With the first few U.S. deaths from coronavirus just emerging, and people beginning to reconsider participation in large gatherings and international travel, FedHealthIT’s President, Susan Sharer, took a moment to sit down with Amwell’s Chief Medical Officer, Dr. Peter Antall, and its Group Vice President, W.B. “Mitch” Mitchell to discuss what we might expect in the coming weeks and months, telehealth and data as a tool, and Government’s response.
Telehealth as a Critical Facet of a Multifaceted Response
As an industry, we need to be ready, says Antall, ready to ramp up and to contribute in a positive way to a public health response. One of the value propositions of telehealth is around caring for the patient where they are, on their own devices. That is an opportunity to bring care to patients, to help them remain in their homes or participate in social distancing if they wish. The goal is not to incite panic but, because there is a risk in hospital or clinic waiting rooms with the confirmation of person to person spread, where we can use that opportunity to keep potentially infected patients away from healthy ones, there should be an awareness that this is an option.
What is the Role of Government in Cases of Pandemics?
Mitchell says over the last few weeks Amwell has noted a significant level of engagement by various departments in Government including CDC and ASPR, in open forum meetings and discussions seeking input from the industry on roles technology can play help mitigate the risks of a surge on US Healthcare critical infrastructure.
“Within our own commercial customers we are seeing them leveraging the technology and infrastructure they have developed and invested in, including making telehealth part of their culture so that if and when a surge occurs, they have already responded by embedding the needed tools into their work flows and processes.
“Being on the front line of care in the digital space, we are serving as a force multiplier in the messaging CDC is delivering,” says Antall. “We are on their site multiple times a day, and on conference calls multiple times a day incorporating their guidance and evolving insights in our own clinical protocols. We maintain an extensive ecosystem of employers, health systems, and payers and we are coordinating with all of them on ways to work together to raise awareness of opportunities to collaborate and support one another, improve access for health plan members and find ways employers can initiate response plans at the HR level.”
“There is a unique opportunity for Government,” says Mitchell. Thinking of the volume and level of engagement providers are having in the digital space with those who are well but worried, or for those who may be symptomatic, thousands of hospitals with telehealth platforms, and millions of patients with access to telehealth provide insights to identify sentinel events, to identify potential outbreaks, and to share with Government to inform evolving response strategies.
“Thinking beyond the current situation, there is also an opportunity to think about video technology, as a means to provide work or school from home options. From a data perspective, this is a valuable learning opportunity,” says Antall.
How is the Current Environment Different from Prior Events?
Antall says it is historically useful to look at 2009 and H1N1 which, between April when it really emerged through the end of November, resulted in 49M cases in the US, and, reaching from one natural flu season to the next, resulted in 15-18 months of constant threat. “There is no way to anticipate how many cases we’ll end up with but by looking back at that event, we do have a way to understand what could happen.”
He says with SARS, which was a similar corona virus from the same region of the world, good public health measures decreased the reproductive rate, causing it to burn out relatively quickly despite the initial panic. “We don’t want panic and we don’t want fear, but we do want to spread preparedness. We must have a healthy respect for new emerging viruses. By the same token we need to have respect for our health system and the measures being put into place.”
What Can we Expect in the Coming Weeks and How Can Technology Help?
Mitchell expects to see leadership within Government, and those local health departments that are boots on the ground recognizing the benefit of keeping those who are well out of infection prone settings and where available, to engage technology and telehealth as appropriate.
“We also recognize the need to protect our healers, to ensure they are able to continue their mission. Institutions are looking at supply chains for masks, gloves, gowns and so on to ensure personal protective items are available. We need to look at ensuring we maintain necessary supply of clinical resources to care fore and treat those directly impacted by this virus”
He says there is recognition that healers will inevitably become infected and so some energy must be put into way we can leverage technology to enable those providers to remain productive if quarantined but not symptomatic or incapacitated, to keep medical forces able to engage in triage and treatment.
Antall points to recent events in South Korea where an active US Service Member tested positive for COVID-19 as instructive and eye opening for the military who must consider the infectious risk of confinement on bases and close contact, as well as factoring in their worldwide presence. We cannot allow this to affect our military readiness or adversely impact our medical force to delivery care in garrison or in the field.
“Where we’re going? We’re seeing some level of fear and there will surely be an increase in telehealth visits for patients who think they may be at risk, by patients who may have normally come to a brick and mortar facility. There will also likely be an increase in the use of telehealth by providers who want to mitigate exposure to staff and other patients.”
He says incidents in Italy and Iran have highlighted what could happen in the US as a worst case, with the disease popping up in urban centers. “We expect the recommendations from CDC will have to evolve. We are at a point now where screening for exposure to someone with the virus who traveled to China will not suffice as sufficient criteria. As more suspected cases arise, CDC may also need to change testing protocol to include only those patients that are clinically very sick and patients with mild symptoms may be asked to recover at home.”
Things to Think About
There are a lot of upcoming conferences and events and whether people attend or not will depend a lot on what happens between now and the event date. People are already being more selective about travel, are opting to work from home a bit more. As this evolves, people will be more and more thoughtful about what they are doing and why.
For those of us in the Federal Healthcare space, this shines a light on why the work we do is important and reinforces the understanding that what we do matters, that we have an impact and can continue to have an impact when it really can make a difference.
About W.B. “Mitch” Mitchell
W.B. “Mitch” Mitchell is Group Vice President, Government Solutions with Amwell. Mitch is a senior strategy and management professional with over 25 years passionately building businesses in Healthcare and Information Technology. He combines expertise in Military and Veteran’s Health, Federal Health Programs, Patient Engagement and Clinical eHealth Strategy Development. Before joining Amwell, Mitch led Government Solutions for Ciox Health and for 15 years prior, he led teams across McKesson/RelayHealth and Change Healthcare, supporting complex commercial and Federal Health IT, Health Information Exchange and Patient Engagement programs.
About Peter Antall
Dr. Peter Antall is the Chief Medical Officer at Amwell, where he is responsible for clinical direction of the platform, as well as guidance and training for all Amwell’s clients. He is also the founder and President of the Amwell Medical Group, the nation’s first national telehealth medical group, where he manages over 700 clinicians in a variety of disciplines, providing telehealth services in all 50 states. Dr. Antall has developed innovative programs to measure and ensure quality in telehealth, developed a national telehealth credentialing program, and has played an active role in national efforts to modernize telehealth laws and regulations. Dr. Antall has a track record of disruptive innovation in the areas of care delivery, medical management, business development, technology and telehealth. He has built and managed medical practices, founded a hospitalist company, written software for mobile apps and for phone-based triage, and has been actively building telehealth programs since 2009.