HIStalk’s Dr. Jayne

Telehealth

Telehealth Linked to Physician EHR Burden

Telehealth is great for a lot of things, but reducing physician EHR burdens isn’t one of them, according to a new study in JAMA Internal Medicine. 

Researchers analyzed the EHR metadata of 1,052 ambulatory physicians at UCSF Health over 115 weeks straddling the onset of the pandemic, comparing usage from August 2018 – September 2019 to August 2020 – September 2021.

They found that telehealth use correlated to more time spent in the EHR both during and outside of patient scheduled hours (PSHs), although the extra work was mostly related to documenting visits rather than messaging patients.

• Comparing the pre- and post-pandemic windows, telehealth use increased from 3.1% to 49.3% of all encounters.

• Time spent working in the EHR during PSHs increased from 4.53 to 5.46 hours for every eight PSHs.

• Time spent working in the EHR outside of PSHs increased from 4.29 to 5.34 hours for every eight PSHs.

• Weekly messages received from patients increased from 16.7 to 30.3, and messages sent to patients increased from 13.8 to 29.8. Despite the spike, further analysis showed that documentation added the bulk of the extra time rather than messaging.

The authors give several explanations for why telehealth might be leading to more time in the EHR, including the fact it allows the physician to compose the note throughout the encounter (instead of a shorter burst afterwards).

• That still wouldn’t account for the increase in EHR time outside of PSHs, which the authors believe might be because telehealth improves appointment adherence and reduces the time between visits that was previously used for documentation.

• It could also be that telehealth requires more before-visit EHR review in the absence of a physical examination.

The Takeaway

There’s plenty of research suggesting that telehealth reduces provider burnout, but this study adds a wrinkle to the underlying explanation. These results make it clear that telehealth isn’t reducing EHR time, which points to other benefits like convenience driving lower burnout, such as more flexibility, autonomy, and even engagement with work.

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The Wire

• Amazon Adds One Medical to Prime: One Medical visits are officially an Amazon Prime benefit, at least for members who are willing to put up an extra $9/mo for unlimited telehealth calls and next-day in-person appointments. That’s a decent cut below One Medical’s typical $199/year membership, especially considering Prime members can add additional subscriptions for just $6/mo. Amazon has been putting on a firework show in healthcare this year, with the One Medical news adding to the nationwide rollout of Amazon Clinic and the introduction of RxPass for generic medications.

• Medicaid Disenrollment Tracker: The latest KFF tracker shows that over 10M people have been disenrolled from Medicaid since the unwinding began in April, with total Medicaid enrollment now standing at 18M. Disenrollments range from 65% in Texas to 10% in Illinois, with a majority losing coverage for procedural reasons rather than being deemed ineligible. Of all those who have been disenrolled, 71% lost coverage because they either didn’t complete the necessary forms or their eligibility wasn’t automatically renewed by the state.

• Best Buy and MGB Home Care Partnership: Best Buy notched its third health system partnership centered around spinning up home care programs that can eventually be marketed to other providers, this time with Mass General Brigham. The partnership will start by using Best Buy’s tech (Current Health, Lively Mobile Plus) to scale MGB’s existing hospital-at-home program, then move onto the development of new products that can help the system reach its goal of moving 10% of inpatient care to patients’ homes over the next five years.

• Viome Acquires Naring Health: Viome Life Sciences acquired Naring Health to round out its at-home diagnostics platform with “multi-omics” data, such as that from genomics, epigenomics, and metabolomics. Viome has traditionally relied on RNA to tailor its tests for gut and oral health (our recent Series C coverage has the full rundown), analyzing saliva, blood, and stool samples to make diet recommendations. Naring-subsidiary Foodome sweetens the M&A by enhancing Viome’s ability to understand which bioactive compounds in food link to different diseases.

• Coaching Improves Cardiometabolic Outcomes: Welldoc published real-world study results for 71 type 2 diabetes patients enrolled in a virtual program aimed at improving nutrition and optimizing medications. Participants who engaged with Welldoc’s continuous AI coaching saw their weight fall from an average of 227.8 lbs to 211.8 lbs (average engagement of 256 days). There were also significant improvements in systolic blood pressure and post-meal blood glucose trends, demonstrating how behavioral coaching can be used to reduce overall cardiovascular risk in a high-risk population at scale.

• The GLP-1 Coverage Debate: Ro CEO Zach Reitano added another installment to his excellent series on the downstream impact of GLP1s, this time making the case that delaying coverage will only amplify health inequity. The post lays out how a lack of coverage for GLP-1s is keeping the medications out of the hands of the populations that need them the most, and explores several paths to avoid “the greatest acceleration of health inequity in our lifetime” (competition, government intervention, advocacy).

• Eleos Series B: Eleos Health secured $40M in Series B funding (total raised now $68M) to help more behavioral health providers quantify their sessions with AI voice analysis. The Eleos platform analyzes patient-provider conversations to track changes in commonly used words and log the time clinicians spend listening versus talking, with the Series B earmarked for developing new tools for case management and other back-of-office tasks.

• Long-COVID Prevalence at 14%: Long-COVID numbers have been notoriously difficult to pin down, but a PLOS One survey of nearly half a million Americans gave perhaps the best estimate yet, with 14% of respondents reporting persistent symptoms. The results showed that 47% knew they had gotten COVID at least once, while three-in-ten of that group said that their symptoms lasted over three months (most commonly among those who were unvaccinated, lower income, and less educated).  

• ChatGPT Gets Upgrades: OpenAI announced another round of upgrades for ChatGPT this week, including a new GPT-4 Turbo version that supports longer prompts and has an updated knowledge base through April 2023 (vs. its previous cutoff of September 2021). The update also gave developers the ability to create customized models for specific tasks dubbed GPTs, as well as a digital marketplace to house them.

• BeMe Teenage Mental Healthcare: Inland Empire Health Plan and Molina Healthcare of California are partnering with BeMe Health to provide app-based behavioral health support to 72k California teenagers with diverse backgrounds. Despite California’s heavy investment in youth mental healthcare, 40% of high schoolers report ongoing sadness or hopelessness. BeMe is seeking to improve those stats by providing access to positive content and skill-building activities, as well as 1:1 coaching, crisis management, and connections to local clinical services.

• Hims Reports Strong Q3, Launches MedMatch: Hims & Hers chained together another quarter of strong growth during Q3, reporting a 57% jump in revenue to $226.7M along with 1.4M new subscribers. Even though Hims & Hers also narrowed its net loss to $7.6M (down from $18.8M in Q3 last year), the headline from the investor call was the announcement of a new AI clinical decision support tool called MedMatch. The idea behind MedMatch is to tap into the data from millions of Hims visits to help its providers identify the best treatment for each patient, starting with those suffering from anxiety and depression.

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