What changes in telehealth and other healthcare technologies can we expect in 2021 and beyond? How has the coronavirus (COVID) pandemic affected the priority put on innovative healthcare models, and technology advancements and implementation? How is SCP Health supporting hospitals and health systems in making the right decisions for innovation, as well as financial stability?
What current innovative healthcare models and technology trends are you paying attention to, or do you feel deserve attention and focus going forward?
Newman: We are paying attention to the fact the consumer has quickly adopted telehealth in the last year. Even the age demographic that we considered slow adopters are doing their visits via telehealth quite successfully. We have noted that consumer behavior has shifted and may be permanent.
Some volume may come back to brick-and-mortar at some point, but we think eHealth and telehealth services are here to stay. Emergency medicine and hospital medicine may have started slowly in their adoption phase, but we believe now things have significantly accelerated in those markets.
Dr. Nichols: The shifting demographics, as well as the pressure of COVID, are two big impacts that have made a huge difference in how we use technology to practice medicine. If you go back to when the iPhone was first rolled out, not many seniors were familiar with smartphones. Now, almost every person who retires has been using smartphones and web technology for years as part of their job.
So, they are very familiar with the technology, and they're used to this kind of on-demand world, scheduling themselves for other things long before COVID. Many clinics have adopted telehealth and telemedicine technology, which they probably avoided for various reasons but due to the pandemic, have been pushed into it.
If we go to clinics right now, their waiting rooms are often still very empty, but it's because the physicians and NPs/PAs are in the back seeing patients in a tele-video way for things that don't require an inpatient visit.
Therefore, in the outpatient world, that's a switch. On the inpatient side, we're going through some changes as well. But now, overall, those two impacts are making a tremendous difference in how the market changes in the continuing months and even the next few years. We are moving from brick-and-mortar to click-and-sorter.
In what ways do you see telehealth use expanding?
Newman: Telepsychiatry and tele-neuro were the first two areas people became comfortable with in the world of telemedicine services. Many times, there were other providers in the physical space, so the consultation services of those two service lines seemed to make sense. Something that's always been true, however, is that many other service lines can be provided via telemedicine platforms.
Our core businesses are hospital medicine and emergency medicine. We were using telemedicine and eHealth in hospital medicine before COVID, and we have elevated those offerings since then for a variety of reasons. Some of our clients implemented telehealth solutions because their workforce was exhausted, and they could provide a handful of hours of care from home on what traditionally would have been an off day. Now, we're able to meet the patient demand COVID has required using these innovative care solutions.
As a result of COVID, there is also a need to separate acutely infectious patients. If you can have a clinician treat those patients safely across the screen, whether they're in the hospital or at home, it provides a level of infection control. We've seen increased use cases for ourselves with COVID with telehealth platforms we were already using.
However, from an emergency medicine standpoint, those same infection control needs are still there, and the same exhausted workforce issue still stands. But we're determined that if you take geography out of the staffing equation, the clinician can quickly connect regardless of where the patients are, whether they’re 10 minutes away or 10 hours away. It allows us to use our workforce resources much more thoughtfully and carefully. There's not a service line that can't benefit from that.
Dr. Nichols: Again, it's just kind of how the technology's expanded over the past few decades. If you count telephone consults with patients or specialists, we've been doing telemedicine for years and years.
I mean, as long as we've had the telephone, and then it got to where we had fax machines, we would fax information back and forth, particularly EKGs. And then as more telehealth technology has developed, the more we're able to do .
Let's step outside the telehealth and telemedicine arena for just a minute. What other healthcare technology trends are you focusing on?
Dr. Nichols: Remote monitoring. Probably the first of two of the biggest ones will be people checking their blood pressure at home. That avoids the whole issue of "white coat syndrome," where people go to the doctor and their blood pressure is artificially elevated. That's a very useful measure.
The other biggest one is going to be glucose monitoring. I'm sure you've seen the ads. People put this little patch on, and every time they query it with their smartphone, it will keep a record of their glucose levels. Downloading this kind of data will give clinicians a much better grasp of what they should be doing for the patient’s blood sugar.
You can do other areas with that kind of remote monitoring, but those are two big ones that affect a significant part of the population.
Newman: The blood glucose monitoring is huge. Being able to have your data transferred to your clinician without you having to write it down is a real advancement.
An argument from a few years ago regarding telehealth was, “How can Dr. Nichols know what my blood pressure is or what my heart rate is, and how can he assess me via video without some of those data points we're used to receiving in person?”
There are new easy-to-use devices that will take your temperature, blood pressure, and pulse then send that information to your provider so they can have a clearer picture of what is going on. There's a handful of those out now, and they’ll only increase and get more accessible and affordable to a variety of patients over time.
We also see payors understand the value of having those devices, and many of them are doing partnerships and pilots where they will be willing to invest and pay for part of that expense.
I would imagine from the telehealth side, we're going to have much more opportunity to see labs, glucose, and blood pressure data, which will only enhance virtual care. So, we're keeping an eye on those technology companies and what they can do for us at SCP.
In that respect, we're talking about wearables and mobile technologies. Those still revolve around the whole idea of telehealth, correct?
Newman: There’s currently a device I can put my fingers on, have an EKG, and I can send that to Dr. Nichols. If I call him and tell him I'm having chest pain, I'll let him know my age and that I had spicy food for lunch. When he sees my EKG, he's probably going to feel okay, especially if he can also see my blood pressure, and pulse.
Typically, otherwise, he would say, call an ambulance or go to the ED; you might be having a heart attack. The fact this information is up in the cloud and easily available is a game-changer in healthcare. I think we're going to see more and more of that. It probably won't be long until I can prick my finger and send him more labs than glucose as well.
Dr. Nichols: Interestingly, some of the big technology players designed these devices for wellness and fitness, which is perfectly fine and very reasonable. But those are for prevention and fitness and not for managing chronic diseases, like hypertension or diabetes. I think that piece will come along.
The other exciting development is going to be how easily people can share this data. That is going to be critical. It has to all flow from one place to another. Right now, we even see this between the different types of EMRs and hospitals. There are some challenges ahead, that's for sure.
Newman: It’s great that I can have that EKG, but can I get it to my doctor? How can I send it? Is the technology I took it on able to be transmitted through the technology he can receive it on? That is one of our larger challenges we will have in the future -- getting all the technology connected.
You mentioned payors a minute ago. Can you talk more about the payor side of things and how technology may be affecting that in some way?
Newman: There are aspects of telehealth that payors were receptive to before COVID. However, COVID has really accelerated their acceptance. Many, if not most of the telehealth services we were providing, and indeed are providing now, we encountered difficulty from both government payors, Medicaid and Medicare, and private payors. With the pandemic, we have seen some significant advancements in how we're being reimbursed for those services.
I think people understand care needs to be delivered safely, and they're willing to pay for whatever the safest manner is at this point. We're hopeful those advancements are going to continue.
We certainly don't have a crystal ball, and we don't know how long this pandemic is going to last. But, we do hope the services we’re being reimbursed for today, we'll be able to continue in the future.
However, I think a huge piece of what happens in the telemedicine and eHealth world will depend on how those payors react to the pandemic. If we open a service we're reimbursed for now, and then they shut it down in 18 months and we can't get reimbursed—we'll have to react to that.
Dr. Nichols: Yes, that's a different kind of interoperability problem. People who have commercial payors or switch payors, such as when they retire, or maybe they go on one of the Medicare plans, there's a huge gap that needs to be bridged in terms of information, and that's not easily done right now. Employers change their commercial payers for various reasons, and there's not an easy continuity flow for all their personal information. That's another very large challenge.
I’ve given this example many times. It was probably 10 years ago; I was driving and visiting a client in Oklahoma. I'm in Texas. I stopped to get my oil changed because I had about 45 minutes to spare.
I went to one of these fast lube places. They were able to tell me the last time I had my oil changed, what type of oil I normally use, and where I got it done—and they did it all in five minutes. It's ridiculous how they can do that for my car, and we can't do it for humans.
Let's go down the COVID road a little more and talk about the effect the pandemic has had on healthcare technology implementation and the various things we're trying to do.
Dr. Nichols: We have become focused on vaccine testing, production, and distribution. Simultaneously, people are working on things like hypertension and electronic EKG delivery, and so forth. So that's good.
But the whole shift beyond just healthcare, in every single way—remote work, remote schooling—all of these other things have placed a tremendous load on the electronic infrastructure.
Just like phone messaging, phone calls, and all the conference calls that we're on daily, bandwidth issues have become strained by everything. COVID has done that, not just within healthcare but across the whole economy, affecting all aspects of it.
That's something we’re starting to recognize along with our dependency on resources outside of the United States. The supply chain for even basic things like computers, generic medications, and so forth has caused us to realize the interdependency we have on other aspects of the world.
Newman: There's always the bell curve of folks early to something, the middle line folks, and those who are late to the party. There are certainly folks who were well prepared for this. Still, I think most hospitals, healthcare systems, and clinics felt a little behind in their overall strategy, whether it is the actual hardware they need to provide some sort of telehealth services or the planning, the resources, and staff.
The pandemic has accelerated many people’s understanding and adoption of this innovative technology. A lot of places may have been old-fashioned in thinking their preference was to have brick-and-mortar services and face-to-face interactions. Many of those facilities have had to rethink their long-term mindset and adjust their bylaws and practices to accommodate this trend.
We've had to come up with quick deployment plans, and respond to requests for support from facilities, some on a larger scale, where we're standing up tents in hospitals, COVID-type units, or even small things like having providers remotely see patients in an urgent care clinic.
Hopefully, there will be a long-term effect on people, not only being receptive but also being a little more thoughtful of their long-term telehealth plans. We definitely have seen more people open and willing to entertain thoughts and ideas of innovative staffing solutions and care paths.
Dr. Nichols: The exuberance of the early adopters is always present, and the reluctance of the middle group or the laggards is there, but they have been forced to jump forward. Many small practice clinics quickly put something together because they had to. Now they aren’t likely to go back as readily. They’re used to it. They can see the advantages and have already made the leap. We’re coming to some rational point that is further ahead than where we were 12 months ago, that's for sure.
How is SCP Health supporting hospitals and health systems in making the right decisions regarding innovation as well as financial stability?
Newman: We have put together a lot of options, which include a mix of onsite care, virtual care, and eHealth on both the inpatient and outpatient side.
One of our key strategies is to take each health system individually and understand what issues they're having. Are they COVID-related or not? What are their challenges, their price points and budgets, and their pain points? We then collaboratively develop a strategy specific to that hospital.
Certainly, we can't say, “Here are our offerings, and we're going to push them through to every health system we work with.” That strategy wouldn't work, and that's not our approach. But we have come to the table with our partners and tried to put various programs in place that have a mixture of staffing approaches.
One of the benefits of providing virtual care is if I have a resource dedicated to one facility and is there physically, then the resource's cost is devoted solely to that facility. However, if I have a provider resource shared among many facilities—maybe they need a specialist only a handful of times a day—we can spread that resource between five, 10, 15, or even more facilities, thereby reducing costs. Our partners have been appreciative of this approach, and it's a new way they can get the unique resources they need.
Dr. Nichols: I absolutely agree, just by working with clients individually, we figured out ways to affordably increase their access, whether it means patients coming in, specialists, or whatever they need. That's a key part of this innovative care approach.
One of the advantages of being a large organization is we have a variety of experiences.
A hot topic right now is giving people monoclonal antibody infusions. Having worked with a few different facilities, we discovered in one location, they needed a place where they could take care of bedridden patients because they had a large nursing home population. In contrast, others hadn't reckoned with the need.
They were expecting ambulatory patients and realized there are bedridden patients who may need this treatment. We were able to help them figure out a better location within their physical campus because patients have to come in.
On the other hand, like the scheduling and the answering of the questions for COVID testing, which we started doing once COVID developed. We all learned from that and had a great experience with various facilities. We're able to take that experience to others and let them learn from it.
The key to all of this is communication, and that's been very different during COVID. We have tons of teleconference calls, and you jump on, and you can explain things better. You can throw up a couple of slides. You don't necessarily have to travel to show people what can be done. That makes a big difference. It's clearly changing the way we operate, at least for now, and probably for the future, and how we do things in all aspects of our lives.
Is the advancement of technology innovation and implementation a silver lining where COVID is concerned?
Newman: I used to feel like it was somewhat of an uphill battle, telling folks the value of telemedicine solutions, assuring them the quality was still there. A lot of those barriers have been taken away. I can't say I wanted them taken away immediately in a matter of months by every customer we have, but it has certainly been a welcome change from my perspective.
Any final thoughts?
Dr. Nichols: This will last; it isn't going to just be through this year. This is going to be for the next few years, if not throughout this decade.
When we look at healthcare at the end of the 2020s, we will be amazed at how different it is. It'll probably be something akin to when we developed antibiotics years ago. Regardless, it will be radically different.
To learn more about SCP Health's eHealth services, contact Jackie Newman. We are ready to help our current and future customers plan their telehealth strategy for 2021 and beyond.