May 1, 2019 | Insights
MedRisk’s ISAB Member Paul Beattie shares how virtual visits and other telehealth capabilities are increasing access to care for patients – including deployed military personnel.
“Force readiness”: it may not be a term that’s often used in civilian life, but it’s certainly a concern shared by employers and the military alike.
“You want to keep your operations in top form. You don’t want to remove people from their jobs unless their health is truly at risk,” said Paul Beattie, PT, PhD, OCS, FAPTA, MedRisk International Scientific Advisory Board (ISAB) Member and faculty in USC’s Doctoral Program in Physical Therapy.
For nearly a decade, Beattie has helped train army, air force and naval chaplains at nearby Fort Jackson to support wounded, injured and emotionally distraught soldiers in the field. The goal: to help soldiers get the care they need while minimizing the need for medical evacuation.
Today, Beattie says this objective is being further bolstered by advances in the military’s telehealth capabilities.
In civilian life, it is not uncommon for people to have primary care physicians who know them well and have even cared for them for years. And when an unexpected issue arises, a referral to a nearby specialist helps connect the patient with the expertise required. According to Beattie, military field sites often rely on just a handful of medical personnel, and physically linking up with healthcare providers, especially for specialty care, has been historically challenging – until now.
The military has dramatically increased access to care through the implementation of telehealth capabilities. Perhaps the most critical telehealth development for the military is the introduction of virtual visits that can now be performed through the military health system website.
Similar to MedRisk’s telerehab program, the military’s Virtual Video Visits, or “V3” appointments, are conducted via a secure video teleconference. This combination of live audio and visual allows medics and physicians who are deployed with soldiers to serve a wider range of patients, without the logistics and costs of in-person visits.
These virtual visits have proven particularly useful in specialty cases that require services like genetic testing, dermatology, nutritional counseling and mental health services, which have been an increasing focus of the military. Similar to injured worker rehabilitation, telehealth can also be a valuable tool in getting back deployed soldiers back on their feet following musculoskeletal injury. Physical therapists are point-of-care in the military, but should a second opinion or specialty care be required, a diagnostic quality image can be captured and sent to a specialist at another military treatment facility (MTF) for interpretation. This often facilitates a faster, complete diagnosis, and the report can be stored and accessed by an authorized user from anywhere in the world.
Beattie cites a groundswell of support to get telehealth functionality implemented in the military. The result has been preventive, acute and life-saving treatment delivered in a more expeditious manner. As for user experience, surveys conducted by the US Army Public Health Command documented high satisfaction among providers, patients and commanders.
With the positive outcomes demonstrated thus far, Beattie expects telehealth will become a pillar of care for the military – and healthcare at large, including workers’ compensation.
“We all have a smartphone on us. The uniform’s even got a pocket for it now,” Beattie said. “I’d say telehealth is here to stay.”
About Paul F. Beattie, PT, PhD, OCS, FAPTA
Paul Beattie is a member of MedRisk’s International Scientific Advisory Board and clinical associate professor at the University of South Carolina Department of Physical Therapy, School of Public Health. A nationally renowned and expert psychometrician specializing in examining, analyzing, and validating patient care questionnaires Dr. Beattie has been instrumental in developing MedRisk’s patient satisfaction instruments as well as consulting on MedRisk’s development of its telerehab program for injured workers.
Dr. Beattie has 30 manuscripts published in peer reviewed journals and more than 100 professional presentations.
Aug 2, 2017 | Insights
As virtual PT services make their way into workers’ comp, which patients stand to benefit most?
There’s no doubt telemedicine is a key element of next generation health services. Seventy-four percent of group health consumers say they would use telehealth options. Before strategizing how to attract and convert patients to use telehealth services, however, the baseline needs of the patient must first be considered.
Research shows that telerehabilitation is effective and comparable to conventional in-clinic care, yet telerehabilitation hasn’t yet entered the mainstream when it comes to the workers’ comp industry. During this transitional phase, as telerehabilitation gains steam as an accepted complement to traditional, in-clinic care, it is imperative that payers work with managed care organizations who focus on identifying the patients who can benefit most from virtual PT services.
As a part of this process, both the requirements for a successful telemedicine engagement and the motivators that will drive patients to see telerehab as a viable healthcare alternative need to be defined.
Prerequisites for Telerehab Success
Not every case can be appropriately treated through virtual services. Even if an injury is found to be appropriate for telerehabilitation, the patient must also have the technology required to remotely connect with their provider. For this reason, a managed care organization need to offer a data-driven screening program to identify ideal telerehab candidates and take into account the following:
Injury/Treatment Plan: Is telerehab clinically appropriate – and if so, when? The severity, nature of the injury and any complicating factors will be the first consideration of any screening program. Some treatment plans will not translate well to telepractice, such as monitored patient with unusual or heavy work demands; s/he may need specialized equipment or in-person supervision. In other instances, in-clinic PT sessions can be supplemented with valuable remote offerings including online education, virtual home exercise supervision and online discharge planning appointments, to create a hybrid treatment plan.
Technology Access: At a minimum, telerehab patients will need a computer, smartphone or other device that is compatible with the HIPAA secure telehealth software. The device must be connected to the internet, either through a dependable wireless or wired connection, or a mobile network. Most telerehab treatment plans necessitate the use of a microphone and camera, which are built-in to most computers and mobile devices but can be purchased as external hardware if needed. Speeds of 15Mbps download and 5Mbps upload are best to ensure a smooth video streaming experience.
Reasons Patients Say ‘Yes’ to Telehealth
Although many patients may meet the requirements outlined above, not all will be interested in using telerehabilitation services. There are many reasons that patients might feel motivated to engage with their provider in a virtual fashion. Here are some of the more common drivers of enthusiastic telerehab adopters:
Location: Healthcare services in rural areas have taken a hit in recent years. According to the National Rural Health Association, 75 rural hospitals have closed and 673 more are in danger of closing. The shortage of clinicians working in remote areas and absence of specialty services like physical therapy often means increased travel times for rural patients. Telerehab services offer these patients a fast and convenient option to get the care they need. In a 2012 report by the Institute of Medicine for the National Academies, it was found that telehealth increases quality of care and reduces costs in rural communities.
Demographic: While interest in technology cannot be dictated strictly by age, conventional wisdom would tell us that telehealth may find more traction among younger patients. After all, research has shown that millennials are 5 times more likely to adopt technology than any other age group. And in a recent survey, 71% of millennial patients indicated they would like to engage with their provider via a mobile app. While younger patients may be more eager to adopt telerehab, older patients should not be excluded from such services. Although little research has been done within virtual PT for workers’ comp, high patient satisfaction among older adults has been reported for telerehab services in home health applications after stroke, fall, etc.
Lifestyle: For some patients, the appeal of telehealth really boils down to convenience. In the workers’ comp arena, convenience may have added weight for frequent business travelers who find it difficult to establish a consistent schedule at a physical “home base” provider or others who have family obligations that make it more difficult to travel to appointments. A survey conducted by the American Telemedicine Association found convenience to be the top motivator for active healthcare users interested in complementing or replacing their in-person care with telehealth services.
Conclusion
Be it the severity of injury, a complex treatment plan or a lack of technology, there will always be instances when telehealth is not a suitable solution. However, in many cases, it represents a more direct route to recovery. As the practice of telerehabilitation becomes more prevalent, buy-in from injured workers and their employers will only increase. Now is the time for payers to establish a standard of care and a foundation of interest as we anticipate increased user growth, advancing technologies and expanded clinical capabilities in the years to come.
Mar 7, 2017 | Insights
How can telehealth capabilities help injured workers along the road to recovery?
For workers who unexpectedly become injured and cannot resume their professional functions, getting to and from appointments has historically been a challenge. Until now.
Advanced telemedicine capabilities are beginning to transform the workers’ compensation industry, providing injured workers with a much-needed alternative to on-site medical care. Workers’ compensation professionals generally define telehealth as a virtual interaction involving multiple parties in the claims process. Some consider telephone communications between injured workers and nurse case managers to be an example of early telehealth at work. However, in recent years, the definition has come to encompass more clinical services, such as virtual face-to-face interactions and the remote measurement of vital signs.
Clinical Outcomes
Following an injured worker’s initial diagnosis and the creation of the doctor’s first report, follow-up visits are generally conducted every 45 days. In some cases, these visits are largely hands-off, and a time for the worker and their provider to discuss how treatment is progressing. This is one example of the 70 percent of clinical encounters that can be successfully performed through telemedicine without an on-site clinic visit, according to the American Medical Association.
In the field of physical therapy, the utility and effectiveness of telemedicine has been analyzed in recent studies, and according to 2016 research, clinical outcomes associated with telehealth sessions may be equal to that of traditional in-person care services.
The Bini & Mahajan study set out to compare the clinical outcomes of total knee replacement patients who underwent traditional in-person outpatient physical therapy to those who participated in physical therapy delivered through an asynchronous video-based tool. The 23 narrated videos created for the study demonstrated the same exercises taught in clinics, were each under 3 minutes in duration and featured on-screen text-based instructions.
On average, study patients engaged with the video-based model reported exercising for a mean of 47 minutes a day. They also logged in 49 times during the study period, posted 9 videos and 5 photographs, and sent 10 messages to their physical therapy providers. And, while patients utilizing the traditional care model logged 11 more minutes of exercise a day, they also reported a mean travel time to appointments of 75 minutes.
Patient satisfaction levels were high among both patient groups, with participants reporting that it was “easy or very easy” to communicate with their physical therapist. On top of this, the study authors write that “clinical outcomes following asynchronous telerehabilitation administered over the web and through a hand-held device were not inferior to those achieved with traditional care,” suggesting that telehealth sessions of this nature are clinically equivalent to the in-person care model.
Practical Benefits
There are several situations when an injured worker’s access to care would be greatly enhanced by telemedicine capabilities. For instance, if a manufacturing employee injured himself or herself while working an overnight shift, the only other option may be to visit an emergency department for evaluation. Or, if a truck driver sustains an injury while on the road, the closest clinic may be at a remote location. Under these circumstances, telemedicine may prove to be an advantageous resource for immediate assessment.
In addition to initial injury evaluations, follow-up appointments such as post-operative visits and second surgical opinions, may be handled through telemedicine technologies. Remote patient monitoring technologies can also allow healthcare providers to monitor complex, high-risk conditions and remain attuned to a patient’s progress and recovery to help prevent re-injury, complication, or delays in treatment.
Considering these positive effects, telehealth-powered care models have the potential to save both time and money for patients and employers alike. It’s true that not every injured worker may be an ideal candidate for telemedicine – and in some circumstances, there is simply no replacement for hands-on care – but any resource than can alleviate obstacles for even a subset of injured workers while upholding exceptional clinical standards is certainly worthy of consideration.
