Telemedicine technology and services vendor Avel eCare recently launched its inaugural annual Customer Forum and Innovation Summit focused on driving innovation in virtual care. This first event featured healthcare leaders from across the country and took place in Nashville.

Topics included the workforce shortage and burnout, increasing access to telebehavioral health, expanding critical and emergency care on demand, cybersecurity, and telehealth waivers and licensing.

Healthcare IT News sat down with Doug Duskin, Avel eCare's chief executive, to get a debriefing on the conference and find out the major themes and learnings.

Q. What was the main message you heard at the conference? What were the overarching themes?

A. There were three major messages. First, there's the concern that still exists within the marketplace around a lack of staffing and clinical resources and how to solve that. The lack of tenured nurses creates a risk to quality outcomes.

The numbers of nurses and doctors coming out of school are on the decline, and many want to work in larger cities where they can maximize the number of patients or disease states they can see. So telemedicine helps bridge that gap in rural or other markets that may not have adequate resource availability.

The second major theme was acceptance. Health systems finally are in a position where the benefit of being able to provide their patients with quality care outweighs any hesitancies around having another doctor or another nurse working with them, especially through a video or voice device.

And the third message I walked away with was around ongoing barriers to the expansion of telemedicine. Connectivity is a challenge for some. There are state licensure issues for doctors, where getting a doctor licensed in multiple states is problematic.

Overall, health systems are trying to provide high-quality care to all of their patients, and they're starting to see that you can't do that in certain markets without the use of telemedicine.

Q. What did you learn about expanding access with behavioral health telemedicine?

A. We've seen a huge increase in the amount of behavioral health encounters over the past two to three years. This is an area that has grown significantly during the pandemic. In some places, mental health is making up around two-thirds of telehealth visits. Talk therapy is an obvious use case for remote care, and the technology can actually create a sense of anonymity for some patients, helping them to open up and communicate better.

But there's this huge gap in how telemedicine is addressing mental health treatment. If you look at our solutions, we tend to focus on assessment at the time of encounter. When someone comes into the emergency room, we're doing behavioral health assessments to understand whether that individual should be admitted or if they can be released to home.

Then, there are other companies that are doing rehabilitation programs. And I think sometimes the variety of offerings can create confusion. That's a reflection of how young the market space is right now. Over time, you'll start to see things consolidate to best serve patient communities.

Q. Critical care on demand was on the menu at the show. What came out of that discussion?

A. If you look at an ICU and you have a surge – whether it's a pandemic or some other issue – the lack of available intensivists to respond to those surges is a problem.

So there's a resource shortage. Most organizations use telemedicine to cover overnights, weekends and holiday shifts. But if you have a surge, you're going to need more resources during the day. This is another area where telemedicine can help fill a gap and solve a problem.

The great thing about critical care on demand is that it allows health systems to augment resources as needed while at the same time managing budget constraints. If you've looked at the news over the past six months, there's a financial strain on hospitals because of the fact they're paying more for clinicians to fill gaps.

The historical 24/7 ICU model for telemedicine is sometimes cost-prohibitive, especially for smaller or rural health systems. Critical care on demand offers more flexibility. It's not nearly as expensive, but at the same time, it provides care when needed.

Q. Was there a lot of talk about so-called "hybrid care," the combination of in-person care and virtual care? Many experts believe that is the future of telehealth.

A. Telemedicine doesn't replace the need for a nurse or a doctor to put hands on a patient to provide care – whether that's surgery or just taking a pulse. In the next several years, telemedicine will evolve to better support the concept of hospital-at-home.

A hospital's census number has historically counted who is in the four walls of the hospital. That has started to change, and hospitals are looking at how to move patients to receiving care in their homes. In this model, patients receive hands-on care up-front, and then it transitions to a telemedicine solution. That's a natural fit for a hybrid care mode, but the question is: What are the technology needs?

We've done some of this work on a pilot basis, with third-party peripherals to take the pulse, look down the throat and provide other patient metrics. But people are still trying to figure out how to do it effectively because there's still always the need to put hands on a patient.

If you can get someone back home more quickly, they often recover faster, and they're less stressed. So we're focused on figuring out how to facilitate a solution.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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