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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.

Our Take: Net Neutrality, Virtual Care, and the Deregulation Demolition Derby

HTML Code: Photo by Markus Spiske on Unsplash

Photo by Markus Spiske on Unsplash

In a 3-2 vote December 14th, the FCC decided to overturn its rules around net neutrality. But, what does this deregulation mean for virtual care?

While no one can truly know the future, some very real concerns have been raised about the impact of internet deregulation on virtual care. As an industry, healthcare relies on the internet to support numerous technologies and services. Particularly when it comes to virtual care, maintaining a basic level of access is critical.

The intent of net neutrality regulations were to help ensure a level playing field for internet users (we call them patients) and businesses and other organizations by banning paid prioritization. That means internet service providers aren’t able to modulate speeds based on the destination. FCC Chair Ajit Pai has stated that eliminating this ban will enable the ability to prioritize healthcare services, though others responded that the regulations allowed for internet “fast lanes” for healthcare and other critical services.

Many thought leaders, however, believe that the repeal of net neutrality has a high likelihood of diminishing access to online care delivery and actively harming small practices. Hematology and oncology publication Healio noted specifically that individual providers and those in rural areas are vulnerable in a tiered pricing system. A pre-overturn piece in Modern Healthcare also noted that, “Prohibitively high Internet costs could exacerbate health disparities between high- and low-income people and between people in urban and rural areas.”

Deregulation’s Impact

I’m less concerned about the impact of deregulation on the internet service provider (ISP) industry than I am about the downstream effects. Healthcare has traditionally been local, with the patient-provider relationship at the heart of care delivery. The regulatory environment already poses challenges to health systems and providers, and healthcare systems throughout the U.S. are facing well-documented financial challenges. This deregulation adds a further layer of complexity and potentially cost for providers and health systems already facing unprecedented challenges.Photo by Deva Darshan on Unsplash

Eliminating the ban on paid prioritization and moving to a tiered pricing system has the potential to unleash a “demolition derby” effect. Smaller organizations like rural providers and critical access hospitals with fewer resources may find themselves crushed and pushed aside. Non-profit health systems which are on increasingly tight operating budgets and are facing a negative outlook for 2018 according to Moody’s, may need to route limited resources away from clinical services and into purchasing connection speeds. Industry monster trucks could end up with free reign to roll over the competition.

Managing Risk in the Demolition Derby

Where telemedicine stands to lose the most is in the modalities that truly require bandwidth like video-based care delivery. And this is important because, as much as I may have railed against the over-reliance on video in the past, it is an important modality for certain patients and use cases. It’s vital that video-based care be able to flourish, along with other bandwidth intensive telehealth needs such as diagnostic imaging.

While a knee-jerk reaction is never a good idea, as citizens and members of the digital health community, it’s important that we monitor how this repeal impacts patient access to care and the ability for all providers and healthcare organizations to deliver care online. Chairman Pai believes that eliminating net neutrality restrictions will improve access to online care for patients. While I’m not fully convinced, I am adopting a hopeful attitude. Organizations like the American Telemedicine Association are closely watching and ready to mobilize if patient access is threatened.

In the interim, providers and healthcare organizations can mitigate their exposure posed by the repeal of net neutrality regulations by leveraging technologies that require lower bandwidth to provide online care. Store-and-forward technology, like our online adaptive interview, provides access to care that doesn’t require the same bandwidth as face-to-face video visits, while maintaining a high standard of care. In fact, it was the use of mobile phones in rural Africa, over super thin bandwidth cell networks, that inspired me to start Zipnosis. One of my maxims is that constraints are where innovation occurs. With new regulation comes new constraints and also new innovations to maximize our potential for better access to healthcare.

What the Net Neutrality Repeal Won’t Do

We don’t have a clear picture of precisely what this deregulation will do, but the one thing it won’t do is slow the adoption of online care. Offering a virtual care solution, tiered bandwidth or no, is going to be critical to the success of health systems and providers going forward.  As such, we need to do our best to manage risk, support care delivery online, and work together as an industry to help ensure that providers and patients are in the driver’s seat.