Narrator: Coming up on Mayo Clinic Q&A,
Dr. Steve Ommen: I think it's going to be to the benefit of
patients that they will get care without having to stop their
lives. And that's got to pay off in the long run for our
patients.
Narrator: Telehealth enables video or phone appointments
between a patient and their health care provider from the
comfort of the patient's home. Use of telehealth has increased
dramatically during the COVID-19 pandemic, and the technology is
providing benefits for the health and convenience of
patients.
Dr. Steve Ommen: We're seeing an increasing demand from what we
refer to as remote patient monitoring. So, this is the
ability for us to have a patient have monitoring devices in their
home, a thermometer, a pulse oximeter and a blood pressure
cuff, maybe even a scale, and that data can be automatically
uploaded to the electronic health record and monitored by a
team that can look for early signs of a patient
deteriorating.
Dr. Halena Gazelka: Welcome, everyone to Mayo Clinic Q&A. I'm
Dr. Halena Gazelka. A recent study from the COVID-19
healthcare coalition shows that patients and providers are
highly satisfied with digital health care as a way to deliver
care. Nationally, providers and patients also reported that they
plan to continue to use digital tools to assist patients after
COVID-19. Here at Mayo Clinic, our use of telehealth rose
dramatically during COVID-19. And even as the pandemic wanes,
telehealth seems that it's here to stay. Joining us to discuss
this today, is cardiologist Dr. Steve Ommen who serves as the
medical director of experience products for the Mayo Clinic
Center for Digital health. I had to look down and read that
Steve, that's quite a title.
Dr. Steve Ommen: It is quite a title. And it seems to change
all the time as we continue to evolve in this new space.
Dr. Halena Gazelka: That's right, we have to add more to
your title as you get more jobs to do so.
Dr. Steve Ommen: Exactly.
Dr. Halena Gazelka: Thank you for being here today, Steve.
This is a topic that I'm excited to talk to you about because it
has been absolutely fascinating to me to see the burgeoning in
telehealth and even particularly video visits during COVID-19,
and I think it's just a silver lining.
Dr. Steve Ommen: Yeah, if you're going to find a positive over
what's happened, it has opened up healthcare industry and
patients' eyes that we can maintain health, get care in
ways that we didn't use to make a habit.
Dr. Halena Gazelka: Yeah, I love the fact that I can now see a
patient in consultation often here in the clinic, but then
when they go home, they can have continuity of care and check in
with me too. I like that. I think they do too.
Dr. Steve Ommen: Yeah, absolutely. The access that
provides patients in a much more convenient way for them to get
their care during life and not having to pause their lives in
order to get care is really one of the key features of this
shift to telehealth and digital health.
Dr. Halena Gazelka: Well, I would love for you to tell our
listeners, Steve, a little of the history of this at Mayo
Clinic because it really was a large undertaking to go from
almost no digital visits or telehealth visits to the number
that we're doing now. Tell us a little about that transition.
Dr. Steve Ommen: Yeah, it's interesting. And it's something
you have seen in the past. So, what we were able to do a year
ago in March to shift from in-person visits to face-to-face
visits didn't actually happen last March, it happened in the
years leading up to that, as we knew that at some point, people
were going to want to get their health care in a similar way
they do travel planning, and banking, and grocery shopping,
and everything that we can do online. We knew that there was
going to be an appetite for telehealth. And so, Mayo Clinic
had the vision years ago to set up what was at that time called
the Center for Connected Care around delivering care to people
when they were at their offices, or in their homes, or during
their school, and not when they were in our buildings. And prior
to the COVID pandemic, really what we had was a bunch of
troughs full of waters, and the horses didn't know they were
thirsty yet. And with COVID, all of a sudden everyone was
thirsty. And because of all the work the team had done ahead of
time, we were able to turn that switch and get most of the
practice up and going with video visits, as you mentioned, within
a few days or weeks with a bunch of self-help implementation
programs, etc. So, it was really while all the all the drama and
glory came last March and April, the work had been done over the
preceding number of years to set up the organization to do that.
Dr. Halena Gazelka: Oh, I'm sure. And it was amazing to me
how quickly they came through the clinic and started putting
these little cameras on the top of our computers. And when they
first put it there, I personally as a pain provider, I didn't
even know why it was there. I had never never done a video
visit until COVID. And been it's been amazing.
Dr. Steve Ommen: Yeah, it really is amazing. And each practice as
you mentioned, has different ways that they want to use these
tools. So, you know a pain doctor can use it one way,
certain cardiologists can use it another way. Neurology has
been doing virtual care for various aspects in their
practice for a while, so there's different levels of maturity.
And I think that what we have seen that across the country,
the use of telemedicine for behavioral health issues has
been a major benefit during the pandemic and beyond that now,
because there's such a paucity of providers for that big need.
Dr. Halena Gazelka: Right. I mean, that is what is amazing is
that where people did not have services before they now can
have access to services they might not have. And it seems to
me that behavioral health might lend itself well to this because
one of the limitations that we talked about is that I can't
examine your back. You're having back pain, when I see you over
the video we can do quite a bit over the video, but behavioral
health works a little differently.
Dr. Steve Ommen: Yeah, exactly. And as you mentioned, there's
the flip side, there are things that just simply can't be done
by remote care. So, if there's a mass or a lump that must be felt
in order to get an idea of its characterization, that obviously
we can't do remotely, yet, I suppose we should say as quickly
as things are changing in this world. But right now, that's an
office visit to make sure that we are keeping that patient
safe.
Dr. Halena Gazelka: Steve, in the intro, I mentioned the
COVID-19 Healthcare Coalition. Could you tell us what that is?
Dr. Steve Ommen: Yeah, so the COVID-19 Healthcare Coalition is
an organization of several large parties that really wanted to
understand the impact that telemedicine had, recognizing
that the COVID pandemic provided a great research opportunity to
understand how we can utilize these tools. Where we were
limping along for years and years trying to accumulate
enough data to do research on, now all of a sudden, we were
faced with a lot of it. So, the Healthcare Coalition brought
together an organization called the Mitre Organization, which is
a not for profit research organization. Mayo Clinic,
Change Healthcare which is a claims warehouse for commercial
payers, the American Heart Association, digital medicine
organizations. And so, it was it was a multi-party collaboration
that really wanted to study the impacts. And we kind of
approached it with three broad approaches. One was simply
analyzing the claims data, that change healthcare guide, and
they process roughly half of the claims in the US. So, we can
see a large number, large volume of data and that impact. The
second was a physician survey. So, we sent a survey, utilizing
the American Medical Associations databases, to a
large number of providers who responded to ask them about
their utilization, their perceptions, etc. And then
lastly, we did the same thing with patients, and we did a
patient survey. And we've combined all of those into kind
of one research effort. You can find it on the C19HCC.org
website, because there are great data visualizations there for
you to look at. But we're also going to publish it in a broader
public internal publication.
Dr. Halena Gazelka: What did you find out? And were you surprised
by any of it?
Dr. Steve Ommen: You know, it was really a satisfying research
project. First, from the collaboration of all these
entities and that people were highly engaged and motivated do
this research. But the claims data show that across almost
every specialty, there was huge uptake. And it spans
specialties, it spans acute care versus chronic care. So, just a
tremendous upswing, and as expected, we saw peak last
May-June in terms of activity, and there was a little bit of a
tail off. Which mirrors kind of our experience at Mayo Clinic as
well, although we had our tail off, and now we're starting to
see an upswing kind of as we've settled back into having an
in-person practice again, but balancing that. Because even
though we are open doesn't mean all the patients need to come
and sit in your office with you to get their first evaluation or
subsequent evaluation with you. So, we're trying to, we're
seeing that start to increase again. In terms of the physician
survey, again, it was interesting that almost no one
was doing telemedicine prior to January of 2020. And then nearly
everyone was doing that. And there was the providers and
their survey felt that they could deliver quality health
care to their patients across the spectrum. It was most, they
were most satisfied with the quality they could give for
their long-term chronic management patients they were
on. They felt like they could do a great job doing that. Maybe
a little less so in the acute care activities.
Dr. Halena Gazelka: Sure.
Dr. Steve Ommen: But that's, but you know, again, there was lots
of positivity in what providers could do, and they all said that
even almost no one was doing it in January. They know their
organizations are expecting them to increase their activities
going forward. So, the industry, the provider industry, is seeing
the importance of transforming the way we practice.
Dr. Halena Gazelka: That's interesting. I think that kind
of makes sense to me what you said about the physicians,
because if someone has an acute issue, I think of those many
times those might be something that you want to actually look
at.
Dr. Steve Ommen: Right.
Dr. Halena Gazelka: Whereas, your chronic patients, you've
known them. You've seen them before; you might be adjusting
medications.
Dr. Steve Ommen: Yeah, I think there's a lot of intuitive
things that make sense now that we've experienced that it
confirms those types of things. The one thing I think that was
surprising was the providers. One of the question sets they
were asked had to do with barriers to further expansion of
telehealth. And I think that physicians actually had more
fears than translated into reality on the patient side of
the surveys. So, physicians highlighted that they thought
that both age, and or being rural would decrease utilization
of telehealth. But on the patient side of things, we
actually see that there is no drop off across age decades, or
across rural versus suburban versus urban. And again, there
might be some intuition there, because who has the least
ability to get to a medical facility? Well, it might be an
elderly person who lives in the country. And so, they actually
have a higher need to do that. And so, they are utilizing it
just as much as their younger urban dwellers might be.
Certainly, there are broadband issues and gaps out there in the
country. But thankfully, most of the telehealth companies are
making sure that we don't need the highest end broadband in
order to deliver good visual and audio connections or data
streams. And we maybe want to talk about other things besides
video telemedicine on this podcast. But the surprising
thing was patients did not display the same reticence about
those demographics being a barrier to using this new
technology.
Dr. Halena Gazelka: I have to say that that surprises me too,
Steve. I would have said the same things. Maybe I was one of
those physicians who said that to you on that survey.
Dr. Steve Ommen: Could be. Could be. I think the other thing I
was going to go to was, and Dr. Halamka is the one who pointed
it out, when you look at the patient survey data, patients
would have either deferred care or risk going in to see their
providers if it wasn't for video telemedicine being available to
them. So, we were able to not defer care for patients and keep
them safer during the height of the public health emergency,
which again, is a positive benefit to this change.
Dr. Halena Gazelka: Steve, you talked about other ways to
deliver digital medicine, other than using video visits, what
else is there?
Dr. Steve Ommen: Well, so we're seeing an increasing demand from
what we refer to as remote patient monitoring. So, this is
the ability for us to have a patient have monitoring devices
in their home, a thermometer, a pulse oximeter, a blood pressure
cuff, maybe even a scale. And that data can be automatically
uploaded to the electronic health record and monitored by a
team that can look for early signs of a patient
deteriorating. We had a program like that prior to COVID for
some of the chronic complex diseases like heart failure and
COPD, diabetes, but then when COVID came, we also developed a
program like that for the COVID positive patients. So, some of
these patients might have had to go to the hospital except now
that we could give them the monitors in their home, we can
monitor them more safely there, keep our hospitals less full,
and preserve all the PPE we needed to do. And then even
lower touch one for positive patients who might not have been
hospitalized let us keep an eye on them. And in our cancer
practice, the preliminary data have shown that the patients who
were issued monitors were sicker at baseline but had fewer
downstream hospitalizations and complications. So, the ability
for us to be watching a patient while they try to be at home and
live their lives, is showing positive benefits. And that's
going to extend access and confidence in patients that
their healthcare organization is watching over them. And that
we're looking for signs of deterioration before you have to
do high cost, high invasive interventions for patients to
help them out. So, I think that's going to be the next wave
of activity we see is in more of this collecting data about our
patients in their homes, or in their offices, or in their life
in general.
Dr. Halena Gazelka: That really is fascinating, Steve. Because
we do put a lot of onus and responsibility on patients and
to interpreting how they feel in deciding whether it's time to
pursue intervention. And if you can monitor them and intervene
potentially earlier, maybe they don't become as sick before they
Dr. Steve Ommen: Exactly. Yes, that's exactly right, and I
come in.
suspect we'll start to see as cognitive computing, or machine
learning, or artificial intelligence for several more
terms you want to put around that, as that gets more robust,
that's going to help our care teams identify those patients
who might need a quick call or something sooner rather than
later. So, that's going to be a very evolving practice going
forward for Mayo Clinic and for others.
Dr. Halena Gazelka: That's fascinating. So, speaking of
which, Steve, what do you see in the future for telehealth? What
does this look like?
Dr. Steve Ommen: Well, it's here to stay for sure. I think that
we will look back at 2020 as a fork in the road, where
healthcare realized the benefit of doing things remotely and not
practicing the traditional way. There's a few wild cards out
there in terms of what the long-term adoption rate is going
to be. And the main thing is, is that during the public health
emergency, the government and the payers relaxed the kind of
prohibitory regulatory and reimbursement environment, to
make it available to patients to get their care this way. Once
the public health emergency is over, then it depends on whether
those prior regulations are put back in effect. And if they are
put back in effect where they were ahead of time, then our
adoption will slow. I don't think it will go to zero, but it
won't grow as much as it had. But we're working with other
healthcare organizations, with state legislators, and at the
federal government level to try to advocate for let's not roll
the clock back, let's make sure that we learn from what happened
over the past year, year and a half, and put appropriate
measures in place to keep patients safe, but also to allow
them to get this kind of excellent access to health care.
So, that's a big wildcard.
Dr. Halena Gazelka: Yeah, that's exciting. Steve can our patients
when they are requesting visits, request that they have a
telehealth visit, instead of an in-person visit? How does that
work?
Dr. Steve Ommen: Yes, they can definitely do that. And many of
our clinical teams, appointment coordinators will actually ask
the patients that, but patients can certainly volunteer it
themselves. There might be cases where a patient asks for a
telehealth visit, and it's not appropriate for that particular
case, as we talked about, but certainly patients, if they want
to do it that way should be asking for it, because we want
to make it available for them.
Dr. Halena Gazelka: Yeah, that's wonderful. Anything else you'd
like to share with us today?
Dr. Steve Ommen: Oh, goodness, I think that again, this has been
an incredible year, in many ways negative, but there are a few
things coming out of it that we will see the way you and I
deliver care to our patients will be different. And I think
it's going to be to the benefit of patients that they will get
care without having to stop their lives. You think about
patients that are in school, or they are a single parent
household, or they're a single person living in a house who has
to stop their lives in the traditional way to get
medication, to go in for testing, to go in for the
doctor's visit. And now they're going to be able to get that
care without having to stop their life for so long. And
that's got payoff in the long run for our patients.
Dr. Halena Gazelka: Yes, and often stopping the life of
someone else too who may be serves as the driver or coming
to help with the kids.
Dr. Steve Ommen: Exactly.
Dr. Halena Gazelka: Yeah, that's really amazing. Well, how
wonderful. Thanks for being here. Steve.
Dr. Steve Ommen: Thank you so much.
Dr. Halena Gazelka: Our thanks to Dr. Steve Ommen, from the
Mayo Clinic, for being here to discuss telehealth options with
us today. I hope that you learned something. I know that
I did. We wish each of you a very wonderful day.
Narrator: Mayo Clinic Q&A is a production of the Mayo Clinic
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