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JeffConnect: Leading the Way in Telehealth

01/18/19

More than 75,000 patients tap into Jefferson’s cutting-edge virtual platform. Here’s why.

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Judd Hollander, MD, senior vice president of Healthcare Delivery Innovation at Thomas Jefferson University and associate dean for Strategic Health Initiatives at SKMC, is famously blunt about the innovative JeffConnect Telemedicine Program he oversees. “Telehealth isn’t a gimmick. And it’s not about the technology,” he said during a recent interview. “I really don’t even want to call it telehealth. It’s just healthcare, the way our patients want it.”

By any name, JeffConnect is attracting attention. Since its 2015 launch, more than 75,000 patients have called in for video medical visits, “and the numbers are growing exponentially,” says Hollander. Meanwhile, JeffConnect’s pioneering projects have won national recognition, including the 2018 Breaking Barriers Award from the Mid-Atlantic Telehealth Resource Center and the 2017 Life Sciences Pennsylvania Patient Impact Award. JeffConnect frequently is in the spotlight at national and international conferences on healthcare information technology—including the Healthcare Information and Management Systems Society’s upcoming 2019 conference.

What’s the buzz all about? Here are four ways JeffConnect is making headlines as it keeps patients healthier.

Urgent Care from Anywhere…Including in the Emergency Room

JeffConnect’s On-Demand Video Visits give residents of the Philadelphia region 24/7 access to Jefferson-affiliated emergency medicine physicians—for a $49 fee that’s often less expensive than a trip to an urgent care center or emergency room.

The 10-minute video visits cover everything from colds and flu to fevers, sprains, headaches, and beyond. “At least 85 percent of the time, people’s concerns can be managed via video visit. We offer an objective perspective on what they should do next. We help patients by reassuring them, diagnosing them, helping to navigate the healthcare system, and by suggesting a treatment course.” says emergency physician and Associate Dean of Healthcare Delivery Brendan Carr. “The most common question we answer—framed in a thousand different ways—is ‘Should I be worried?’ We’ve worked hard to build barriers between patients and providers and this is the pendulum swing back—putting doctors on the front line to take care of patients.”

One JeffConnect innovation: The service is always staffed by a Jefferson physician. “Some services use out-of-network doctors after hours, who may not know the area or the health system,” Hollander says. “Our doctors can help you set up a follow-up with your primary care doctor, order a test, and make sure a record of the visit is in your electronic medical record.”

Another innovation: For medical issues that are not life-threatening, patients who arrive at the emergency departments of Thomas Jefferson University Hospital in Center City and Jefferson Methodist Hospital on South Broad Street begin their ER visit via telehealth—right in the waiting area. The service began in October 2017 and is one of just a few in the United States.

“People sit at a terminal and have a video consultation with an emergency physician immediately,” Hollander says. “Their visit begins right away. Tests and treatments can be ordered and ready for when they are seen in person. I think patients feel reassured instead of just sitting in the waiting area and worrying. And the emergency department has the information they need for triaging the most urgent cases.”

Timesaving Virtual Follow-Up Appointments with Specialists

When Jefferson launched Scheduled Video Visits for follow-up appointments with its health-system specialists in 2015, it immediately became the largest specialist telehealth system in the Northeast, according to Stephen K. Klasko, MD, MBA, CEO of Jefferson Health. And it’s only gotten bigger since then, Hollander says. Today, every health-system specialty—ranging from general surgery, otolaryngology, urology, and dermatology to neurology, internal medicine, family medicine, medical oncology, and obstetrics and gynecology—offers the service. How it works: Patients who’ve seen their doctor at least once can schedule a virtual return visit, which takes place using the JeffConnect mobile app on a smartphone or tablet or with a computer with a video camera.

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Doctors are noticing a surprising benefit. “Patients are more relaxed and remember things better,” Katherine Sherif, MD, director of Women’s Primary Care and vice chair of the university’s Department of Medicine, notes in a 2018 American Hospital Association Health Forum case study spotlighting this JeffConnect service. “They may just be more comfortable in their surroundings.” The visits cover the same content as an in-person appointment, such as reviews of lab tests, current health, and adherence to treatments. “But the patient doesn’t have to spend two hours driving to and from Center City Philadelphia, pay $29 for parking, and wait in a waiting room,” Sherif notes.

In a recent Jefferson study of 3,018 video follow-up visits from 2015 and 2016, published in the Journal of Medical Internet Research Medical Informatics, Rhea E. Powell, MD, MPH, and a team of Jefferson researchers found that 91 percent of patients were satisfied with their virtual visits. Eighty-three percent said the telehealth appointment was on par with an in-person visit, and 41 percent said they saved three or more hours of travel and waiting time thanks to telehealth. More than half would recommend it to others, too.

Virtual Rounds for Far-Flung Family Members

Linked via videoconferencing software that works like logging in for a webinar, far-flung relatives of Jefferson inpatients can be present—virtually—at their loved one’s bedside with healthcare teams during daily rounds.

“The largest number of family members we have engaged is four at once, all from different states, including relatives as far away as Hawaii, California, and Texas,” Hollander says. It’s one of the few—perhaps the only—virtual rounds services at a U.S. hospital, he adds.

Not every patient makes use of the service. “Telehealth is just another way to access healthcare, not the only way,” Hollander says. In a 2016 study of 218 oncology patients offered virtual rounds at Jefferson, Kristin L. Rising, MD, MS, assistant professor, Department of Emergency Medicine and the National Academic Center for Telehealth, and her team found that about half were interested. Some patients said they didn’t need the service (presumably because family members could visit in person), and about 10 percent of families lacked the equipment at home to participate. But half of those who did give it a try asked for a second virtual round.

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Families and patients find comfort and empowerment through the service, noted Vanessa Christopher, MD ’18, now a first-year resident in otolaryngology at Jefferson, in a 2016 article about virtual rounds in the journal Healthcare Transformation.

Christopher volunteered with the virtual rounds program during medical school and wrote about the experience. One of its benefits? “Patients’ family and friends…have a direct line of communication with the care team, receiving the most up-to-date medical information directly from the most reliable source,” instead of using a telephone chain to pass along information, she noted. For one woman undergoing cancer treatment and her husband, daily virtual rounds kept their son and daughter informed—and the routine seemed to provide “some form of peace and consistency amid daily chaos,” Christopher added.

Telehealth Training and Research

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Providing virtual healthcare is both an art and a science, and Jefferson’s National Academic Center for Telehealth (NACT) is one of the few centers in the United States to train healthcare practitioners, research best practices, and even pioneer a new allied health specialty in telehealth: the telehealth facilitator. “We now include telehealth training for medical students and residents and offer a fellowship that has brought doctors out of retirement, at mid-career, and just starting their practice in for training,” Hollander says. “While telehealth is simply healthcare, it’s also unique. Providers have to be aware of making eye contact, learn how to perform exams when they cannot physically touch a patient, and know what to do or who to call if the connection gets cut off during the visit.”

Meanwhile, over 100 people have undergone training at the center to receive certificates as telehealth facilitators. “These are nurses, administrators, and people just getting started in healthcare careers,” Hollander says. “You need people in hospitals and practices who know how telehealth works.”

The center is also pioneering research to learn what works best in clinical telehealth. “We can’t assume that something that sounds like a great idea is really going to work well for patients,” Hollander says. “We want to know what our patients really want—and what we’ve learned really surprises us sometimes. For example, we’ve learned that men often prefer virtual visits after a vasectomy and women often prefer a virtual visit after a mastectomy or breast surgery. Some people feel more comfortable being in the privacy of their own home, instead of sitting in a cold room in a hospital gown, with staff bustling in and out. We’ve also learned that some people prefer receiving difficult news, such as a cancer diagnosis, in a virtual visit instead of in person. They can be at home with their family members—and not face a harrowing drive home, too. That’s not something we would have predicted. We are always learning from our patients. That’s what it’s all about.”

Telehealth in a Disaster

Connecting with a doctor during a hurricane or other natural disaster can bring peace of mind, help you refill an important prescription, or even save your life. But as Brendan Carr, MD, associate dean of Healthcare Delivery Innovation at Jefferson, outlined in a recent article in the Journal of the American Medical Association, there are still many barriers to widespread use of telehealth in disaster preparedness in the United States.

“Telemedicine can provide important services during and after a disaster,” says Carr, who co-authored the opinion piece with Nicole Lurie, MD, of Massachusetts General Hospital in Boston. “Most of what people need in a time like that can be provided by telemedicine—such as help managing a chronic disease, getting medications refilled or replaced, and advice about getting treatment for superficial injuries and infections. Right now physicians volunteer through the National Disaster Medical System to go in person to disaster areas. And we need that. But many more would help out if they could volunteer eight or ten or 12 hours a week on a phone line during a disaster.”

What’s standing in the way? “Insurance companies don’t fully reimburse yet for telehealth,” says Carr, who is also director of the U.S. Department of Health and Human Services Emergency Care Coordination Center. “The federal government doesn’t have virtual teams and telehealth infrastructure ready in advance of a disaster. But it will happen in the future.”

Pediatrician Beth Shortridge, MD ’88 Res, ’90 Fel, a pediatric hospitalist with Jefferson-affiliated Nemours/Alfred I. duPont Hospital for Children, provided telehealth care for Florida families through Nemours CareConnect during Hurricane Irma in 2017.

“One family with a 4-year-old having her first asthma attack reached out via telehealth video conferencing. They had no power, so they used battery-powered smartphones and flashlights so I could examine their daughter via my computer screen. Orlando was under a curfew, but we arranged a police escort to the ER,” recalls Shortridge, a volunteer clinical assistant professor in Pediatrics at SKMC.

Shortridge emphasizes that telemedicine eliminates geographical barriers so she can diagnose patients who are hundreds of miles away, and even review some patients’ electronic medical records online and connect with their caregivers. The powerful technology helps her provide lifesaving assistance when a family emergency occurs in the midst of a regional one.

“Another mother was about to evacuate to Georgia because her young infant had developed a fever. Her subspecialist management plan included in-person testing to prevent the baby from getting kidney damage; however, I was able to consult with her Nemours urologist to work out a plan with antibiotics the mother had on hand. Everyone was OK.”