It’s time to harness the power of telehealth to treat a wider patient population, says Vimal Mishra, M.D. internist and medical director of telehealth at Virginia Commonwealth University (VCU) Health System.
With that philosophy of expansion at the core of its strategy, VCU takes a different approach to telehealth than some other healthcare systems, Dr. Mishra explains, by keeping in mind the value streams of access, experience, effectiveness and care redesign.
Dr. Mishra, who provides leadership for VCU’s enterprise-wide telehealth efforts to enhance access, improve clinical outcomes, and gain clinical efficiency and effectiveness, will share VCU’s approach at the Telemed Leadership Forum 2019 in Washington, D.C., April 3-5.
VCU is engaged in three different categories of telehealth services, says Dr. Mishra. For the past 20 years, VCU has provided telehealth services across Virginia, presently providing telehealth services to around 30 correctional facilities for the Virginia Department of Corrections. A second category of service, which VCU is expanding, is the “VCU Health Anywhere” direct-to-consumer telehealth app that facilitates telehealth visits for acute or chronic care. The third category is remote patient monitoring (RPM), which is currently in the pilot phase, says Dr. Mishra.
Dr. Mishra explains that, while remote patient monitoring (RPM) is not a new way of taking care of patients, VCU Health is redesigning RPM to be very interdisciplinary. “By combining different aspects of telehealth modality – remote patient monitoring and virtual visits – we are changing how we can deliver care and how we are organizing care around patients,” says Dr. Mishra.
For example, VCU Telemedicine has a service agreement with the VCU hospital endocrinologists to get diabetes patients with uncontrolled diabetes into the home monitoring program. A nurse contacts the patient being monitored if blood sugars are too high or too low, and if the problem continues, the nurse contacts the pharmacy. There is also a service agreement with the pharmacy, which contacts the patient. “This is an interdisciplinary new way of delivering care, where we are not only utilizing providers, we are utilizing the whole care team to provide care,” says Dr. Mishra.
Another area of care redesign for VCU is the approach to virtual visits. Dr. Mishra says that studies have shown that chronic care patients are bottle-necking access to face-to-face doctor visits for other patients who can be easily seen. VCU’s approach is to provide follow-up care for chronic patients through telehealth, increasing face-to-face access for other patients with acute care needs, and for new patients. “[Telehealth] is helping the [physician] burnout, it is helping [reduce] clogging of the clinics, it is increasing patient satisfaction and improving the quality of care as well,” says Dr. Mishra.
There’s more exciting work on VCU’s agenda, Dr. Mishra says. In November, they relaunched the second phase of their innovative Project Echo work. As part of that project, VCU is at the vanguard of using telehealth to battle the opioid epidemic in the state of Virginia. They’ve designed what Dr. Mishra calls “a very interdisciplinary program” somewhat based on their successful telehealth diabetes treatment program.
“We already have Sickle Cell Project ECHO, but we are also planning to launch Palliative Project ECHO,” he says. “It's so hard finding primary care provider who can take care of palliative and hospice patients.”
Dr. Mishra is clearly enthusiastic about Project ECHO. “I think it is a fantastic way of engaging the community and delivering the public health service we need to improve health of the community. Not from a perspective of a health system, but a perspective of how we take care of our patients better,” he says.
The industry doesn’t have a lot of data “in terms of applying telehealth at a strategic and enterprise level and showing improvement in all different dimensions,” says Dr. Mishra. But he wants to see this change by developing strong partnerships with other health systems and creating multi-center trials. With strong partners, we can “amplify the value, the effort and the impact, and showcase the industry,” says Mishra. “That’s what drives me to go around and talk about what we are doing here.”