Tag: emr

Hospitals should prepare now for future telehealth demands

In an article published in the Journal of the American Informatics Association this week, Duke University researchers examined COVID-19’s effect on transforming the telehealth landscape.

“Whether healthcare enterprises are ready or not, the new reality is that virtual care has arrived,” researchers said.


As federal and state governments evolve in messaging around COVID-19, healthcare facilities have responded accordingly. These responses have included ramping up support for telehealth services to minimize in-person contact in both inpatient and outpatient care.

After examining a number of examples reported by U.S. healthcare organizations, researchers noted the advantages and limitations of a variety of telehealth platforms during multiple phases of the novel coronavirus pandemic.

“Telehealth is ideally suited to meet the demands of inpatient care while at the same time reducing virus transmission, stretching human and technical resources, and protecting patients and healthcare workers in the inpatient care setting,” said researchers in the article.

The researchers divided telehealth encounters into several categories: e-consult, in which providers asynchronously communicate with other providers; remote patient monitoring via connected device or patient self-reporting; patient-initiated chats with automated or live agents; and patient-provider communication using video or telephone messaging.

Some methods, they noted, require tight electronic health record integration to be useful. This was the case with patient-initiated chats, which could otherwise lack the context necessary for effective services.

Although video-based communication showed improvement in clinical care and favorable payer reimbursement when compared to telephone-based communication, the article authors noted that it requires technology some patients may not have access to – particularly the sickest patients or those with the most complex cases.

Much of the messaging around telehealth has highlighted its advantages for high-risk patients.

Researchers also pointed out, however, that “telehealth approaches allow staff – including those in quarantine, those in high-risk groups (older, immunosuppressed), and those with childcare responsibilities – to work remotely, supplementing in-person clinical services during the surge.”

Given the high numbers of patients being admitted to the ICU with COVID-19, researchers paid particular attention to the necessary considerations for executing a tele-ICU service.

When developing and deploying tele-ICU services, health systems should consider key stakeholders, such as physicians, potential vendors and IT departments; changes to processes; and any technology adaptations or upgrades.

“Healthcare enterprises may already have in place technologies that can be employed to accomplish telehealth,” researchers observed.

“New devices, such as tablets, can be secured with an adjustable clamp on mobile structures such as intravenous medication poles and moved to locations as needed,” they continued. “These are … relatively inexpensive and quick alternatives to traditional telehealth carts.”


Patient telehealth visit numbers have skyrocketed since the COVID-19 crisis began, with some health systems reporting staggering amounts of growth.

Providers have frequently turned to virtual services for outpatient care. Some hospitals, such as Mount Sinai Health System in New York City, have also begun streaming live footage from inpatient units to reduce the frequency of in-person visits.

Even after the crisis subsides, researchers predict that the demand for telehealth could increase sevenfold – particularly as technology advances and regulations are overhauled.

Analysts at research firm Frost & Sullivan forecast the development of more practical applications of AI and robotics, along with more user-friendly sensors and remote diagnostic equipment.


Researchers warned that the effects of COVID-19 may materialize beyond patients seeking care for the disease – and proposed telehealth as a potential solution.

“A growing ‘care debt’ or deferred medical or surgical treatment may lead to increasing demand on a constrained healthcare system,” they wrote. “This may include COVID-19 patients, as well as those with other forms of acute and chronic disease.”

“Cancelled elective surgical cases and treatments during the pandemic can add to this ‘care debt’ that both patients and health systems may face,” they continued. “Along with the economic uncertainty of many healthcare organizations, further constraints to care capacity may be present during the post-pandemic recovery phase.”

“Proactive patient engagement through telehealth may help a healthcare system to effectively manage these contingencies,” they said.

“Specifically, health systems should work to create a strong, sustainable telehealth infrastructure now that will allow for more efficient use of hospital space and staff.”


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How the Coronavirus Could Push Health IT to EHR Interoperability

How the Coronavirus Could Push Health IT to EHR Interoperability

Three health tech and economy experts said the coronavirus pandemic will force EHR vendors to work with one another and deploy the FHIR APIs.

The Office of the National Coordinator for Health Information Technology’s (ONC) interoperability rule was finalized in early March, right before the massive spread of the coronavirus pandemic. However, the spread of that virus has put the importance of EHR interoperability under a microscope, health technology experts wrote in a recent post for the MIT Initiative on the Digital Economy.

For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.

On March 17, the Trump Administration announced the expansion of telehealth solutions in an attempt to lessen the impact of COVID-19, also loosening restrictions on health data exchange across providers.

But, the lack of interoperability between separate EHR vendors makes it difficult to exchange important patient data. If providers cannot access patient data immediately, there could be deadly consequences.

While the ONC final rule takes a hard stance on information blocking, it also calls on medical providers and device developers to promote patient data access using third-party apps and application programming interfaces (APIs).

Ultimately, ONC adopted Fast Healthcare Interoperability Resources (FHIR) Release 4 for its foundational FHIR standard.

“If electronic health records had the well-defined interfaces necessary for intercompatibility — such as Fast Healthcare Interoperability Resources application programming interfaces — it would be easier to connect and create an ecosystem of third-party service providers,” wrote co-authors Geoffrey Parker, professor at the Thayer School of Engineering at Dartmouth College, Edward Anderson, professor at the University of Texas McCombs School of Business, and Nora Belcher, executive director of the Texas e-Health Alliance.

“With better compatibility, telehealth and other healthcare organizations would not need to provide services for which they do not have the resources. Instead, they could use EHR intercompatibility to leverage the platform ecosystem, such as Cerner recently connected Uber’s non-emergency medical transportation service.”

If EHRs were interoperable, then providers would not be running into patient data exchange issues, especially now that the providers are under extreme duress during the pandemic. The writers expressed the need for the third-party platforms that could relieve stress for providers at this time.

However, with EHR vendors, such as Epic, not initially on board with the ONC interoperability rule, it shows how difficult it will be to achieve nationwide interoperability.

It’s important and interesting to consider the reactions of the various players in the health care IT industry,” they wrote. “Why have some electronic health record giants been fighting the implementation of the 21st Century Cures Act with such surprising vigor? The crux of their argument is the valid concern that poorly conceived applications could leak data a la Cambridge Analytica.”

“However, the concern is also self-serving because these EHR providers’ ecosystems of platform applications are weaker than their competitors’ and blocking implementation impedes their competition,” they continued. “Other EHR players — as well as Microsoft and Apple — have given the rules strong support, as have health insurers and providers.”

If providers and vendors can successfully deploy the main components of the final rule, then the writers believe patient data exchange could be a possibility.

“The coronavirus pandemic underscores the potentially deadly implications of the lack of intercompatibility of electronic health records and the need for the tremendous innovation and agility of open platforms,” the group concluded. “In the long term, such innovation will also help the nation cope with the issues of cost.”

“However, for this vision of innovation and data exchange to be realized, governing bodies (including the federal government itself) must require that all electronic health records, no matter their brand, work with one another, and, specifically, that tools like Fast Healthcare Interoperability Resources APIs be deployed across the industry.”