Telehealth services can offer healthcare providers the opportunity and the capability to reach broader populations – and they can serve as disease prevention tools for these populations, contends Gary Hamilton, CEO of InteliChart, vendor of a patient-engagement platform.

Telemedicine tools can ensure physicians and their care teams can better manage patient care, and the associated workflow, to help their patients stay their healthiest, he adds.

We spoke with Hamilton to discuss how telehealth can be the key to creating successful preventative care programs, how virtual care can be a disease prevention tool, and how telehealth fits into the importance of preventative care in value-based care reimbursement models.

Q. Telehealth is the key to creating a successful preventative care program, you say. How so?

A. Amid the pandemic, telehealth's rapid adoption was driven out of necessity as the rules and regulations regarding in-person patient visits were a constantly moving target. Though today telehealth's value continues to hinge on improving patient access, convenience now also plays a significant role in its continued widespread adoption.

There is no one-size-fits-all when it comes to convenience. For example, defining convenience for a demographic between the ages of 22 to 45 with a 9-to-5 job might be influenced by the inability to take a day off work for a doctor's visit.

However, from a preventative standpoint, telehealth really comes into play for patients with more considerable access challenges. This may have to do with insecurities regarding transportation or socio-demographic issues.

For example, some aging populations may need to coordinate transportation with family members, friends or other care services. It's much more conducive to those particular patients that telehealth is used for accessibility, especially when it's preventative from a wellness standpoint.

All that said, simply encouraging people to see practitioners when they ordinarily wouldn't or couldn't creates a justifiable, longitudinal use case for telehealth.

Q. You suggest that telemedicine services can serve as disease-prevention tools for populations of patients. Please elaborate.

A. Telehealth equips providers with the tools to monitor and oversee patients remotely. In particular, providers are able to more easily monitor and track populations of patients that have unique identifiers that need to be addressed. Those providers are then measured on their ability to successfully treat those patients, which is the essence of value-based care.

One of the most challenging aspects of care is ensuring the patient actually receives the evaluation and treatment they need. This includes treatment under the direct management of a current physician and, perhaps more importantly, when that treatment involves a referral or transition of care.

In transitioning, telehealth gives the patient more options for provider access, increasing the likelihood for the patient to follow through with their referral visit. Seamless integration allows clinicians to access all the tools and data they need with one single system, introducing cost savings and workflow efficiencies – while providing a convenient way for patients and providers to communicate without barriers.

By automating and streamlining manual workflows, telehealth tools can free up staff members and providers to respond quickly and proactively engage with patients. When the patient comes in for an in-person appointment, there are many staff-related workflows for that patient's visit.

From checking in to waiting in a waiting room to taking vitals at a nurse's station, and ultimately rooming the patient, all those processes create a sizable workload for office staff and care teams. Telehealth requires fewer steps to process the patient visit, and by affording a lighter workflow burden for providers and staff, the emphasis and focus [is] on the patient and their problem – not the associated workflows.

Applying telehealth as a preventative measure means making it easier for the patient to access their providers and creating a much lighter lift for the provider organization to yield that visit. The result is a situation where a telehealth visit can be provided by one to two staff, whereas an in-person visit may involve considerably more than that.

When talking about chronic disease and chronic populations, there are a lot of factors that must be considered when managing these patients. Often, it's managing the patient on things they need to be doing on their own, whether taking medication or recording findings such as home glucose or blood pressure readings and weight.

Being able to provide telehealth to the patient, whenever or wherever the patient is, continues to facilitate proper management. You're also more likely to have a patient adhere to prescribed care – especially if they have the ability to take a more active role in their own health.

Q. How does telemedicine as a disease prevention tool help physicians better manage patient care and the associated workflow?

A. With an in-person visit, there typically are both subjective and objective findings. With telehealth, since you can't physically touch the patient, providers can lose a certain level of objective examination.

In that sense, the physical examination can be somewhat limited, but with telehealth a different scenario is created altogether compared to an in-person visit. Telehealth focuses more on listening to the patient about their condition.

That is not to say that you can't obtain objective findings via telehealth, but a telehealth visit becomes much more focused on the interview, and that establishes a unique and valuable dynamic between the patient and the provider.

Additionally, the innovation and evolution of new remote telehealth tools are exciting to see develop. For instance, the evolution of home evaluation tools such as Tyto Home allows for evaluation of the patient with a stethoscope, otoscope and high-definition cameras to increase the effectiveness of the remote exam.

Ordinarily, providers would have to do that type of evaluation in the office. Telehealth tools are getting much more robust and enabling providers to facilitate more enhanced remote care.

Ultimately, telehealth creates a different kind of workflow. One that's less burdensome when compared to an in-person visit. It doesn't require the assistance of somebody getting an EKG, taking the patient in and getting some films, or performing venipuncture for a lab draw.

Telehealth is a much more specific, much more concise evaluation that requires fewer people, thereby offering providers a much more streamlined workflow. Simply put, because there are far fewer moving parts, telehealth optimizes the entire patient's visit.

Q. How does virtual care fit into the importance of preventative care in value-based care reimbursement models?

A. When you have a group of patients that you're managing, the patient's performance, via specific metrics – lab findings, blood pressure findings, etc. – will impact your quality performance scores. At the end of the day, whatever can be done to encourage patient care will be helpful.

Theoretically, if a provider had the ability to call the patient every day and check in with them, as simple as that may sound, it would help with patient care and their health outcomes. Getting the patient to engage at some level will always be essential.

Most importantly, when the patient is due to be seen by a provider on a scheduled, iterative basis or because the patient develops a health issue, telehealth ensures better provider accessibility. Maybe that issue stems from not taking a particular medication, or the patient is doing something they shouldn't.

There also might be a situation where the patient's doing precisely what they've been prescribed, but they're having adverse reactions to medications. That said, when the patient is encouraged to engage with their care with the right tools, it allows the provider to assess and change course or reinforce existing instructions.

It is crucial to ensure that ongoing patient management remains intact. Managing the patient when they're not within the four walls of the doctor's office is one of the fundamental problems with holistic patient care, not just in the context of value-based care.

What does the patient do when the patient is no longer a "patient"? That is the most fundamental challenge for all providers, being influential to the patient in that dynamic. If provider organizations can provide a mechanism to engage with patients when they are outside of a provider's care, telehealth becomes extremely meaningful. The ability to connect when the patient is in the convenience of their home, apartment, vacation or wherever is incredibly impactful.

Impact is what's necessary to drive value-based care. It's a critical level of engagement and involvement that can move the needle on those populations of at-risk patients in a positive manner. A provider could try everything. They could spend a lot of money on all sorts of solutions, techniques and treatments.

In the end, if it doesn't connect with the patient, it won't matter. If you can give patients convenience, if you can provide them with accessibility, if you can give them comfort, and you can apply it toward preventative care, the probability is pretty good that you're going to make a massive difference in their overall health outcomes.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email the writer: bsiwicki@himss.org
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