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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.

Under the Hood: Developing and Maintaining Clinical Content for Virtual Care

One of the big compliments we receive from customers is around the strength of our proprietary clinical content that forms the foundation of our virtual care platform. This means a lot to our team. As individuals and as an organization, we maintain a rigorous focus on clinical quality, and that comes through in our algorithms and clinical protocols.

What you don’t necessarily get to see is the amount of work and expertise that goes into developing, maintaining and improving our clinical content. We have a full team of clinicians and informatics specialists devoted exclusively to creating and maintaining our protocols and clinical content – and their contribution to the Zipnosis platform is worth talking about.

Starting off with Clinical Content Development

When we launched the Zipnosis platform, we knew that the only way the technology would work is if it was backed by unassailable clinical content. Remember, this was 2008, and nothing like the Zipnosis platform had been available before. Store-and-forward virtual care was still considered the providence of provider-to-provider care, specifically in imaging for radiology, dermatology, pathology, etc. It definitely wasn’t considered a means for collecting patient-generated symptom and health history information for diagnosis and treatment of common, low-acuity conditions.

Our original clinical content was something truly brand new in the outpatient healthcare space. We started with an enormous quantity of clinical guidelines for in-person care and painstakingly translated them into a few targeted protocols for virtual care.

From those humble beginnings, we expanded our protocol library to support diagnosing and treating more than 90 conditions. Each one required not only research into the standard of care, but a reframing of what care delivery for that particular patient complaint means without lowering the standard.

Clinical Content: Care and Feeding

Considering the extensive amount of work that goes into developing clinical protocols, you may be surprised to learn that protocol maintenance and improvement is where our clinical content team truly shines. The truth is, once a protocol is built, that’s not the end of the work it requires. Like a pet, clinical content supporting virtual care requires constant care and feeding.

At Zipnosis we have a rigorous maintenance process that includes annual content reviews, during which our content team delves into the latest research to ensure that our protocols meet the standard of care and can offer the same or greater guideline adherence as in-person care.

We also closely monitor alerts and updates from the CDC, departments of health, and the FDA to ensure that the treatment recommendations are in line with the latest guidelines. These alerts don’t always align with our protocol review schedule, so we also update protocols on an ad hoc basis when guidelines change.

Clinical Content Beyond the Standard of Care

Our clinical content is the foundation on which the entire Zipnosis platform rests. That means its importance to the quality of care providers deliver through Zipnosis is critical, but it also means that clinical content has a major impact on patient experience.

We dig into how protocols are utilized by patients and consult with our customers to identify opportunities for enhancing our content. This is a more intensive process than our annual clinical reviews, looking at how patients experience the content.

    • Is the language clear, conversational and understandable?
    • Are we effectively conveying empathy?
    • How many questions do patients have to answer at maximum and minimum? Can we reduce the number of questions?
    • Where are patients being referred out of the online system and into our customers’ brick-and-mortar clinics?
  • Do the patient education information and questions match health literacy targets?

A full protocol enhancement project takes 10 weeks, and involves the clinical content team as well as people throughout Zipnosis – and even our customers. We perform a deep dive into how patients are interacting with the content, and make modifications – sometimes minor tweaks, sometimes major overhauls – to ensure patients are having a positive experience. And, through it all, we maintain that laser focus on the standard of care.

What’s Next for Zipnosis Content

As we expand the platform into new areas like surgical care and behavioral health, our clinical team just keeps blazing new trails. And, with our Clinical Quality Advisory Council’s assistance and input, our team is even better able to monitor and report on adherence to clinical guidelines. Keep your eyes peeled – there’s always more on the horizon.

Transforming Care in the Digital Age

Zipnosis Chief Clinical Officer Kevin Smith’s most recent article for Health IT Outcomes discusses how virtual care can make an impact on care quality. Responding to a study published in JAMA Ophthalmology, he notes that virtual care can help more effectively capture patient-reported symptom information and ensure EHR records are accurate. Read more.

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.

 

Do You Have to Sacrifice Clinical Quality for Convenience?

People are busy these days. And making a trip to the doctor either eats into working hours or free time. That’s why patients are demanding alternatives to the ways they access care.

This demand has forced health systems to take a leap of faith and offer telemedicine services. Some of which are based on outsourced clinical support. But can health systems depend on outsourced telemedicine vendors to provide quality care that adheres to national best practices? Can patients be certain the diagnoses and treatments they receive are accurate and clinically adherent?

JAMA Study Finds Guideline Adherence in Live Video Visits Spotty

Capturing quality metrics for the telemedicine space has been tricky. But researchers at the University of California at San Francisco decided to try anyway. They evaluated the care provided by eight telemedicine vendors against national best practices. It should be noted that Zipnosis was not part of the study.

Results of this 2-year study were published in the May edition of JAMA Internal Medicine, and were not encouraging. Over the 599 virtual visits studied, adherence to national best practice protocols for care ranged from 34.4 to 66.1 percent. The variation range increased for treatment of viral pharyngitis and acute rhinosinusitis (sinusitis), with clinicians adhering to guidelines anywhere from 12.8 percent to 82.1 percent of the time.

So, what did all eight of the companies evaluated have in common? All were direct-to-consumer telemedicine providers that exclusively use synchronous – or live – video technology, apparently lacking the use of effective clinical decision support tools to ensure guideline adherence, to treat patients.

Convenience without Compromise

While the results of this study don’t bode well for outsourced and direct-to-consumer telemedicine vendors that rely primarily on video, high quality virtual care is within reach. An internal review of more than 1,700 asynchronous patient encounters through two major health systems for treatment of acute sinusitis on the Zipnosis platform had contrasting results to the JAMA study – a guideline adherence rate of 95 percent.

The backbone of this success is the adaptive online interview embedded within the Zipnosis platform, which guides patients through a structured interview grounded in evidence-based national best practices. Once the interview is complete, clinicians receive a comprehensive clinical note and are then guided through curated diagnosis and treatment options based on patient inputs – the final diagnosis is issued by a local provider, not an outsourced clinician.

The whole process leaves little room for error; harried clinicians won’t miss a question and organically designed clinical decision support means patients get the right care quickly and consistently. Best of all, since Zipnosis’ partners use their own clinicians, they can directly monitor and improve clinical quality without the hassle of working through a 3rd party clinical team.

Patients are demanding more convenient access to healthcare. The data is clear: Traditional, direct-to-consumer, outsourced telemedicine services that address patient convenience face challenges in the area of clinical quality. In the absence of a better alternative, this would be fine. But it is time to stop compromising and expect virtual care to improve access and quality at the same time. At least, that’s what we believe and are proving here at Zipnosis.  

Maintaining Quality in Healthcare Continuum

Imagine having the equivalent of a clinic in your pocket without the concern that the quality of care would be less than you want or deserve. When done well, virtual care can improve access, decrease cost, and save time without sacrificing quality and continuity of care.

As the market becomes crowded with organizations offering various iterations of telemedicine, healthcare organizations must consider several key factors to determine whether a particular offering is right for the organization. For instance, will clinicians within your network field the inquiries of your patients or will they be handled by clinicians outside the network? Another key factor is whether you will have the ability to integrate information about a patient’s visit into your electronic health records (EHR) system – a key element for providers who strive to utilize all information about a patient in their encounters.

Through its virtual care solution, Zipnosis patients receive treatment for minor medical conditions quickly and safely from healthcare providers within their own network. Patients are treated using its pioneering software-guided online interview that mimics the questions physicians would ask in a clinic. An in-network clinician reviews the interview and either offers a treatment protocol, triages the patient into a phone or video encounter or directs them to visit a clinic.

The entire process is grounded in evidence-based medicine and complies with national best-practice guidelines. If at any point the patient provides information indicating a serious illness, Zipnosis will determine that virtual care is not appropriate and direct the patient to the most appropriate level of care. For example, if a patient believes she/he has a sinus infection and also indicates a fever of 103, the Zipnosis platform will stop the virtual visit and recommend an appropriate in-person site, such as the health system’s urgent care clinic.

With its white-labeled, fully integrated virtual care platform, Zipnosis also offers the technology that will enable you to seamlessly integrate patient visits into your EHR.

Virtual care, if designed to fit not only into the slipstream of your patient’s life, but also into the continuum of care your organization strives to provide, can make clinical care more convenient while maintaining quality – one patient at a time.

Resources

Calculator: Patient Acquisition Revenue

  • Offering virtual care can help you add new patients to your health system, where allowed by regulations. Answer a few easy questions and discover your potential revenue impact of patient acquisition through virtual care!
  • Enter a number between 1 and 100 - no % necessary. Independent research indicates a 25% conversion rate of virtual care users to health system patients.
  • Logic

    Back End Calculations

Case Study: Bryan Health Meets Demand for Virtual Care Without Sacrificing Quality

Click here to view the case study!

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Report: 2018 On-Demand Virtual Care Benchmark Survey Report

2018 On-Demand Virtual Care Benchmark Survey Report

Virtual care is increasingly critical in healthcare delivery, and numerous surveys and studies have been done evaluating everything from effectiveness to patient readiness to provider adoption. This body of research is lacking in one crucial area: how health systems are deploying and using virtual care. The 2018 On-Demand Virtual Care Benchmark survey is our attempt to fill that gap.

The results of this report are organized into three key categories: virtual care operations, technology and clinical.

Virtual Care Operations

This section explores how virtual care is set up and supported in healthcare organizations.

Topics include: Patient populations and utilization, strategy and operational responsibility, budget and finance, goals and challenges, and future plans.

Technology

This section looks at the technology used for on-demand virtual care, as well as how virtual care fits into the digital health landscape.

Topics include: Modalities, integration, other telehealth solutions in place, other patient-facing technologies in use.

Clinical

This section delves into clinical uses and outcomes from on-demand virtual care programs.

Topics include: Staffing and efficiency, conditions treated, and clinical quality.

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eBook: Shopping the System – Consumers Find Value in Virtual Care

Shopping the System: Consumers Find Value in Virtual Care

The shift from passive customers to savvy healthcare consumers has been predicted for years, but traditional brick-and-mortar care providers have remained relatively immune. Not anymore. Shifts in the market and advances in technology, among other factors, have given patients the incentives, tools and options to make different decisions about how they receive care.

Qualities Consumers Value

  • Price
  • Convenience
  • Service
  • Quality

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