Day two of the virtual event kicked off with David Fletcher and Dr. Hari Eswaran thanking those involved and HRSA’s Deputy Associate Administrator, Heather Dimeris, speaking about the current telehealth landscape.
The opening plenary focused on funding. Dr. Bill England began by discussing the wide range of resources available at HRSA with his presentation, “Telehealth and Research at HRSA. HRSA’s 8 bureaus and offices (Ryan White, Maternal and child health, rural health policy, healthcare systems, etc.) offer many services in several healthcare arenas. In 2019, Health Centers across the nation served 30 million patients. England stated that HRSA is a “grant making” organization and encouraged those in attendance to utilize Grants.gov using the keyword “telehealth.” HRSA’s total budget before the pandemic was 11 billion, which included $29 million for OAT programs [where the Telehealth Resource Centers (TRCs) fall under]. England discussed TRC regions and national centers (CCHP and TTAC), and touted the CCHP compendium of state laws as a valuable resource. He also lauded the NETRC with their “incredible library” of publications and research. According to England, broadband is the largest impediment to delivery of service to people in their homes and ended by promoting several websites – The new HHS website, telehealth.HHS.gov, (available in Spanish and English) contains a lot of info for providers. He also mentioned two valid vendor directories: Digital Health Directory (ATA) https://www.techhealthdirectory.com/ and University of Arizona/SWTRC telemedicine and telehealth service provider director https://telemedicine.arizona.edu/servicedirectory.
Dr. Roxanne Jensen followed with her presentation, “Cancer Care Deliver and Telehealth Research: Post-Pandemic Priorities.” She stated that research at the National Cancer Institute within NIH focuses on 3 areas: Healthcare assessment, health systems and interventions, and outcomes. According to Jensen, the best resource for NIH grants is at their website, https://grants.nigh.gov/grants/guide/. She mentioned the IMPACT Consortium as a research highlight, with the goal of the program being to accelerate the clinical adoption of integrated systems, to monitor patient-reported symptoms and provide decision support.
Regarding patient/provider telehealth, Jensen asked, what happens next? Their next steps are to foster and accelerate areas of telehealth research in cancer care delivery using new tools, utilizing methodological approaches and using available technology. In June, the institute performed a portfolio analysis of active grants and found they mostly fell in 3 categories: supportive care, psychosocial, and preventative. And in July, they sent out RFI to identify gaps and needs. Here’s what they identified: who is accessing telehealth, what services are best suited for telehealth, what are the outcomes of in-person vs. telehealth.
Penny Mohr from Patient-Centered Outcomes Research Institute (PCORI) was the last to speak in the plenary with her presentation on, “Post-pandemic Digital Health: A Perspective From the Patient-centered Outcomes Research Institute.” Mohr called engagement the “hallmark” of PCORI research and discussed examples of what they’re looking for. Early on in pandemic, PCORI funded enhancements to existing awards, those with existing infrastructure as well as a targeted announcement for target areas, specifically adaptations to healthcare delivery. She closed by discussing a current ongoing study that is looking at 110 primary care practices and the effectiveness of telehealth among their 205k patients. Specifically, they’re looking at three different types: in-person, telehealth, and a hybrid of the two.
After a quick break, Dr. Elizabeth Krupinski discussed human factors in research: examining social, biological, psychological, and physical components that influence design, development and operation products or systems. The goal of identifying human factors is to optimize improved outcomes in telemedicine. “It’s a process,” Krupinski said. It’s not a one-time thing – analyze, design, evaluation… rinse and repeat. She discussed the tech acceptance model where perceived usefulness and perceived ease of use is a determining factor in whether or not people are going to use telemedicine. She listed things to look at: patient/clinician dynamics, organizational factors, environmental factors – “critically important” – not just broadband, but how the tech integrates into what you’re wanting to achieve. Krupinski warned that when looking at RPM devices, you shouldn’t just look at them for what they can do but how well it’s suited to your patient population. She closed her presentation with some tips… conduct a meta-analysis, conduct surveys/questionnaires, conduct a task analysis. Make contextual inquiries: observe behavior, catalog behaviors, look at what people see as important, ask questions.
From there, attendees were offered three back to back sessions with two tracks each where panels of professionals conducted ten minute flash presentations with Q/A and discussion at the end:
Session 1
- Track A: Models of Virtual Care and Cost Analysis
- Virtual vs Traditional Care Settings for Low Acuity Urgent Conditions: An Economic Analysis of Cost and Utilization Using Claims Data, Tim Lovell
- A Generative Co-design Framework for Virtual Care Innovation, Dr. Marissa Bird
- Real World Application of Telehealth Economic Evaluation Framework, Dr. Alison Curfman
- Track B: Telehealth in the Time of COVID
- Virtual Urgent Care: From Hurricanes to Pandemics, Dr. Kathy Wibberly
- Remote Patient Monitoring for COVID19 Patients After ED Discharge, Dr. Ahmad Aalam
- Rapid Implementation of an Interprofessional 1-800-COVID19 Hotline Call Center to Support a Public Health Crisis, Dr. Kevin Sexton
Session 2
- Track A: Emergency Care and Management
- What Drives Greater Assimilation of Telestroke in Emergency Departments?, Dr. Lori Uscher-Pines
- The Impact of PICU to ED Telemedicine on Changes in Severity of Illness, Dr. Elizabeth Dorwart
- Ophthalmology Residents as in Situ Telemedicine Extenders in the Emergency Department During the COVID19 Surge, Dr. Jessica Fleischer-Black
- Track B: SPROUT Update and SPROUT Initiatives with guest speakers Dr. John Chuo, Dr. Alison Curfman, Brooke McSwain, and Dr. Christina Olson
Session 3
- Track A: Education and Innovation
- Integration of a Checklist to Assess Telehealth Etiquette in an Online Training Program, Dr. Beverly W. Henry
- Using the ECHO Model to Address the Needs of HealthCare Professionals During an Emerging Threat, Jessica Leffelman
- Utilizing Emergency Medical Technicians as Telehealth Facilitators in Addressing Changes in Condition for Home-based Primary Care Patients, A. Camille McBride
- Track B: Obstetric, Neonatal, and Pediatric Interventions
- A Qualitative Analysis of the Impact of Videoconferencing with the Premature Infant on Breast Milk Expression, Dr. Adrienne Hoyt-Austin
- Evaluation of a Telemedicine Program Managing High-Risk Pregnant Women with Pre-Existing Diabetes, Dr. Yi-Shan Sung
- An Investigation of the Efficacy of the Telepractice Service Delivery Model as Compared to the In-Person Service Delivery Model Using a Phonemic Awareness Intervention with Head Start Preschoolers, Dr. Pamela Storey
After the rapid fire presentations from a wide variety of professionals across the public health and healthcare spectrum, time was allotted for attendees to view a new day’s worth of interesting and noteworthy poster sessions on an array of topics: RPM pediatric palliative care, developing a great lit review manuscript, patient/physician perspectives on adult and pediatric neurology telemedicine, post-discharge intervention for stroke caregivers, developing a continuous virtual monitoring program, telemental health in-person versus in video, EMT perspectives on telehealth care delivery model serving homebound older adults, using telemedicine for retinopathy in a level 2 NICU, and teledermatology at large safety-net hospitals.
Dr. Krupinski came back for the day’s last virtual assembly presentation, “Getting Informed Consent Within Telemedicine.” She discussed all the opportunities telehealth presents: improved quality, access, and research… faster recruitment which accelerates trial participant access… improved participant retention and greater control. Telehealth reduces attrition: texts, RPM, and video appointments are a “much more efficient manner” than the traditional model. Krupinski noted that most institutions do not require IRB consent or approval for standard of care situations… however, prospective studies do require prior approval. “It all depends on what sort of telemedicine you’re doing,” she said. Remote consent vs. in person consent often removes the face to face explanations that naturally comes in a standard situation. Is telehealth the intervention or enabler or platform? It’s important to distinguish. Challenges in all scenarios and multi-site studies “exacerbates” challenges: grants, funding sources, timelines and logistics are likely to differ and be impacted. Krupinski listed some study elements to be considered when dealing with the IRB: technology, regulatory/reimbursement, design/initiation, implementation/sustainability. She closed with some things to think about:
- Much could be solved if telehealth wasn’t considered different than standard treatment of care
- Telehealth needs to be considered as just another tool in delivery of healthcare
- Researchers need to frame protocols to using telehealth isn’t different that standard of care
The day ended the same as the day before with a networking table (i.e. virtual breakout room), Moving Telehealth Research Forward: Meet the SPROUT-CTSA Network Topic Working Groups hosted by Dr. John Chuo.
