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Healthcare’s STD Infection Crisis – How Virtual Care Can Help

Last week, the Centers for Disease Control and Prevention announced that rates of chlamydia, gonorrhea and syphilis in the U.S. climbed for the fifth year in a row. The newly released data prompted a call for federal intervention at the 2018 STD Prevention Conference. This begs the question, how did we get here? And more importantly, what can we do about it?

STD Infection by the Numbers

In 2015, the American Sexual Health Association noted that rates of chlamydia, gonorrhea and syphilis reached a record high. And they’ve kept growing from there.

Preliminary CDC data from 2017 shows a 31% growth rate in diagnoses of these three common STDs since 2013. Individually, diagnosed cases of gonorrhea increased 67% and syphilis 76%. Chlamydia didn’t see quite the same rate of increase, but it remains the most common of these conditions with more than 1.7 million diagnosed cases in 2017.

Candy Hadsall, RN, MA, a prevention nurse specialist with the Minnesota Department of Health was at the conference and noted that the data wasn’t particularly surprising. “The CDC’s announcement that STD infection rates climbed again in 2017 just confirmed what we’re seeing in the field,” she said.

These numbers present a concerning – and initially, more than a little baffling – trend. After all, each of these infections is curable with appropriate antibiotic intervention, and the long-term effects of going untreated can be serious. So, why are infection rates continuing to grow?

The Root of the Problem

The factors influencing the increase in infections are complex and varied. A 2007 study in Sexually Transmitted Infections found an abundance of socio-demographic influences on infection rates, including race, income, gender, state of residence, age and history of incarceration. It also notes that attitudes toward sexual behavior and STD testing are prime factors in the diseases’ spread.

In the CDC’s recent announcement, Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention noted, “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

At its core, the STD infection crisis is driven by this combination of attitudinal, demographic, economic and healthcare infrastructure influences.

Virtual Care’s Role in Fighting STD Infection

One of the best ways to stem the tide of STD infection is by reducing access barriers to testing and treatment, and here is where virtual care shows its value. The ways that virtual care can help patients overcome common barriers to care like geography, time and cost is well-documented. When it comes to sensitive issues like sexually transmitted diseases, virtual care can help mitigate emotional barriers, as well.

In an interview with MedCity News, Geri Lynn Baumblatt (then of Emmi Solutions from Wolters Kluwer Health) noted that patients tend to “engage in impression management” when seeing their doctor. What that means is, they try to paint themselves in the best possible light – consciously or unconsciously – in an attempt to avoid judgement and shame. While Baumblatt was speaking specifically about addiction concerns, this concept translates to sexual behavior. A solution that doesn’t require a face-to-face discussion can often produce more honest answers about sexual behavior and STD risk.

Hadsall concurs that the feeling of anonymity could help patients overcome the shame and stigma associated with STD infection. She also notes that adequate resources are a challenge in STD screening. “It’s just not possible to effectively screen everyone who should be screened,” she said. “Even at very high infectivity rates of 10-15%, that’s still 85-90 out of 100 people who are screened and test negative. With an online screening option, we could do a lot more and potentially make a real dent in STD infections.”

A Virtual Solution

Image: Stop STD Infection

Understanding the value of lowering barriers to STD testing and treatment, we developed evidence based protocols to support health systems as they work to manage steeply climbing STD rates for their patient populations. Our expedited partner therapy protocol enables patients whose partner has been diagnosed with chlamydia to get treatment. As the most commonly diagnosed STD across the country, and the one that is most frequently asymptomatic, this facilitates quick, discreet care for patients – without even requiring a test. By lowering barriers to receiving care for known chlamydia exposure, health systems can help reduce the continued spread of chlamydia.

We also recently created an evidence-based virtual care STD testing protocol that gathers risk assessment data and enables patients to access lab tests for chlamydia, gonorrhea and syphilis. This protocol leverages lab integration workflows to capture patient information and seamlessly route them to a lab location for testing. Our aim is to help health systems use the asynchronous patient interview to overcome the embarrassment patients feel talking about STDs, potentially increasing the likelihood of individuals to seek testing.

The continued rise of STD infections is a complex issue, impacted by everything from socio-cultural norms to poverty rates and education to healthcare access. It may feel overwhelming, but looking at individual pieces can still make a sizable impact. There are many factors virtual care can’t impact. What we can do is help take the strain off of the systems currently unable to manage this growing health crisis and lowering barriers to STD testing and treatment.

Virtual Care Puts Consistency and Quality Back in Healthcare

Over the past decade or so, the U.S. healthcare system has transitioned from paper-based documentation of patient records to the use of electronic health records (EHRs). One might assume that computerized health records and systems would result in dramatically improving the efficiency and quality of care. The outcome isn’t so cut and dry.

While some efficiencies have been achieved with EHRs, a recent survey showed that fewer physicians believe that use of an EHR has facilitated improved treatment decisions (46 percent in 2015 vs. 62 percent in 2012). What about improvements in the quality of care? We know that overuse of antibiotics is a problem of global proportions, resulting in increased antibiotic-resistant organisms making it more difficult to treat certain infections. Another study demonstrated that patients with viral upper respiratory infections (the common cold) receive inappropriate antibiotic prescriptions 65% of the time. And a third study found antibiotic guideline adherence rates for treating sinus infections were just 43%. This is in spite of the many tools in EHRs that are supposed to assist with improving the quality of care. So how can we improve?

That’s where effective clinical decision support – and the Zipnosis platform – come in.

Clinical Decision Support Boosts Care Quality

There are many ways to improve the quality of care. One approach is akin to a pre-flight checklist. When we fly in an airplane, we trust that the pilot is using a checklist to make sure everything on the plane is working properly before take-off. “Engines, check. Wings attached, check.” We would be less comfortable if our pilot relied only on their experience and intuition and skipped the checklist.

In healthcare, the equivalent of a pre-flight checklist is used less often than you would expect, with busy clinicians sometimes relying solely on their experience and intuition, which is often very good. However, a clinical checklist approach includes tools which clearly spell out best practice guidelines based on the current scientific literature. Health professionals do their best to keep up on the latest studies, but no single human can manage to wade through the estimated 2.5 million scientific articles published each year – in the English language alone. However, one form of clinical decision support includes summarizing relevant clinical guidelines and providing the best practices to clinicians at the time they are making treatment decisions.

To ensure that the clinical decision support (CDS) is effective, it is necessary to be able to measure the rates of clinician guideline adherence to determine if care provided followed the established best-practice standards. Studies have shown that when specific CDS features were used, clinical guideline adherence was significantly improved. Overall, internal analysis of visits through the Zipnosis platform, where CDS is incorporated into the diagnosis and treatment process, have shown a guideline adherence rate of 94%. In my doctoral research, implementing clinical decision support, along with other educational interventions, resulted in an increase in guideline adherence of 3.3% for treatment of sinusitis, from 95.2% to 98.4%.

Clinical Decision Support Meets Virtual Care

At Zipnosis, we help providers improve the quality of care they deliver. Our proprietary protocols are grounded in national best practices, and offer built-in CDS.

The process starts with an adaptive patient interview that systematically captures the appropriate patient symptom history by asking the same questions that would be asked in a face-to-face visit – except the software never forgets a question.

This history is then summarized and presented to the clinician, along with curated diagnosis pathways and treatment options enhanced by CDS in the form of clearly summarized guidelines and best practices. This reduces the variability in diagnosis and treatment, which in turn, results in higher rates of guideline adherent diagnosis and treatment.

Health systems can effectively track guideline adherence through the Zipnosis platform, too. Both the patient history and the diagnosis and treatment plan are stored as structured data, allowing for efficient and accurate quality reporting. At any point, our Statnosis™ real-time analytics platform allows clients to easily report on how well clinical providers adhere to the best practice guidelines.

Achieving Adherence with Zipnosis

Let’s look at a real-world example. Remember the not-so-impressive statistic above – inappropriate antibiotic prescriptions for the common cold 65% of the time? In an analysis of over 1,700 virtual care patient visits for upper respiratory infection symptoms from two large health systems, adherence to best practice guidelines was achieved in over 95% of the cases. At Zipnosis, we take the issue of appropriate antibiotic use very seriously. We saw the need to do better, and we did.

High quality care that is safe, effective and adheres to best practice guidelines can and is being be achieved in the virtual care setting. And the outcomes exceed the quality of care the more traditional face-to-face setting represented in the study above.

Providing quality care is vital – as healthcare practitioners, it’s our job. Ideally, there should be no differentiation in quality standards based on the setting (virtual care versus in-person care). The quality of care is good or it is not and Zipnosis helps health systems meet the highest standards of healthcare today. Quality care – check!

About the Author

Kevin Smith, Zipnosis Chief Clinical Officer

Kevin Smith, Chief Clinical Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.

 

5 Unexpected Benefits Integration Brings to Your Virtual Care Service

Offering virtual care is a great way to meet market demand and attract new patients. But to get the most out of your virtual care service, integration with your internal IT systems is a must. Benefits of integration, like enhancing the value of your patient portal and ensuring continuity of care, are just the tip of the iceberg. Choosing a virtual care partner who offers advanced integration with your internal IT systems can bring you some surprising advantages.

1.  Enhance patient experience

Patient experience is a major focus in healthcare these days. Health systems are launching virtual care services in an attempt to improve patient experience, but when the virtual care experience is disconnected from other care delivery systems, this goal is hard to attain. Integrating virtual care with your patient portal and EHR, however, can tie a virtual care offering to patient experience objectives.

    • A CCDA integration with your EHR can help make the online adaptive interview more personalized by accessing information from the patient health record, including medication allergies and health history.
    • Offering single sign-on (SSO) from the patient portal to your virtual care service means patients experience a seamless handoff when moving between these systems

2.  Improve patient retention

The healthcare landscape is becoming more competitive, and patients are making healthcare purchasing decisions differently. This combination means that healthcare consumers are increasingly likely to seek care outside of their primary care provider or medical home. Offering virtual care can help attract and retain these patients, and integrating with your patient portal through SSO can foster closer ties with your health system. Integrating with your appointment scheduling system can help prevent patients from seeking care elsewhere by making scheduling follow-up care or other appointments quick and easy.

3.  Seamlessly transition between virtual and in-person care

Systems integration can help marry the virtual visit with in-clinic services. Integrating your virtual care platform with your patient scheduling system, as well as with systems like labs, can help fit virtual care into the overall care continuum. Pairing virtual visits with in-clinic services can also increase the number of conditions your health system can safely treat through your virtual care platform. Start by pairing virtual visits with in-clinic services such as lab testing or imaging, and grow your virtual care service by incorporating follow-up care or referrals. Our ZipTicket® workflow and integration with lab systems brings the virtual visit and in-clinic services together in a process that saves patients time and adds depth to clients’ virtual care services.

4.  Reduce physician time spent on EHR data entry

Let’s face it, your health system has spent good money on your EHR system. But recent studies show it’s eating into patient interactions and physicians’ personal time, and that EHR-related data entry is a major cause of physician burnout. Effective integration, however, can reduce time spent entering data into the EHR. A standard EHR integration with a store-and-forward virtual care platform like Zipnosis can map information from the virtual visit directly to the EMR, eliminating the need for double documentation. Advanced integrations can take things even further. HL7 and other EHR integration options can create patient records in the EHR, eliminating the need to create a new record when the patient comes in for an office visit. And, by pairing EHR integration with certain patient scheduling integrations, your health system can add an adaptive interview to the front end of an office visit. This provides the clinician with a structured clinical note already added to the EHR, giving them more time to interact with the patient and minimizing the amount of data entry necessary per visit.

5.  Get ready for the future

Moving forward, consumer driven data from wearables and the “internet of things” is going to inform health decisions – both from a patient and provider standpoint. The healthcare industry is poised to see numerous benefits from this transition, according to a recent CIO article. However, flexibility and communication are going to be increasingly important to reaping these benefits, particularly as technology moves forward. Effective integration between virtual care and your IT systems can tighten workflows, improve communication and give your health system the foundation to adapt as your patients further embed technology in their lives.

Put integration to work for you

At Zipnosis, we offer advanced integration options to effectively connect your existing systems with our leading-edge virtual care platform. We interoperate effectively with any EHR, and offer advanced options including:

    • HL7 integration, covering use cases for patient registration, transcriptions, billing, results, and more
    • CCDA integration with your EHR provides a more streamlined workflow and personalized adaptive interview
    • Advanced EHR integrations reduce the need for double documentation, since information is securely transferred from one system to another
    • Single sign-on (SSO) – both patient and provider portal options offer a more seamless experience
    • Integration with your patient scheduling system removes barriers to care and ties patients more closely to your health system
    • ZipTicket effectively provides service continuity between virtual visits and in-clinic services, increasing the number and type of conditions your virtual care platform can address

Want more information on virtual care? Check out our guide to best practices!

Launching Virtual Care: Myth vs. Reality

If you are interested in launching a virtual care service, you are not alone. While market estimates vary, one thing all analysts agree on is that virtual care, also known as telemedicine, is growing rapidly and will continue to do so for the foreseeable future. This growth – past, current and anticipated – has flooded the marketplace with companies that offer telemedicine services, as well as three big myths related to launching a virtual care service.

Myth: You don’t have the clinical capacity to support virtual care.

Reality: You can manage thousands of virtual visits annually with your current staffing.

Outsourcing may initially seem appealing, but with external clinicians serving your patients, you lose control over clinical quality and may experience greater patient leakage. By leveraging marginal capacity through a virtual care platform, you can actually increase the number of patients treatable by your current clinical staff.

Myth: If you build it, patients will come.

Reality: Virtual care is a service, not a technology.

If you build in-house, you’ll have ultimate control. But that comes at a premium cost and with significant time investment. And, you don’t have any guarantees that the tool you build will match patients’ needs and expectations.

Myth: Embedding virtual care in your organization will be too hard.

Reality: Integrating virtual care takes as little as 60 days.

Buying a virtual care platform offers a middle road for cost and control, and the software as a service model makes for a quick launch. By starting small, securing organizational buy-in and scaling appropriately, you can grow your service to meet additional patient needs and maximize clinical efficiency.

Balancing the costs and rewards of your options can be challenging. How is a health system to decide what model of virtual care is best for them?

Start by checking out our ebook To Outsource, to Build or to Buy? for valuable information that will help get you started on the path best suited to your health system.

Can Virtual Care Reverse Clerical Burden Induced Physician Burnout?

The healthcare industry is faced with a crisis: physician burnout. An article in the September/October edition of Family Practice Management labeled physician burnout an “epidemic.” And this epidemic is costing health systems in a major way.

Physicians experiencing burnout are less engaged, leading to higher levels of turnover and an increased likelihood of medical errors – both of which can dramatically affect a health system’s bottom line. Moreover, burnout may lead to increased substance abuse, depression and suicide among medical professionals.

While there is no one single cause of burnout, recent research published in Mayo Clinic Proceedings indicates a correlation between use of EHR/EMR systems and physician burnout. Mirroring findings from a report issued in 2013, this new research indicates that things have not improved over the past several years.

The link between EHR/EMR systems and physician burnout is the amount of time spent on administrative or clerical tasks, such as data entry. The more time physicians are required to spend entering data into their EMR, the lower their job satisfaction and the higher their likelihood of burnout.

Traditional Telemedicine Falls Short

Traditional telemedicine, where physicians interact with patients via telephone or video chat, doesn’t lessen the burden of data entry. Physicians must still spend significant time on documenting the encounter. This type of telemedicine service requires a physician be waiting at a computer terminal for a patient to request a virtual visit. Consequently, physicians supporting telemedicine may be tasked with additional clerical or administrative work to fill the time between patient calls.

Far from lessening administrative burden, this may actually put greater strain on clinicians who support a direct-to-video telemedicine service.

Technology May Still be the Answer

While traditional telemedicine doesn’t offer a solution to physicians’ ever-growing list of administrative tasks, technology applications can still offer some respite. QuantidaMD, a community and educational resource for physicians, suggests that mobile health and virtual care might offer a solution to combat burnout. They indicate that technology can empower patients to take control of their health, as well as offering physicians simple means of capturing patient data.

Mobile health (mHealth) and virtual care have the potential to significantly decrease the amount of data entry required of physicians. In a recent whitepaper on mobile technology, Athena Health noted that mobile devices and apps can help optimize clinical workflows and patient care through clinical decision support, enhancing clinical efficiency, and providing tools for engaging patients and supporting population health.

So, How Does that Work in Practice?

At Zipnosis, we view virtual care technology as a means to meet patient needs while making life easier for physicians. We leverage an online adaptive interview, which asks the same questions a clinician would and records patient responses. Clinicians then receive a comprehensive clinical note, along with clinical decision support in the form of curated diagnosis and treatment options. Physicians can diagnose and prescribe treatment for common conditions with just a few taps on their smartphone or tablet.

The best part? All data from the virtual visit is securely transmitted to the health system for inclusion in the EMR, eliminating the need for physicians to spend their time entering information into an EMR. And, we offer health systems deeper integration options, which can further simplify the process and enhance physician experience.

People don’t seek out a career in medicine because they want to spend hours each day on data entry. Rather, they want to solve problems and help patients. At Zipnosis, our goal is to offer innovative access to mainstream medicine, while easing the burden on providers. We’re gratified to find that our obsessive focus on ease of use has created a platform that can help address this growing cause of physician burnout.

Resources

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Offering Virtual Care to the Marketplace

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