Tag Archives: telehealth

A Telehealth Success Story

I’ve been hearing for years about how good broadband can open access to telemedicine. It’s certainly something that is increasingly needed as rural hospitals and clinics are closing across the country. But telehealth is not just a rural issue, and a recent article by Sean Gonvales points out a successful telehealth program in San Francisco.

The SF Tech Council, a collaboration of government and nonprofit entities, undertook an effort to train patients on how to use patient medical portals. Patient portals are online systems that allow patients to communicate with doctors, manage appointments, check lab results, or ask for refills on prescriptions. I’ve been using a portal with my own family doctor, and it’s a great tool for handling things that used to require phone calls or even a doctor visit. A well-run portal makes life easier for patients and physicians.

What the group in San Fransico realized is that a lot of patients were unfamiliar with portals and didn’t understand how to establish a portal connection or use a portal. Using funding from a State digital inclusion grant, the group created a hands-on training effort to help patients learn how to navigate a portal. In San Francisco, the training has been aimed at low-income patients, those with low computer literacy skills, or the many people in the community who speak Chinese or Spanish.

I found this story to be intriguing because it demonstrates the need for hands-on digital skills training. Portals are being increasingly used because they allow the entities we communicate with online verify who they are talking with. In addition to medical portals, portals are used to communicate with an increasing number of federal, state, and local government agencies like FEMA and Social Security. Portals are being used by banks, credit card companies, mortgage companies, and student loan processors.

The folks in San Francisco realized that people were leaving a doctor visit with instructions to follow up through the portal, but then never made the digital connection. The grants funded the ability to establish a hands-on session with a digital navigator who walked people through using a portal in a 45-minute training session.

The feedback was that nearly all participants in the training walked away knowing how to establish and navigate a portal. It’s likely that this training will also give folks more confidence in using the increasing number of other kinds of portals. The feedback was that once people knew how to use a portal, they saw the benefits and were eager to use it.

Every time I read about one of these success stories, I’m saddened that the federal government backed out of funding for digital skills training. This particular success story comes from a State grant, and States can certainly fill in some of the gap created by the cancelled federal funding. However, the federal grant funding for these kinds of training efforts was only going to last for a few years, so there was already going to be a need to establish ongoing programs for these kinds of training efforts.

One thing that the opportunity for federal funding for digital inclusion did was to get a lot of people interested in establishing local digital equity efforts. Hopefully, this momentum will mean these efforts will move forward without the federal funds. At the local level, there are a lot of government agencies and nonprofits that might offer basic skills training like this one. Perhaps a coalition of doctors and hospitals might take on the role to make sure that patients know how to use the needed digital tools. It would make sense if insurance companies would embrace this – they all acknowledge that preventive care saves money, and making sure that patients follow-up visits through a portal is part of the preventive care process.

A Rural Polycrisis?

A polycrisis is a situation where multiple distinct problems interact and amplify each other, resulting in a more severe outcome than the sum of the individual crises. The term is being used to describe the complex interconnections between related problems, which can lead to cascading and overwhelming ompacts. The term is mostly applied to large geopolitical issues, but perhaps it can also be applied to more local issues.

Consider the numerous problems that plague rural America today. Every rural area is a little different, but much of rural America already had problems with access to healthcare, which are magnified as rural hospitals and clinics are closed. Rural America struggles with low incomes that are the result of globalization and the closure of many factories over the last decades. Much of rural America has a population crisis, in that populations are shrinking from the out-migration of younger residents, leaving an aging remaining population. Rural America has a connectivity problem since many rural areas have inadequate broadband, and even more have nonfunctional cellular coverage. The populations in rural America tend to have lower levels of achieved education. I have to think that all of these problems collectively create a polycrisis.

It’s never easy to fix a polycrisis because the problems interact with each other. As I’ve worked around the country in rural areas over the last decade or two, I’ve talked to many local governments that put high hope that better broadband can improve many of the issues that plague their area. Consider what fast, affordable broadband can mean to a rural community.

  • Telehealth becomes essential when local hospitals and clinics close. Even when they don’t close, telehealth can enable residents to consult with specialists in distant cities when the need arises. Lack of telehealth can lead to numerous negative repercussions, such reduced ability to work and earn a living.
  • A lot of communities have told me that allowing residents to work from home is the primary benefit after a rural area gets good connectivity. Working from home can allow people to find work when there are no local jobs. Working from home can mean higher household incomes, which has a positive multiplier effect across the whole community.
  • Reliable connectivity means improved education opportunities. Several studies have shown that K12 students in homes with broadband significantly outperform students in homes with no broadband. Broadband also brings the opportunity to pursue training and advanced degrees online, which improves the opportunity for higher earnings.
  • Good connectivity increases the opportunity for entrepreneurship. For example, the Etsy platform, where people can sell homemade goods and products, says that being an Etsy seller increases household income by an average of 11%.
  • Good broadband has become essential to rural agriculture, and farming communities without broadband are at a significant disadvantage to peer communities with good broadband.

Broadband alone doesn’t automatically make these things better for everybody, and communities are learning that they must pursue all aspects of solving the digital divide to make a real difference. That means not just making better broadband available. It means having broadband at affordable rates. It means making sure that everybody has access to computers and devices and knows how to use them. Communities that make a concerted effort to tackle all of the aspects of good broadband should see improvements over time in some of the issues that trouble them.

This is not to say that broadband is a panacea, and that broadband alone can fix an ailing rural community. But bringing good, affordable broadband can make things better if the community fully embraces what good broadband can bring.

Telehealth Successes

The American Medical Association fully supports telehealth. The group now has gathered enough evidence of the effectiveness of telehealth and touts the advantages of telehealth to its member physicians. There are still a few ongoing issues involving compensation, privacy, liability, and of course, rural patients without broadband access.

The AMA has published a few case studies to help member physicians understand the range of benefits of telehealth. Following are a few of the many case studies highlighted by the AMA.

Telepsychiatry at Virginia Commonwealth University Health. The University serves a wide range of patients over a large footprint, including cities, suburbs and rural areas. VCU Health conducts from 3,000 – 5,000 psychiatric sessions per week and had launched an online trial of psychiatric visits before the pandemic and was conducting up to 20% of psychiatry sessions online when the pandemic hit in March 2020. The numbers flipped with the pandemic, and by April 2020, University Health conducted 90% of sessions online, with the rest in person in hospitals.

Over time it was discovered that patients liked having these visits from the comfort of their home and 80% of visits are still conducted online. The biggest overall benefit of the change to telehealth was that no-shows dropped from 11% pre-pandemic to 6% with more telehealth visits. This was partially credited to an online system that reminded patients of upcoming sessions.

Hypertension Program, Ochsner Health Systems. Ochsner is a non-profit academic health system that operates in over 90 clinics and 20 hospitals in and around New Orleans. Ochsner launched a virtual hypertension program in 2015, long before the pandemic. The program is aimed at helping patients control high blood pressure. A lot of the patients are elderly and low-income. Each patient is assigned a dedicated team consisting of a clinician, pharmacist, and health coach. Patents are given brood pressure monitors that report results back to Ochsner. The average patient checks blood pressure 42 times per week. Patients who aren’t submitting pressure readings get reminders.

The program has been extremely successful. 79% of the virtual patients maintain the desired blood pressure compared to only 26% using traditional office visits. Medication adherence improved by 14% for the on-line patients. The best result is that the out-of-pocket cost for online patients went down an average of $77 per month due to not needing live doctor visits.

Teleneurology and Telestroke – Massachusetts General Hospital. Mass General is a large teaching hospital located in Boston. The hospital tried the first trial with telestroke assistance in 2000 with a small remote hospital located in Martha’s Vineyard. The program provides specialists at Mass General to quickly help doctors at smaller hospitals understand if a patient is undergoing an acute ischemic stroke. If so, it’s vital to administer tPA, a lifesaving drug, within 60 minutes. The small hospital transmits brain scans and other data to Mass General to help in the diagnosis.

The trial was successful, and Mass General has extended the service to 34 community hospitals. This is a cost-savings program since otherwise, each small hospital is required to have a physician with acute stroke experience available 24/7. The Mass General team is able to respond to requests from smaller hospitals in an average of 5 minutes.

 

Broadband Shorts – July 2017

Today I’m going to talk about a few topics that relate to broadband, but that are too short for a separate blog.

Popularity of Telehealth. The Health Industry Distributors Association conducted a follow-up survey of people who had met with a doctor via a broadband connection instead of a live office visit. The survey found that a majority of people were very satisfied with the telehealth visit and 54% said that they thought the experience was better than a live office visit.

Interestingly over half of the telehealth users were under 50 and they preferred telehealth because of the convenience. Many said that once they found their doctor would allow telehealth visits that they requested them whenever possible. Of course, many telehealth users live in rural areas where it can be a long drive to make a routine doctor office visit. The doctors involved in telehealth also like it for routine office visits. They do complain, however, that not enough insurance companies have caught up with the concept and that they often encounter reimbursement problems.

Explosion of Mobile Data Usage. Ericsson, the company that supplies a lot of electronics for the cellular industry, has warned cellular companies to prepare for an explosive growth in cellular data traffic over the next five years. They warn that within five years that the average cellphone user will grow from the average of today’s monthly usage of 5 gigabytes to a monthly usage of 26 gigabytes. They say the usage will be up to 6.9 gigabytes just by the end of this year – a 40% growth over last year.

They say that several factors will contribute to the strong growth. Obviously video usage drives a lot of the usage, but there is also huge annual growth from social media usage as those platforms incorporate more video. They also predict that by 2022, as we start to meld 5G cellular into the network, that users will feel more comfortable using data on their cellphones.

New Satellite Broadband. ViaSat just launched a new satellite that will allow for data speeds up to 200 Mbps. The satellite was recently launched and that has a throughput of 300 gigabits per second. The satellite is expected to be placed into service in early 2018 and will boost the company’s Excede broadband product.

The new satellite, dubbed ViaSat 2, will originally augment and eventually replace the company’s current ViaSat 1 satellite. The company currently serves 659,000 customers from the ViaSat 1 satellite plus a few it purchased from WildBlue in 2009. The new satellite will allow an expansion of the customer base.

The company expects that the majority of customers will continue to buy data products with speeds up to 25 Mbps, like those already offered by Excede. This tells me that the faster speeds, while available, are going to be expensive. This satellite will still be in a high earth orbit, which means the continued high latency that makes satellite service incompatible with any real-time applications. And there is no word if the larger capacity will allow the company to raise the stingy data caps that customers seem to universally hate.

Growth of Music Streaming. Nielsen released statistics that show that streaming audio is growing at an explosive rate and seems to have crossed the threshold to become the primary way that most people listen to music. Audio streams in 2017 are 62% higher than just a year ago. The industry has grown from an annual number of 113.5 billion steams to 184 billion in just one year.

Nielsen estimates that total listens to music from all media including albums and music downloads will be 235 billion this year, meaning that streaming video now accounts for 78% of all music listened to.

And this growth has made for some eye-popping numbers. For example, Drake’s release of More Life in March saw 385 million streams in the week after release. Those kinds of numbers swamp the number of people that would listen to a new artist under older media.