About three years ago, Dr. Alfred Atanda was in southern Delaware, about 100 miles from the Nemours/Alfred I. duPont Hospital for Children, where he is a pediatric orthopedic surgeon. Atanda happened to stop in a beach shop owned by the father of a recent post-op patient, where he learned that the patient was having trouble with his brace.
Atanda and the patient’s father called the boy, who was having trouble explaining the problem. So Atanda started an impromptu video chat. He looked at the brace via the video chat, showed the boy how to adjust it, and also asked him about his appetite and other aspects of his recovery.
Driving home, Atanda realized the family had made the same 200-mile drive several times — sometimes for follow-up appointments that were no more than five minutes.
“I couldn’t believe I’d seen him six times in the office — and every time, dad closes the shop, and the son takes off time from school,” he says. The patient had another appointment in two days, but he told the family not to come. This experience helped crystalize the power and value of telemedicine for both patient and doctor convenience.
Improving Patient Satisfaction: Telemedicine Technology Keeps Patients Out of the Office
Telemedicine technology is already at work improving the patient and provider experience in many innovative organizations. At the Cleveland Clinic, the telemedicine program encompasses a wide range of technology — from connected devices to virtual visits to remote imaging transfers — which are used inside the hospital and in a patient’s home, says Dr. Peter Rasmussen, the organization’s medical director of distance health.
“The Cleveland Clinic has four pillars of operations: patient access, the patient experience, patient safety and patient retention,” he says. “Telemedicine helps us in all of those regards. We believe that every caregiver can use some kind of digital tech in care delivery.”
For the Cleveland Clinic, Nemours and other healthcare organizations, telemedicine can play a key role in improving both patient engagement — the extent to which patients participate in their own care — as well as patient satisfaction — the degree to which patients recommend an organization’s services.
At Nemours, Atanda conducts two or three virtual visits per day. These appointments revolve around information transfer, he says — reviewing a recent MRI, conducting preoperation counseling or following up after a surgery. Visits typically take place in the hours before or after patients go to school or their parents go to work.
In postvisit satisfaction surveys, 98 percent of patients says they would be interested in future telemedicine visits, and 99 percent would recommend telemedicine, Atanda reports in a recent paper for The BMJ. “I keep people out of office who don’t need to be there,” he says, adding that this also lets the practice keep slots open for potential new surgery candidates.
A desire to keep patients out of the hospital drives many of the Cleveland Clinic’s telemedicine initiatives, Rasmussen says. He notes that, as a hospital with an international presence, many patients could otherwise travel for hours for appointments that may take less than 15 minutes. One example is bone marrow transplants. Patients who undergo this procedure face a high risk of infection, as their immune systems are compromised, and often take medication that increases their blood pressure, Rasmussen says.
Traditionally, these patients return to the hospital every day for temperature and blood pressure readings. This places a burden on patients, and it also means being in a facility where germs can run rampant. Now, through a telemedicine program, bone marrow transplant patients can go home with a blood pressure cuff, thermometer and activity tracker. Nurses can monitor patients’ progress from afar and reach out only to those patients who are not making progress, Rasmussen says.
A similar obstetrics program allows women with low-risk pregnancies to measure their weight, blood pressure and urine analysis at home, using equipment supplied by Cleveland Clinic. The women then participate in video visits with their obstetrician, who have access to the data collected by their patients.
“If you’re a busy mom, you don’t want to be wasting your time going to the doctor for all this,” says Rasmussen, noting that women typically have at least nine appointments with an obstetrician before giving birth. “This is a 1- to 2-minute video visit. It’s incredibly convenient for the woman and the caregivers.”
Improving Patient Engagement: Virtual Doctor Visits Allow Patients to Connect
The convenience that telemedicine offers, and the potential to engage patient populations, extends beyond care delivery.
Front Porch manages retirement, active adult and affordable housing communities in four states; the majority of its residents are in California. Many of the communities offer continuing care services. Using technology to support residents’ wellness and independence is an important part of that mission, says Davis Park, director of Front Porch’s center for innovation and wellbeing.
“We’re really interested in multisensory places to address the needs of cognitively challenged adults,” Park says. Products run the gamut from virtual reality to voice assistants to counseling applications available on an iPad, he says.
As Front Porch pilots products, the goal is to make technology engaging for residents in the context of their everyday lives, Park says. An early text-based medication adherence pilot struggled for a few reasons: Residents didn’t know how to charge cell phones, didn’t wear clothing with pockets to carry phones, or left phones in their cars because they only used them in emergencies.
“There needs to be certain messaging talking about mobile health. Your loved ones and caregivers are out for your best interests, and this solution will only help those around you provide high-quality care,” he says. “What’s important is how we engage with the patients and meaningfully connect with them to receive the information that’s important to them.”
Virtual Options Increase Patients’ Quality of Life
While telemedicine technology is often regarded as a type of “high-tech” care, it can also support meaningful connections with patients who may require more “high-touch” care, especially while at home.
As detailed in a 2014 paper by researchers at Johns Hopkins, poor medication adherence contributes to up to $300 billion in avoidable healthcare costs, primarily through increased service utilization tied to poor health outcomes.
To address this issue in a high-risk population, the Lynn (Mass.) Community Health Center is planning to provide patients with a medication dispenser that alerts both pharmacists and community health workers when patients miss a dose. The program will initially target patients who have been diagnosed with a mental illness and are covered by the state’s Medicaid program, MassHealth, says Emily Johnson, the center’s director of community outreach.
The program will support the center’s larger care coordination goal of engaging patients in preventive care that supports their health and wellness goals and lowers care costs, Johnson says. Once community health workers help patients set up their medication dispenser, patients will be able to load their medications into the device on their own.
“People with a major mental illness have a 20- to 25-year shorter lifespan,” Johnson says. “The hope is that we can reduce their total cost of care, increase their quality of life, and teach them the skills to maintain themselves independently.”