinics with Stephen Klotz, MD, Larry York, PharmD, and our lead clinical coordinator, Cesar Egurrola. This multidisciplinary team approach allows the physician to guide the patient’s care, the HIV clinical pharmacist to manage the medication aspects, and the clinical coordinator to manage the behavioral and social needs.

COVID-19 and stay at home orders forced many practices, hospitals, urgent care, and clinics to turn their operations upside down overnight. Patients were canceling appointments left and right due to "the fear of the waiting room". Many primary care providers were seeing upwards of 80% cancellations.

Last month, Psych Associates (Springfield, MO), where I practice, went to an “online office,” which meant every provider in our practice set up a virtual therapy room in their home. We’re all trained up on Telehealth, so ready, here we go! I’m a newbie to the world of virtual therapy so I really didn’t know what to expect, but I’m brave in my work, so I trusted that everything would work out fine. The threat of coming in contact with the deadly coronavirus Covid-19 was real, and of course we all wanted to stay well, and keep our clients well, so we acted quickly. Luckily, it was a smooth transition.

My introduction to telemedicine was in 8th grade, while I was taking a medical science course with Dr. Weinstein, to prove that the medical school curriculum could be integrated earlier into the American school system. I remember thinking, “Wow, this is one of the coolest applications of technology, why aren’t more people using it?” It wasn’t until my sophomore year at the UofA I reconnected with Dr. Weinstein and started to explore the answer to that question I asked many years ago. As I continued to work with Dr. Weinstein I began to realize the answer to that question was more nuanced than my 8th grade self would have thought. By analyzing the Arizona Telemedicine Council (ATC), which is a non-statutory advisory council to the Arizona Telemedicine Program (ATP), for a paper on the relationship between telemedicine and governance it shed light on the legal, financial, and practical barriers of telemedicine.