Monthly Archives: May 2015

The New House Call- Telehealth is Bringing the Doctor Back Home

woman video chat with DrWatch any movie set in the late 19th or early twentieth century where someone has taken ill and inevitably, a doctor will arrive at the patient’s home, black bag in hand, and sit next to them in their own bed to take a look. In fact, this is the origin of the term “bedside manner”.

In the 1930’s house calls were standard practice for physicians. Approximately 40 percent of doctor patient visits happened in the patient’s home. By 1950, this had decreased to 10 percent, and by 1980, to about only 1 percent. –American Academy of Family Physicians

In a way, some of this shift to medical care at a dedicated facility outside of the home makes sense. A physician at an emergency room (ER) for example may need access to a CAT scan machine, an MRI machine, a cardiology lab, or a lab for blood work. It is hard to imagine all of this being taken to the patient’s home in that traditional little, black doctor’s bag. The propagation of the modern day insurance system also played a part in the reduction of house calls by physicians due to their policy for reimbursement on these type of visits.

The house calls, for all intents and purposes, are gone. However, the march of technology and the need to better allocate the limited resources of a physician’s time, while reducing the cost of medical care are bringing back the house call in an innovative new way.

Enter Telehealth.

Telehealth as a concept has been around for some time, but it seems that the introduction of new technology alone is not enough to tip the scales. You need an accompanying change in the attitudes and acceptance of the technology by the patients themselves. You also need acceptance of the technology by both the medical community, as well as by the medical insurance system to assure payment. For the last few years, these needed changes had been slow to materialize, however today the pendulum has begun to swing in favor of telehealth.

A recent Harris Poll showed that 66% of people surveyed are open to visiting with their doctor over video. The appeal of convenience and shorter wait times were strong drivers of this willingness. Another interesting revelation in the poll was that for “middle of the night” care, 21% of respondents indicated they would choose a video visit. This may on the surface seem low, but when you consider the fact that 17% said they would call a 24 hour nurse line, and an additional 5% indicated they would use an online symptom checker, the result is that 43% of the respondents chose methods that did not require seeing a doctor in person. That means telehealth in some form has now reached the same level of preference as a visit to the ER, (44% chose this method), when it comes to middle of the night care.

For obtaining prescriptions, an overwhelming 70% of respondents said they would prefer a video visit with the doctor. Prescription refills, birth control, antibiotics, and prescriptions for chronic illness are all situations that align well with online consultations.

Doctors Matter

Another telling finding in the Harris Poll on telehealth was that doctors still matter. Just because patients are willing to meet with a doctor over video doesn’t mean that they are willing to meet with any doctor available. In fact, 88% of those polled wanted the ability to choose their online doctor just as they would their primary care physician (PCP). 7% of respondents said they would be willing to switch PCPs to get video visits, which indicates that adding telehealth services would not dramatically attract new patients to a practice, but would create opportunities to retain more existing patients, especially younger patients who would be more likely to leave.

Doctors do indeed matter, and not just in a patient’s choice of physician, but also in the doctor’s choice to use telemedicine in their practice. As stated above, doctors do not currently face a mass exodus if they choose not to employ telehealth. However, doctors who have made the leap have found they can offer the same quality of care and positive patient outcomes when they utilize HD video for patient visits.

“The first thing I do when I treat a patient is I look at their face,” said Dr. Peter Antall, President and Medical Director of the Online Care Group, which provides telehealth services. “A person’s facial expressions and body language give me an understanding for their overall well-being that could be missed over the phone. Beyond that, video gives me an opportunity to see skin rashes or tonsils – important signs when making a diagnosis. With the HD-quality video, I can assess the patient closely and provide a diagnosis that will produce the best possible outcome.”

This aligns well with the Federation of State Medical Boards’ policy recommendations of utilizing both high quality audio and video in telehealth.

Cost of Care

The survey shows that 62% of patients expect telehealth visits to cost less than an in person visits. This is a reasonable assumption, and has proven to be true in reality. Studies have shown that “telehealth visit saves about $100 or more compared to the estimated cost for in-person care.”  Given these savings, it seems odd that insurance companies have been slow to embrace reimbursements for these visits.  Today however, 22 states now have laws requiring that telehealth visits be paid in the same way as traditional office visits, and the Affordable Care Act also has rules in place that will continue to pave the way for increased technology in healthcare.

With consumer attitudes on telehealth dramatically shifting, insurance policies rapidly changing to allow for telehealth reimbursements, telehealth’s innate cost advantages, and the growing acceptance of telehealth in the medical community based on realized positive outcomes, it is no surprise that telehealth is poised to revolutionize healthcare.  It all adds up to one thing.

The house call…is back!

 

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes.  Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

 

Resources:

#1: http://www.aafp.org/afp/2011/0415/p925.html

#2: http://www.fiercehealthit.com/story/patients-increasingly-open-video-doctor-visits/2015-01-23

#3: http://cdn2.hubspot.net/hub/214366/file-2374840622-pdf/TelehealthConsumerSurvey_eBook_NDF_Electronic_Version_(2).pdf\

#4: http://www.fiercehealthit.com/story/new-york-enacts-telehealth-parity-law/2015-01-12

 

Joel Harris

About Joel Harris

Joel Harris brings invaluable insight to the Avidex team in his role as CEO, with years of experience leading national technology, healthcare and business organizations. You can reach Joel at jharris@avidexav.com

Technology Vision and Execution at the Heart Hospital Baylor Plano

THHBP_OR6_01The first and only freestanding, full-service hospital in Texas resides in Plano.  It is The Heart Hospital Baylor Plano, joint ownership with physicians, and part of the Baylor Scott & White Health system, and it is one of the top ten heart surgery centers in the United States.  It opened in 2007 with 68 beds, and grew rapidly to its planned capacity of 116 beds.  Services range from non-invasive EKGs and echocardiograms to performing heart valves surgeries.  The Heart Hospital has risen to become the seventh-largest vascular program in the country (out of about 1,700), and is #14 in the nation in terms of overall volume of procedures, while earning its place in the top 1.68% of cardiovascular facilities nationwide when it comes to patient outcomes and quality of care.  It has also achieved the highest rating the Society of Thoracic Surgeons can bestow, a coveted 3 star rating. All this in under 10 years.

THHBP_SlideSo how has The Heart Hospital Baylor Plano been able to achieve all this in a relatively short amount of time? 

The Heart Hospital Baylor Plano is a joint ownership venture where the physicians actually own a portion of the hospital.  As such there is an attitude of proprietorship that permeates their culture and is exemplified by their executive team and their physicians.

Mark A. Valentine is the president of The Heart Hospital Baylor Plano.  He began his career as a respiratory therapist in Ohio, which ultimately led to expanding his career into heart and vascular leadership within the Cleveland Clinic Health System, the top cardiovascular program in the world.  It is Mr. Valentine’s unique leadership style that seems to further set him apart from many of his peers.  The team at The Heart Hospital Baylor Plano credits much of their success to Valentine.  He empowers “his leadership team with the ‘keys to the franchise’ and expects each business unit to succeed within the vision he has provided. This strategy enables a level of collaboration, integration and quality that reinforces the culture of excellence while enabling staff and physicians to work more closely together toward shared goals. As such, accountability is high and consistent both individually and collectively throughout the hospital.”

Founding member and interventional cardiologist Dr. David Brown has also made an impact since the beginning.  His vision for The Heart Hospital Baylor Plano: “We will provide the highest quality levels for future outcomes, future innovation, and we will be the lowest-cost provider of the best healthcare in the country.”

NursingEd_081413_01It is in part due to the role of “future innovation” that The Heart Hospital Baylor Plano has risen to the top. Thomas Edison has been credited with saying that “Vision without execution is hallucination.” Luckily, The Heart Hospital Baylor Plano’s technology department has both vision and execution, alive and breathing in the persons of Nayan Patel and Jim Walker.

Nayan Patel has been at The Heart Hospital Baylor Plano for four years. He is the director of information technology and came from a background in corporate IT and electrical engineering, but not in healthcare. Patel took the position and, to his credit, quickly realized that he needed to be networking with other CIOs in the healthcare space to be able to take The Heart Hospital Baylor Plano’s technology to the next level. He credits HIMSS (Healthcare Information Management Systems Society) and CHIME (College of Healthcare Information Management Executives) with helping him achieve his success, both of which he is an active member.

“The hospital had asked for a lot of technology up front when it was built,” says Patel, “which gave us a great base to build upon.” He was not content, however, to assume that the existing technology was being utilized to its full potential. He needed to assess all of the hospital’s capabilities from a technology standpoint, and he needed someone well-versed in the specific equipment to do that.

Enter Jim Walker.

Jim Walker is The Heart Hospital Baylor Plano’s Audiovisual Technical Consultant. Much like Nayan Patel, he came from an electrical engineering background. His career had taken him into the world of audio video systems design and support in the very unique and demanding live event and museum industries. When Walker came aboard, Patel commissioned him with evaluating the usage of all the AV equipment at the hospital. Rather than giving Patel a list of specifications and features, he took a different approach.

Walker took a physical inventory of all the technology in the facility. Then he assessed all the capabilities of the equipment, as well as its current usage. He would then work with Patel to maximize, repurpose, or de-purpose the equipment. “We found that there were pieces of technology in the facility that were underutilized, others that were used initially but had not been used in some time, and some that had never been used at all,” says Patel. This was the beginning of a reevaluation process that Patel and Walker continually use to “question and validate” the technology and its role in the hospital.

COI_Teaching_01“Having a resource like Jim on staff is invaluable to us,” states Patel. “We have a relationship with an AV integrator for large projects or major expansions, but a lot of things can happen in the day to day life of the hospital that need to be addressed ASAP. There may be problems with recording or cables. A lot of cables seem to get unplugged here.” Walker also facilitates impromptu meetings and events and has developed mobile carts for video conferencing and presentations as well.

The technology on premises has also allowed The Heart Hospital Baylor Plano to leverage things like video remote interpreting to get certified medical interpreters via videoconferencing to communicate with patients in their own language. They create discharge videos and patient education videos for aftercare and maintenance that can be accessed by patients online. They even utilize remote monitoring survey technology to continually collect patient data from patients at home, proactively delivering care and helping minimize readmissions. These are just some of the ways that Patel and Walker’s unique vision and skills continue to help the hospital improve care and reduce costs.

Not only does Walker handle the management of the AV systems and equipment, he also has taken on the role of producing videos for The Heart Hospital Baylor Plano.  This has extended his role to include being in the OR during live procedures, but how did Walker know exactly what to capture on camera?

BioSkills_081413_02“I did a lot of observation at first, watching procedures and how the surgeons used technology in the OR,” says Walker. “The surgeons really facilitated my learning.” He goes on to joke that, “Not only are the doctors here amazing surgeons, but they also know more about Power Point than almost anyone I know.” It seems that the innovative nature of the procedures performed by these surgeons also means they have a high affinity for and love of technology themselves.

Patel refers to each surgery as an “event” and rightfully so. The coordination, planning, and then execution and filming of the procedure is not unlike producing a television show. “The surgeons sometimes tell me to get in closer to get a shot of what they are doing,” says Walker. The hospital then has the ability to live stream the event from the OR to multiple locations in the hospital. Many times, they stream events to the 100 seat auditorium on the first floor, or to the Center of Innovation located on the 5th floor.

The Center of Innovation has a 40 seat auditorium with two 144” projection screens and various flat panel displays. A video teleconferencing system allows visiting surgeons and students to observe live-case feeds and surgical procedures and even interact with the performing surgeon in real time through the surgeon’s microphone and the OR audio system. Other facilities, like The Heart Hospital Baylor Denton, Joint ownership with physicians, a new facility in the Baylor Scott & White Health system serving northwest Dallas, can observe and interact as well.

Of course the procedures are also recorded and saved for later review or future learning opportunities as well. The hospital’s marketing department leverages them in its efforts, and even the surgeons themselves use the videos of their procedures in their own lectures and speaking engagements.

The Center of Innovation also acts as an educational environment for in-house hospital staff. Manufacturers and vendors of artificial heart valves, cardiac monitoring and testing equipment, and even pig hearts utilize the center to conduct on-site training and education on their products, keeping the staff up-to-date. “It’s a win-win situation for all parties involved,” says Patel. “The manufacturers and vendors get the space for less than they would pay at a local hotel, and the hospital staff doesn’t have to travel off-site to learn about new innovations.”

It is this continued pursuit of education, knowledge transfer, and transparency that has created a partnership between The Heart Hospital Baylor Plano and The Clinic for Heart Surgery in Leipzig Germany to create the Dallas-Leipzig Valve Symposium as well.

Baylor Heart Hospital Plano“The hospital is as well prepared as any in the country to embrace technological changes,” says Patel in a statement that is more a matter of fact than a boast. Nayan Patel’s vision and his confidence in the ability of Jim Walker to execute on a daily basis have made this statement a reality. Their partnership and unique approach to technology in healthcare have made these two non-surgeons a major force for good. A force that has helped achieve the financial and medical successes that have earned The Heart Hospital Baylor Plano its elite status.

Avidex is focused on providing educational posts about audiovisual solutions applied to the healthcare environment. If you are a technology or marketing professional in the healthcare space and you are interested in learning more about how technology can drive your organization forward, the team at AvidexAV would love to help. 

 Please Call Bob Higginbotham at 800.798.0330 with any AV Technology Questions.

Resources:

#1: https://www.thehearthospitalbaylor.com/handler.cfm?

#2: http://www.dmagazine.com/publications/d-magazine/2015/april/david-brown-baylor-heart-hospital-plano

#3: http://www.himss.org/aboutHIMSS/

#4: http://chimecentral.org/

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com