Advancing Patient Care with Telemedicine

Cleveland Clinic has been moving rapidly in recent years to incorporate telemedicine in our delivery of healthcare services in pursuit of the triple aim — enhancing patient care, improving the health of populations, and reducing the cost of care. Telemedicine, in the form of virtual visits and the use of remote patient monitoring, allows us to deliver care that is cost-effective and efficient while maintaining our patient safety and quality standards.

 

In 2015, Cleveland Clinic partnered with American Well to connect patients with healthcare providers via a downloadable app to receive advice for minor health issues. Available any time of day or night, Cleveland Clinic’s Express Care Online allows patients to use their computer or mobile device to meet with a doctor by video 365 days a year.

 

Nearly 3,000 patients in Florida have used Express Care Online since it was first introduced, two-thirds of whom are women. Acute sinusitis and acute upper respiratory infection are the two leading diagnoses followed by urinary tract infection and acute bronchitis.

 

Physicians in our orthopaedic surgery and neurosurgery departments in Florida have been conducting post-operative virtual visits for the past year, making care more convenient and easily accessible for patients. When appropriate, patients are able to video conference from their home or office with their surgeon in the weeks or months following a procedure, such as total joint replacement, as part of routine follow-up care.

 

Last month, we also began conducting follow-up virtual visits for patients undergoing non-surgical orthopaedic treatments, as well as within the endocrinology department. Plans are in place to roll-out virtual visits in other departments in the coming months.

 

Internet of Medical Things (IoMT) is defined as the collection of medical devices and applications that connect to healthcare IT systems through online computer networks. These devices and apps are helping providers track chronic illnesses for patients by recording medical measurements such as EKG, glucose level, and blood pressure outside of the healthcare setting. They are also providing physicians with near real-time access to remote monitoring information for hospitalized patients while away from the bedside. This allows for the early identification and intervention of health problems before they become critical.

 

One of our earliest remote monitoring programs involves providing an extra layer of inpatient care for our intensive care patients. Cleveland Clinic in Ohio developed a tele-ICU program called eHospital, which allows Cleveland-based board-certified intensivists to remotely monitor the sickest patients from a command center between 7 p.m. and 7 a.m. They oversee ICU beds within our community hospitals in Ohio as well as our Florida hospital in Weston. Through early intervention, we’ve increased quality of care and reduced length of stay in our ICUs.

 

In Florida, our team of cardiac electrophysiologists provide long-term remote follow-up and remote monitoring of patients who have pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices. They also use remote surveillance of injectable subcutaneous cardiac monitors for diagnostic rhythm monitoring, atrial fibrillation management, and cryptogenic stroke.

 

In addition, our cardiologists are using a mobile app to monitor telemetry data for hospitalized patients. This data is integrated with our electronic medical record system, providing all our physicians with access. Our goal for remote monitoring is to provide the most efficient, high quality care that supports the best outcome and patient experience.

 

Two major federal bills passed last year included elements to broaden access to telemedicine across the nation. The Bipartisan Budget Act of 2018 changed Medicare reimbursement and coverage for certain telehealth services, as did the SUPPORT for Patient and Communities Act. Unfortunately, the recently passed Florida telehealth legislation failed to require health plans to cover telehealth services.

 

More national and state legislation is needed to address barriers to telemedicine, including current reimbursement limitations and restrictions. Until then, hospitals and health systems will continue to struggle to bring these innovative programs to patients.