Telehealth, Remaining Innovative as Technology Changes

October 9, 2018

The medical director of digital health at Cleveland Clinic spoke about the role telehealth plays in a society where technology constantly advances and changes.

Peter Rasmussen, MD

When speaking with NeurologyLive in an interview, Peter Rasmussen, MD, Medical Director of Digital Health at the Cleveland Clinic, spoke about the role telehealth has in today’s society. As technology is constantly advancing and patients utilize phones, tablets and computers to access almost everything aside from health care, Rasmussen noted that the industry needs to embrace this change and new way of delivering care via electronic means.

A variety of telehealth tools are available, and clinicians need to recognize it’s what patients want and payers are moving toward. From virtual visits to patient portals, remote monitoring and access of health records, Rasmussen stresses that there’s an enormous amount of information that can be gleaned from nonmedical aspects of patients, aspects that care providers typically do not have access to but if shared, could provide a great benefit in delivering health care.

Rasmussen recommends that clinicians stay curious as to what the future holds, remain innovative and recognize that digital and technology tools will aid in delivering the best care and treatment plan for patients.

NeurologyLive: Why telehealth?

Peter Rasmussen, MD: I think there is an enormous amount of information that can be gleaned from nonmedical aspects of patients such as psychological and social behaviors, financial conditions, living situations, or if there’s caregiver, meaning a spouse or a family member who helps you with your chronic illness and has tremendous influence on whether you get readmitted to the hospital and how soon after hospitalization, access to a car or a bus line, the ability to purchase healthy food and get to a pharmacy and refill medications in a timely fashion, these things also impact health status so patients can get health care if needed or not—all these things greatly impact patients health that frequently clinicians don’t have insights on, yet, a mobile phone does.

Mobile phones know where you live and the proximity of where you live to a bus line or whether you have a car, and your mobile phone probably has a pretty good inkling about how much money you make and how you spend it, but your health care team doesn’t, and I think if that sort of data is shared back with the health care team, it will provide a great benefit in delivering health care to patients.

Particularly as we move toward these accountable care organization and value-based care deliveries strategies, these are very important things for your care team to know about, and how much energy and time to have social work and pharmacy and healing services play into overall care. Obviously, there’s going to be some reticent for patients to share that kind of information with the care team and there’s the potential for a lot of abuse, but if patients are willing to do that and people act honorably I think there can be a benefit to patients overall.

What do you think our audience should know about telehealth?

PR: I think there should be a recognition that this is what patients are looking for. If physicians or clinicians think that patients enjoy coming into our offices and sitting in our waiting rooms, waiting 20—30 minutes to see us for 5-15 minutes is what they want, I think we’re sadly mistaken.

I don’t think anyone these days would design the health care system to look like the way it looks now. We really need to embrace this change and new way of delivering care via electronic means, that’s through the electronic health records, virtual visits, or asynchronous data transmission, whether it be physiological data or photographs. I think we need to recognize that this is what our patients want, and payers are moving to. CMS and Medicare are certainly interested in this kind of behavior and we really just need to keep an open mind for this.

I think there are a lot of other interesting things on the cusp of being more mainstream and is out there already, particularly in the neurology community. As it stands right now, patients with things like Parkinson disease, tremor, or movement disorders, we really don’t understand how these patients respond to treatments when they leave the offices, so by simply incorporating things like the smartphone technology into a data gathering app if you will, we can glean a lot of information on how they’re doing, by asking the patient to hold the phone in their hand for 5 minutes a day is going to give us insights into how well we’re managing their tremor or if the tremor is worsening by tracking their overall daily activity. If they have movement disorders, low back pain, or other problems we might be managing we should be seeing an improvement in the amount of activity if we’re managing them well because obviously, people are going to be feeling better and functioning better. I think these are all things that we need to be thinking about and how these alternate surrogate endpoints if you will, of treatment success can be utilized. That can also increase the frequency of the iteration of our treatment strategy, so as opposed to perhaps making a medication change for Parkinson disease once every month or 2 months, or 3 months, and then seeing the patient back in the office by using virtual visits and tools that we talked about we can iterate on their treatment plan much more quickly with improving the speed to treatment success as opposed to the current strategies that we are now.

I also can’t overstate how important telestroke is in terms of managing patients. If we look at our own experience in Cleveland and hospitals where “general neurologists” were seeing patients with acute strokes in their ED. We were seeing about a 4%—6% prescription rate of intravenous thrombolysis and when we implemented telestroke programs into these emergencies we quadrupled the rate of thrombolysis in the exact same patient group in the same EDs. There’s certainly something very powerful about projecting expertise to where it’s needed to benefit patients.

What’s the best advice you can provide to practitioners utilizing telehealth?

PR: I would just say do more and use it in different ways, and you know experiment with it, because it is what patients want. Patients do everything else online these days or have their computer and health care is one of the last things I think to come to a patient’s computers, tablets, or mobile phones. I think we all need to be innovators in the space and just look for different ways of interacting with patients just using the digital tools.

I think there’s a lot of exciting things coming with new technologies that will augment video visits. We already have ways of measuring blood pressure, weight, activity, pulse and a variety of other physiological variables, EKG etc. I think the future is going to hold the passive assimilation of other patient’s specific factors, things like social behavior, diet, a glimpse into their financial status, their psychology, their living situation which all of these things play heavily on patients’ health and should help us in delivering a care plan and treatment plan that patients require and I think that’s all going to be facilitated through digital tools and technology tools.

I think the biggest advice is probably to just stay curious as to what the future holds and remain innovative.

What’s Cleveland Clinic’s relationship with Apple Health?

PR: We, like the government and other groups, believe that patients should be empowered by having easy access to the data that they own. One way we’ve done that is by working with Apple Health so that patients can very simply upload their selected aspects of the electronic health record from the electronic health record to their phone in Apple Health. That did require a little bit of operability work, but that was facilitated both by EPIC and Apple. This has allowed patients to take control of some of their health data.

I think we’re only halfway there though because just getting the data to the patient isn’t particularly all that helpful. For the most part, any hospital or health system that has had electronic health record has granted patients access to their records.

The powerful part of this equation will be when the patient is then able to push their health record from their phone to a new provider or new health system and have it reside in their electronic health record. That’s something we’re advocating for and working with various electronics vendors to accomplish this as well, because I think that’s really going to be a powerful thing for patients, it’ll make it that much easier for them to seek speciality care or second opinions when they’re empowered by having full access and control and portability of their health information.

Transcript edited for clarity.