From the 2018 HVPAA National Conference
Kathleen Duffy Fray (NYU Langone Health), Nicole Adler (NYU Langone Health), William Winfree (NYU Langone Health), Paul Testa (NYU Langone Health), Jason Sherwin (NYU Langone Health), Diego Rodriguez (NYU Langone Health), Meredith Curtis (NYU Langone Health), Annette Rabinovich (NYU Langone Health), David Ranson (NYU Langone Health), Michael Grossbard (NYU Langone Health), Robert Press (NYU Langone Health)
Background
Patients with life-limiting illness are high utilizers of health system resources and are more likely to visit the Emergency Department (ED). Leveraging novel video-visit tools in the Electronic Medical Record (EMR), our team launched a pilot video-visit program in a subset of high-risk Hematology-Oncology patients at our Clinical Cancer Center.
Objectives
When compared to no inter-visit patient outreach, we hypothesized that scheduled video-visits for symptom management, medication review, and general patient monitoring would reduce preventable ED utilization and improve patients’ engagement in their care.
Methods
The pilot population for this program was determined based on the following criteria: active chemotherapy treatment with preference given to those patients with late-stage or metastatic disease and history of ED utilization; New York State residency status; access to a smart phone and wireless internet. An initial population of twenty patients was selected by a multi-disciplinary team in the Thoracic and Hematology Disease Management Groups (DMGs). Patients that met the criteria were approached by the clinical team and introduced to the video-visit concept as an additional support method to help manage their symptoms. Patients who agreed to participate were then referred to the appropriate virtual health clinical lead: a registered nurse in the Hematology DMG or a nurse practitioner in the Thoracic DMG. A clinical note type was created in the EMR and a tracking tool was developed to capture clinical interventions and technological successes or challenges.
Results
In the first three months of the pilot, there were 34 scheduled telehealth visits with 9 unique patients: 27 of these visits successfully took place. Of the 27 successful visits, 17 included a live video connection, while 10 were telephone encounters only. The most frequent clinical interventions included medication adjustments and referrals to social work or nutrition. Patient and caregiver education also took place at each visit. In the three months following the launch of the program, ED utilization for the entire cohort averaged 1.33 ED visits per month, compared to 2.0 ED visits per month in the three months prior to launching program (33% reduction). Additionally, all patients have verbally expressed satisfaction and perceived value of the program. Early challenges largely stemmed from patient difficulty using the system due to password recall and overall orientation and comfort using the technology.
Conclusion
The use of video-visit technology as a supplemental service to regularly scheduled clinic visits can be a powerful tool for managing patient utilization and engagement in high-risk, advanced disease Hematology or Oncology patients. Although the program is in its infancy and the pilot population is small, early results indicate that the use of video-visit technology could be an effective modality for providing symptom and medication management in an alternative setting to the oncology office practice.
Implications for the Patient
Delivering care virtually eliminates the requirement for patients to travel to the practice and provides an additional check-in with a clinician, which could ease patient anxiety and reduce preventable ED visits.
