Telehealth

By Sy Atezaz Saeed, MD, MS, FACPsych
ABT Advisory Council Member

Professor and Chair, Department of Psychiatry and Behavioral Medicine at Brody School of Medicine; Director, Center for Telepsychiatry and e-Behavioral Health; and Executive Director, North Carolina Statewide Telepsychiatry Program (NC-STeP), East Carolina University, Greenville, NC

The state of North Carolina, where I practice and teach psychiatry at East Carolina University, re-envisioned its psychiatry services in 2011-12 to provide better access to evidence-based care to residents who needed mental health care but did not have access to it. In 2012, 162,000 people who needed mental health services headed to the emergency department (ED). This was 10 percent of the people who sought services in North Carolina EDs, twice the national average at 5 percent.

To address this situation and at the request of the NC Department of Health and Human Services, I led a statewide coalition of mental health professionals, health care providers and medical societies to develop a solution that met the behavioral health needs of our residents. Over a one-year period, we developed a telepsychiatry program funded by state legislatures; today, that program covers 60 hospitals throughout North Carolina.

The NC State Telepsychiatry Program (NC-STeP) serves the entire state. It is especially focused on the 90 counties in North Carolina classified as Mental Health Shortage Areas. Plus, it serves other counties that don’t meet this designation but also face a shortage of mental health professionals.

Our multi-disciplinary and multi-stakeholder program thrives on coordination of care – not competition – with physicians or EDs. We exist to help hospitals without a staff psychiatrist, and to serve patients in crisis. Now in its eighth year, NC-STeP resides at East Carolina University and operates throughout the state.

The program helps mental health patients avoid hospital stays based on access to psychiatric care when and where they need it. Through assessments, proper medication and/or ongoing access to psychiatric care, these patients become informed patients that move forward in their lives.

During my career, I’ve studied many Greek philosophers and incorporated into my work the advice of Aristotle who said, “We are what we repeatedly do. Excellence then is not an act, but a habit.” Providing the right treatment to the right patient through evidence-based practice permeates my work as the common thread that ties everything together through telemedicine.

That same consistency of purpose and focus on evidence-based principles constitutes the CORE Concepts in Telehealth Certificate Program from the American Board of Telehealth (ABT). As a member of ABT’s Expert Panel, I know the education and training offered for clinicians and administrators addresses how knowledge grows and science evolves in telemedicine.

Watch for updates on new courses, including the Telebehavioral Health Certificate Course that is now live and open for registration.

Acquired by AHA in October 2021, the American Board of Telehealth is now the AHA Center for Telehealth. Healthcare is complex; delivering optimal telehealth care doesn't have to be. The AHA Center for Telehealth leads connected care, keeping people at the center.

By Andrew M. Watson, MD, MLitt, FACS, Physician, Division of Colorectal Surgery, Department of Surgery; Vice President, Clinical Information Technology Transformation, International Div.; Medical Director, Telemedicine, University of Pittsburgh Medical Center

I come from four generations of surgeons, a legacy that I’ve continued as a colorectal surgeon at the University of Pittsburgh Medical Center and one of eight family surgeons now practicing in this same area of the state.

My introduction to telemedicine actually began in 2005 with a patient during a post-operative visit. After answering my questions about her diet and digestive system, she wanted to know why she couldn’t see a physician at the local hospital near her home instead of traveling an hour each way for this follow-up appointment.

With this insight from my patient, telemedicine soon made sense to me for many reasons.

• Physicians can visit patients at home, a practice of my ancestors that I wanted to follow.
• Patient care becomes more humane because sick patients don’t have to travel; they can stay home and recover.
• Safety takes priority. One of my patients in her 70s drove to and from her appointments on the Pennsylvania Turnpike in all types of weather. I could now see her in a local, rural hospital close to her home.
• Medicine returns to its roots, and the humanity of practicing medicine becomes more focused on better access to care for patients.

As society undergoes this digital overhaul, the transition to telemedicine will take time because it means physicians must learn a new skill set. They must conduct an exam over video instead of the look, listen and feel, directives followed during in-person encounters.

Physicians have long thought they must see patients face-to-face, visits long considered currency for health care. As remote visits replace in-person appointments, we no longer can identify that currency.

Giving Back to ABT

With the genetic pressure of my family, I had to make sure I wanted to become surgeon. I was fortunate to study abroad for two years at Oxford where I became a student of 17th century Baroque architecture and Sir Christopher Wren. That path led me to English physician Dr. William Harvey, also of that era, who confirmed full circulation of the blood in the human body.

In defending my thesis, my professors asked, “How do you give back? How do you help the overall body of knowledge”? This humbling experience confirmed my choice of surgery as a profession and an opportunity to eventually help better the world.

I met that goal with the American Board of Telehealth (ABT), a national organization of experts carefully focused on telehealth to bring merit and governance to remote patient care. As a member of the ABT Expert Panel, I collaborate with my telemedicine colleagues to improve remote patient care through the ABT Telehealth Certificate Program.

Medical boards and physician leaders look for and depend on the level of confidence infused into educational courses. The ABT certificate program meets that criteria with preparation and test taking assessments to ensure students understand and can implement standardized telehealth services.

Find out more about the Telehealth Certificate Program.

Acquired by AHA in October 2021, the American Board of Telehealth is now the AHA Center for Telehealth. Healthcare is complex; delivering optimal telehealth care doesn't have to be. The AHA Center for Telehealth leads connected care, keeping people at the center.

By Walter Panzirer, Trustee for the Leona M. and Harry B. Helmsley Charitable Trust and Founding Board Member, American Board of Telehealth

When my grandmother Leona Helmsley died in 2007, the trustees of the Leona M. and Harry B. Helmsley Charitable Trust found that 85 percent of the trust’s spending went to health care.

Further research through the Rockefeller Philanthropy Advisors uncovered data that indicated:

• 3.5 percent of all private foundations and their monies go to the Upper Midwest in seven states (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming).
• Minnesota receives 80 percent of that 3.5 percent of all donations, based on internationally known and Minnesota-based health care providers where patients travel to for care.

With this research, we also learned that these seven upper Midwest states are the most underserved for quality health care in the United States.

As a result of our research, those states became our focus at the Charitable Trust.

It’s Real – the Need for Quality Rural Health Care

I brought the idea of improving health care delivery in the Upper Midwest to the Helmsley Charitable Trust because I had lived and worked with people in rural America who needed better health care.

From my own career as a fire fighter and paramedic on the west coast, I understood the schism between rural and urban America for delivery of quality health care. I also worked as a paramedic in Oakland, California, and beyond, traveling in both rural and urban settings before I transitioned to law enforcement in Sturgis, S.D. Behavioral health became a new focus for me as a police officer because I saw people who suffered from mental health issues sometimes evolved to criminal behavior.

Now, I own a home in a county with just 1,300 people. Like my neighbors, I rely on fewer and fewer clinicians for my basic medical care, a scenario familiar to many in rural America.

Telehealth is the great equalizer when it comes to quality in patient care. During this pandemic, remote patient care has rapidly transitioned from unique to widely used by clinicians and their patients. But, without a standardized approach to understanding and implementing telehealth services, I believe quality will suffer.

Acquired by AHA in October 2021, the American Board of Telehealth is now the AHA Center for Telehealth. Healthcare is complex; delivering optimal telehealth care doesn't have to be. The AHA Center for Telehealth leads connected care, keeping people at the center.

By Walter Panzirer, Trustee for the Leona M. and Harry B. Helmsley Charitable Trust and Founding Board Member, American Board of Telehealth

In my previous post on the case for quality in telehealth services, I established why the Helmsley Trust focuses on telehealth. Now, let’s look at how to maintain quality in the delivery of virtual care. I include three vital components of quality in telehealth care delivery: consistency, expertise and economic impact.

Quality Brings Consistency to Remote Care Delivery

Consistency matters in patient care delivery; patient encounters, whether in-person or virtual, must be seamless and frictionless. Without a standard approach to delivering virtual care, quality is challenged.

Quality Identifies Well-Trained Clinicians and Administrators

In a world in which technology makes many of our activities possible, some view telemedicine as a lucrative proposition. As a result, clinicians and administrators trained to meet quality standards for telehealth delivery are vital to ensuring quality remains a primary factor in any telemedicine program.

Quality Affects the Economic Impact of Physicians in All Communities

Clinicians want to work and live in communities in which clinical practices and hospitals deliver quality patient care. For example, statistics from the 2018 AMA The National Economic Impact of Physicians Report (PDF) illustrate with detailed information why quality care delivery matters in any location, but especially in rural America.

Here are data on South Dakota:

• Each dollar in direct output applied to physician services supports $1.82 in economic activity.
• Each physician supports 11.3 average jobs and generates $1.9 million in average economic output.

In addition, a remote connection to clinical peers matters, as David Erickson, MD, executive vice president and chief medical officer, Avera Health, describes in his bio. Before joining the executive team at Avera Health, Dr. Erickson was a family practitioner in Dell Rapids, S.D., where his remote consultations with medical specialists benefited him and his patients.

“To be in a rural situation and be able to immediately access a specialist in intensive care or emergency medicine is just a huge win for physicians in rural practice.”

Find out more about the AHA Center for Telehealth’s Certificate Programs.

Acquired by AHA in October 2021, the American Board of Telehealth is now the AHA Center for Telehealth. Healthcare is complex; delivering optimal telehealth care doesn't have to be. The AHA Center for Telehealth leads connected care, keeping people at the center.

by Brian S. Skow, MD, MBA, CPE, FACEP Chief Medical Officer, Avera eCARE

I became a physician in emergency medicine to treat patients at all stages of life – from newborns to the elderly, to take care of them during their time of need rather than on their ability to pay for services.

My emergency department (ED) colleagues and I often discussed how care might improve if we could see patients earlier to avoid unneeded transport to tertiary facilities. That way, patients treated by local clinicians could then remain in their own community.

Introducing Telemedicine

About 10 years ago, with 2-3 pilot sites in our Avera Health network, we tested this approach with telemedicine. With support from the Helmsley Charitable Trust, the program expanded exponentially through word of mouth and growth of Avera.

Since that time, I’ve conducted more than 15,000 telemedicine visits with patients through Avera eCARE, which provides care to 200 critical care access sites in 16 states with a hub in Sioux Falls, SD. Our emergency clinicians have immediate access to patients through video consultations, a time savings that matters in life-threatening situations, as our research shows.

Ongoing collaboration and consultation between eEmergency physicians and their clinician colleagues in rural communities matters; we work as a team to improve access to specialty care, lower costs and overall, improve patient care.

Saving Time and Lives

For example, a 50-year-old man recently came into the ED with a heart attack in one of our rural community hospitals. The hub team of e-Emergency physicians and nurses saw him in real time via video. In about 20 minutes, they obtained an EKG on arrival, administered lifesaving thromoblytics, called the helicopter for transport to a heart hospital, and talked by phone with a cardiologist. By the time the bedside physician arrived, with the flight team also in the room, the local doctor conducted his exam. The patient then flew to a cardiac catheterization lab and was home in a day.

Telemedicine goes where the need exists, and in a bittersweet moment, the current pandemic demonstrated what remote patient care can accomplish. Through the Covid-19 virtual command center at the hub location, we transferred Covid hotline phone calls to our video platform and avoided many ED visits because – via the camera – we determined whether or not patients needed emergent treatment.

Looking Ahead with Telemedicine

Despite this immediate response to the virus, we sometimes don’t realize available service options until they are created through observation of our current telehealth connections. One rural ED in our system, for example, transferred sexual assault cases to a larger facility for certified exams that required a 3-hour ride, many times in the back of police vehicle. Now, over the camera, trained sexual assault nurse examiners assist local clinicians and conduct the exam locally.

As a member of the American Board of Telehealth Expert Panel, I interact with telemedicine leaders across the country who deliver quality patient care with telehealth services. The ABT Telehealth Certificate Program offers clinicians and administrators specialized knowledge with standards in place to implement quality remote patient care.

Find out more about the AHA Center for Telehealth’s Certificate Programs.

Acquired by AHA in October 2021, the American Board of Telehealth is now the AHA Center for Telehealth. Healthcare is complex; delivering optimal telehealth care doesn't have to be. The AHA Center for Telehealth leads connected care, keeping people at the center.