Patient engagement with caregivers, physicians, nurses, technicians, and healthcare providers has been fundamentally transformed given the constraints and impact triggered by the COVID-19 pandemic.
This disruption has culminated in an unprecedented and exponential increase in Digital Health Innovation (DHI) for Virtual Healthcare Delivery (VHD) such as telehealth, remote patient monitoring, AI and analytics, mHealth apps, and robots.
In this blog, I explore a 7-step “Digital Patient Engagement (DPE) Lifecycle” that evaluates the healthcare experience from a “pre-pandemic” and a “post-pandemic” perspective.
Copyright Andy Dé. All rights reserved
1.Initial Patient Screening and Scheduling
While it has been standard practice for scheduling patients and verifying their eligibility for treatment via phone call, the disruption triggered by COVID-19 is now “virtualizing” this process via telehealth, on a mHealth app, or via chatbot, with the option of a phone call, especially for seniors who are often not very tech-savvy, but are slowly increasingly embracing social media like Facebook and Instagram. According to research reports, 87% of seniors use social media and 94% access the internet daily, which makes them far more amenable to digital patient engagement.
2.Patient Data Capture
Given the risks posed by the unavailability of adequate N-95 masks, gloves, and PPE to caregivers, the days of capturing temperature, weight, and blood sugar by nurses and caregivers in person is behind us.
It's my humble prediction that given the new regulations from the FDA, as well as new CMA reimbursement models, we will see an explosion of new AI-powered cloud-based apps, chatbots, and mHealth devices for proactive screening, testing, analysis, monitoring, capture, and recording of vital signs integrated with current patient portals. These will include infrared thermometers, pulse oximeters, blood pressure, blood sugar, and respiratory disease vital sign monitoring.
3.Initial Patient – Physician Appointment
Before COVID-19, it was virtually impossible to even imagine a first appointment with a primary care physician (PCP) or specialist that was not an in-person consultation. The risks posed by in-person engagement between patients infected by COVID-19 and caregivers without adequate N-95 masks, gloves, or PPE for protection has changed this completely. Given these risks to the health, safety, and lives of our caregivers, the initial patient-physician consultations are being accomplished via telehealth.
Telehealth (often synonymous with telemedicine) is growing astronomically as we speak given the advent of COVID-19 and is here to stay beyond the pandemic. Seniors above 65, as well as patients with chronic conditions like cancer, Chronic Obstructive Pulmonary Disease (COPD), cardiovascular disease, etc., are most vulnerable to death if afflicted by COVID-19, and are also locomotion challenged. Leveraging telehealth to diagnose and treat them remotely for conditions that are not acute can lower risks of infection for both these vulnerable patients as well as caregivers.
This astronomical adoption of telehealth to screen, triage, and treat patients, especially seniors and those with chronic conditions, is here to stay and is being supported by new regulations and new CMS and payer supported reimbursement models, according to industry leaders like Dr. Eric Topol and other practitioners.
But are patients open and receptive to embracing telehealth as a medium to engage with their PCPs and specialists, as well as nurses and care coordinators, which is critical to long term adoption and sustenance?
According to a recent survey by Amwell (formerly American Well), consumers remain interested in telehealth, with 66% reporting they're willing to use it. Unsurprisingly, the younger demographics are most open to it, with 74% of 18-34-year-olds and 72% of 35-44-year-olds saying they're willing to use it. While the senior population has the lowest interest overall, 52% of seniors are still open to using telehealth. That means that of the 47.8 million Americans over the age of 65, 24.85 million are willing to use telehealth, which makes this one of the most promising digital health technologies that will likely become ubiquitous in the “New Normal” beyond the pandemic.
Washington-based Providence St. Joseph’s Health was among the first to treat COVID-19 patients and reported that virtual visits increased 20 to 30-fold in the first few weeks of the pandemic. However, the system reported confusion around billing for the virtual visits, and it had to act quickly to spread the correct coding and billing information.
New York was one of the hardest-hit states with COVID-19 cases, and demand for telehealth services has increased 312% amid the pandemic. Stony Brook (N.Y.) University Hospital has seen an increase in demand for telecommunications within the hospital and is in search of resources to support those visits. Stony Brook University Hospital has asked community members to donate iPads to connect inpatients to their providers and families.
4. Intervention, Surgery, or Procedure
While many interventions involving complex procedures or invasive surgeries will be done in person, there is significant innovation underway to utilize AI-enabled minimally invasive robotic surgeries such as those enabled by the DaVinci Robots from Intuitive Surgical which offer the following measurable benefits:
Smaller incisions and scars
Reduced risk of infection
Less need for blood transfusions
Faster recovery times and reduced post-care discomfort
Shorter hospital stays
This is clearly an arena that I predict will witness disproportionate investments and innovation in the wake of the COVID-19 triggered disruption.
5.Prescription Filling and Fulfillment
Despite e-prescribing being practically ubiquitous at this time, the process of filling, fulfilling, and picking up prescriptions from the pharmacy has not significantly changed over the last three decades. This still involves lining up at the pharmacy, waiting for them to fill your prescription, and then lining up yet again to pick up and pay for your prescription. This presents significant risks to seniors and those with co-morbidities or low immunity, and in the age of social distancing, is completely avoidable.
It is perhaps very reasonable and logical to predict that patients in large numbers will turn to a service like “Pillpack by Amazon Pharmacy” to fill their prescriptions and have these delivered to their doorstep as we move forward to mitigate risk and lower hassle and inconvenience. Amazon acquired an online pharmacy called “Pillpack” for $ 750 million in 2019. Pillpack sorts a customer’s medications by dose and delivers them right to their front door. Printed on the outside of each packet is the list of medications to take at the recommended time of day. Not only that, patients receive automatic prescription refills and customer support 24/7.
6.Post-Discharge Care Coordination across the Continuum of Care
Following discharge from the hospital, high-risk patients were monitored by care coordinators for medication adherence and compliance with their follow-up appointments using a combination of spreadsheets, telephone calls, and data entry into Electronic Health Records (EHRs) in ways that have not proven to be very efficient.
Given the imperative to closely monitor these high-risk patients, Remote Patient Monitoring (RPM) systems with sophisticated predictive analytics are seeing significant adoption.
Like telehealth, Remote Patient Monitoring (RPM) adoption is exploding as we speak and will be here to stay in the post-pandemic era. For high-risk seniors, patients with chronic diseases like cancer, COPD, cardiovascular diseases, diabetes with complications, and kidney disease, having care coordinators leverage RPM to reduce the number of office visits by patients, while still receiving substantial compensation from CMS, presents a sustainable opportunity for healthcare providers to reduce 30 and 90 day re-admission risk, while assuring better patient outcomes.
Innovative and disruptive RPM systems help care teams monitor, manage, and engage patients in the comfort of their homes, which contributes to reducing cost, mitigating risks, while improving outcomes and increasing reimbursements.
These systems continuously stratify patient risk via artificial intelligence (AI)-driven algorithms and alerting, empowering care teams with optimal windows of opportunities to intervene when needed. Automated visual/audio reminders and phone calls enable higher patient engagement, medication adherence with integration with telehealth, and virtual video conferencing and visits which enable rapid patient health assessment, optimized for various chronic diseases.
According to a 2019 Spyglass Consulting report referenced in a recent article in "Healthcare IT News", over 88% of hospitals in the U.S. have plans to invest in RPM in 2020, which have been accelerated in the wake of the pandemic, and will ensure that this is a Digital Patient Engagement (DPE) modality that will thrive and prosper in the “New Normal”.
7.Follow-Up Scheduling and Appointments
Here again, we will see a shift from in-person appointments scheduled over phone calls to the use of telehealth and videoconferencing consultations which will mitigate risk, lower hassles and inconvenience for seniors and high-risk patients, and improve caregiver productivity.
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