The shape of telemedicine during the first half-year of the pandemic: significant but wildly uneven usage

There has been a plethora of tracking studies starting last year on how telemedicine stepped in for in-person visits during the early months of the COVID-19 pandemic. Telehealth visits peaked, then tapered off as medical offices reopened. Reviewing our articles:

  • Commonwealth/Phreesia: tracking the latter’s practices, they dropped from a high of 13.9 percent on 18 April to 6.3 percent by early October. Where telemedicine use stayed high was behavioral health–psychiatry–which remained at 41 percent.
  • Epic Health Research Network’s data, which concentrated on hospitals and clinics, showed a similar drop from the mid-April high of 69 percent but ended August at 21 percent. Regionally, the South had the least takeup of telehealth even in the critical period. 
  • FAIR Health, using insurer claims data, tracked with Commonwealth/Phreesia from 13 percent in April to 6 percent by August.

The latest study has been just published in Health Affairs (abstract free, paid access full study). Using data from 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020, the steep rise from a negligible base was the same but the percentages were between the Commonwealth and Epic studies. 30.1 percent of all visits were provided via telemedicine (including telephonic) and the weekly number of visits increased twenty-three-fold compared with the prepandemic period. The database also permitted a deeper analysis of usage.

  • Telemedicine use was lower in communities with higher rates of poverty (31.9 percent versus 27.9 percent for the lowest and highest quartiles of poverty rate, respectively). Unfortunately for comparison, not included in the information was the actual rate in wealthy counties.
  • Overall visits (in-person and virtual) plummeted by 35 percent, a backlog in deferred care still being made up
  • Rural telemedicine use was lower than urban–24 percent versus 31 percent by county
  • How specialties incorporated telehealth varied widely. As previously reported, psychiatry had a high uptake of telemedicine and reported the least drop in overall visits. Surprisingly, endocrinology (68 percent) and neurology also had high utilization. Only 9 percent of ophthalmologists reported telehealth use, because the physical exam requires highly specialized equipment. 
  • Management of chronic conditions was in between those two extremes. Conditions like hypertension and diabetes had a big drop in care volume that was mitigated by a large increase in telemedicine use.

Healthcare Dive 

Short takes, 4 Feb: HIMSS 21 Global/APAC go ‘hybrid’; ATA announcements including virtual ATA2021; Hillrom acquires EarlySense monitoring tech

It’s 4 Feb, and while All Is Not Right With the World, we should be reassured that a real, in-person HIMSS 21 Global conference is apparently still On Target for 9-13 August in Las Vegas. What’s new is that it will have a virtual component (the ‘hybrid’) in addition to the Three Ring Circus spread among the Venetian-Sands Expo Center, Caesars Forum Conference Center, and the Wynn. t Hotel reservations ARE open, but registration is not. (Those who wish to transfer the 2020 registrations to 2021 will have to wait for an email.) HISTalk, which always seems to have the Inside Line on the conference, confirmed that HIMSS is kicking the can down the road on an in-person conference. It’ll depend on vaccination rates, infection rates, and federal guidelines, all of which are indefinable bars to something six months down the road. The next HIMSS21 update will be published on 19 February. It may include an announcement of the registration opening date. As the HIMSS update page is singularly uninformative, this Editor is subscribing to their update emails as offered.

Reading further down on HISTalk, the long-standing co-located CHIME (College of Healthcare Information Management Executives) annual conference is no more. CHIME will be holding a hybrid Fall Forum in October and virtual events in April and June. Will this mean that a lot of CIOs and senior IT people–the deciders–will not be as eager to go to Las Vegas and HIMSS will turn even more into a ‘boat show’, in HISTalk’s words? 

Meanwhile, in Singapore on 18-19 May, HIMSS APAC is full hybrid with both in-person and virtual sessions. The theme is Future-Proof Healthcare: The Emergence of Asia. If you’d like to nab a speaking or panel spot, act fast–it closes on 28 February and is only open to government/healthcare providers. More info is on their website.

The American Telemedicine Association just wrapped its four-part ATA EDGE virtual conference. Like a lot of virtual events, it’s split into relatively short sessions (about 2.5 hours) and multiple days. EDGE was on Tuesdays starting 12 January and wrapped 2 February. Announcements and related news from EDGE and ATA include an announcement for ATA2021:

  • The Telehealth Equity Coalition (TEC) launched. TEC is a data-driven project to review public data on telehealth adoption in communities across the country. The objective is “to improve access to quality and affordable healthcare by increasing adoption of telehealth, especially among those who have been left out or left behind. Together with nonprofit, academic, and industry partners, TEC will offer a unique voice to optimize equitable telehealth delivery and utilization.” Founding members are Hims & Hers, the ATA, and the National Health IT Collaborative for the Underserved. Release
  • ATA2021 will be full virtual in June and take place on Tuesdays and Thursdays. This year’s theme is Telehealth: Enabling Flexible, Inclusive and Contemporary Care Delivery. More information on the content and program, including links to proposal submission forms, is here. Deadline for General Program speaker nominations and Research Presentations/Posters is 26 February. The registration page is not yet active.
  • On the policy front, ATA commended Texas Governor Greg Abbott on his advocacy of telehealth expansion as key to quality care for Texans. In his State of the State annual address, he outlined goals for the executive and the legislature in expanding both telehealth and broadband access. Release  ATA also sent a letter to the Arizona State Legislature in support of House Bill 2454 which makes some comprehensive changes to telehealth policy that will increase telehealth options in that state. Letter

And in the Continuing Story of Big Company Buys Little Company’s Tech, Hillrom, which just acquired cardiac monitoring company BardyDx, has now acquired contact-free continuous monitoring technology from EarlySense. Hillrom already has equity in the Massachusetts and Israel-based company. A portion will go in payment for the monitoring technology, plus a cash consideration of $30 million with potential payments based on the achievement of certain commercial milestones. EarlySense will also have a license to the technology, useful as EarlySense continues to develop next-generation AI-based sensing technologies specifically for the remote patient care market. Hillrom is incorporating it in its Centrella Smart+ med-surg bed and ecosystem of connected devices for the monitoring of heart and respiratory rates over 100 times per minute. Release 

Communicare247 advances in Scotland’s Project Liberty social care with Stage 2 funding

Glasgow-based Communicare247 has won over £130,000 in funding for further development of telecare systems to be implemented in the second phase of Scotland’s Project Liberty. Project Liberty is designed to support social care for vulnerable individuals with chronic care needs, including cognitive, to live at home independently, while unobtrusively allowing health and care professionals to manage their risks and health. The support for Project Liberty comes via Scotland’s £9.2million Can Do Innovation Challenge Fund, and is expected to be completed by 3rd Quarter of this year.

The second phase of the project incorporates consumer devices such as voice-activated speakers (e.g. Alexa, left above), smartphones, and other smart wearables, sensors, and location technologies, through a novel monitoring system that can integrate with existing telecare home care alarms. It will deploy and test the system with those living independently and managing complex care needs, including Alzheimer’s.

Tom Morton, Chief Executive of Communicare247, emphasized the need to change over telecare from analogue to digital systems not only because of telecom, but also to extend care with advanced digital devices.  “A telecare system that uses Alexa and smart watches is a game changer. We are integrating common and easy to use consumer products along with IoT sensors and innovative telehealth monitoring in an existing data-led system that reports to carers, family members and emergency services as required. Currently, across the UK, there is an estimated 4 million elderly and shielding people who rely on analogue telecare systems to help keep them safe. Most of these systems are at risk of becoming obsolete due to the telephone network switch from analogue to digital. This gives the UK an unprecedented opportunity to adopt a leading digital-enabled assisted living care which will be delivered through Project Liberty.”

Starting in 2018, the Health and Social Care Alliance Scotland (the Alliance) engaged with users on improvements to their supportive telecare. The first phase of Project Liberty started in January 2019. Communicare247 led and project managed this part of Glasgow City Council’s “Technology-enabled Glasgow” challenge, joined by partners and stakeholders including the Alliance, the Glasgow Health and Social Care Partnership, and Tunstall.

The objective for Project Liberty is to be a scalable digital telecare template system to be deployed by local authorities, housing associations, and care providers across the UK. Interestingly, and perhaps uniquely for Scotland, the smart home devices for home care will connect with Scotland’s long-range wide area network (LoRaWAN) which enables devices to collect and send data without the need for 3G, 4G, or Wi-Fi. 

Additional information on Project Liberty can be found on the Alliance’s website and their webinar ‘Proof of Concept to Deployment’. There is also a 37-minute talk between Mr. Morton and Business Development Manager Ashley Mitchell on YouTube. Mr. Morton earlier contributed a TTA OnePerspective article in 2018 on telecare’s digital changeover

Bluestream Health telehealth partners with Impresiv Health management consultants

Bluestream Health, which we noted back in November as partnering with LanguageLine to add language interpretation to their telehealth platform, has a new partnership with the interestingly named Impresiv Health. Impresiv is a national healthcare management consulting firm concentrating in clinical, operations management, and software consulting for payers and accountable care organizations (ACOs). They also provide permanent and interim staffing in multiple healthcare areas. Adding virtual care now allows Impresiv to deliver telehealth services as part of their management services menu. Bluestream Health is a secure telehealth platform which provides whitelabeled telehealth services to approximately 50,000 providers. Release   Hat tip to Erin Farrell-Talbot