Delivery of Care

Learning to listen in 10 different ways

The use of new texting software platforms to connect patients, doctors and nurses on a daily basis is upending the traditional office visit

Imagine courtesy of YouTube video

Lily Tomlin performing as Ernestine, a switchboard operator.

By Richard Asinof
Posted 5/4/20
New texting platforms that connect patients to providers are rewriting the methods about how patients connect to providers and how their voices are heard.
What are the data constructs needed to maintain broader testing and tracing protocols? Can similar kinds of texting software platforms be deployed? What is the current waiting time to be seen for an appointment by a primary care provider in Rhode Island? How many state employees are currently participating in the Survey Monkey texting platform to communicate daily with COVID-19 patients and those in quarantine? Could a similar texting software be put into practice for nursing home workers?
In a week, Bryant University will begin hosting a series of Zoom panel discussions, “Pandemic Economics: What does it mean for Rhode Island?” which were described as conversations “with leaders and policy makers to help Rhode Islanders understand the economic impact of COVID-19 and how the state can move forward toward recovery and growth for all.”
Does the tone of that description sound a bit patronizing to you? As if you were being talked down to? It does to ConvergenceRI.
Translated, the usual suspects from the business community are being asked to interpret the meaning of the pandemic, in a top-down approach to decision-making and “expert” interpretation.
The question is: who has a better grip on what is happening on the front lines in Rhode Island? A retiring university president or a young pediatrician who just opened up a new practice in one of Rhode Island’s urban core cities?
Rhode Island just completed a new strategic plan for its innovation economy, “Rhode Island Innovates 2.0,” but it contains absolutely no mention of any needed investments in public health infrastructure.
The business models of hospitals and nursing homes have been blown up by the coronavirus pandemic, but from perusing the list of planned speakers, there is no one scheduled to talk who is conversant about the work of Health Equity Zones in Rhode Island. Why not?
No one on the panels is equipped to talk about the wealth gap in Rhode Island – they all have health insurance through their employer, they all are not about to lose their job or be laid off, they all are not at risk of being evicted, having their home foreclosed on, or having their vehicle repossessed.
To better frame the empathic break around health and wealth and economic well being, consider the recent promotion advertised by the Greater Providence Chamber of Commerce, as part of its recent daily e-newsletter to share what the business community was doing in response to the pandemic.
In a special deal, the Chamber announced: “Earn $100 for every $250 spent at Fleming’s [restaurant]” as part of their catering menu. Really?
For top Rhode Island CEOs, maybe that is a money-saving bargain. Perhaps that is the perfect deal for the audience the Chamber seeks to reach. But for the rest of us hunkered down, practicing social distancing and worried about paying bills and juggling the demands of childcare and working from home, spending $250 on a meal is the kind of extravagance that perfectly illustrates the extreme wealth gap in Rhode Island.

PROVIDENCE – Once upon a time, when dinosaurs still roamed the Earth, and Lily Tomlin had an entire comedic routine on the TV show, “Laugh In,” built around a ditzy telephone operator, Ernestine, conducting switchboard calls, with her trademark line: “one ringy dingy [snort], two ringy dingies [snort],” primary care doctors actually made house calls to care for sick patients. [See link below to YouTube video, “Ernestine calls General Motors.”

Today, in a world disrupted by the coronavirus pandemic, the idea of patients traveling to a doctor’s office to be seen for a mere 15-minute-visit carries with it much too much risk – mostly for the provider, it seems, as well as for the patient.

Instead, new texting software platforms have been introduced, connecting patients to providers in a new kind of modern data switchboard.

In one fell swoop, many of the foundational underpinnings of the modern health care delivery model – the management of population health through accountable entities that measure outcomes by algorithms and electronic health records – have been swept away, hit by the rogue wave of pandemic.

Among the assumptions that have been blown up:

• The idea that residents of Rhode Island, despite health insurance requirements, have a primary care provider. It turns out that in some communities, as many as 20-30 percent of residents do not have a primary care provider.

• The idea that if you have a primary care provider, you can receive prompt access to scheduling an appointment to be seen, instead of having to wait weeks if not months for such an appointment. If you don’t have a primary care provider, or want to switch from one primary care provider to another, the reality is that it will take at least six months.

All the self-congratulation by government officials about Rhode Island having a low rate of uninsured residents sound hollow during this time of pandemic, when the darkness about health, economic and social disparities becomes visible.

In November of 2016, Christina Paxson, the president of Brown University, during a presentation on “Unpacking racial health disparities,” said: We cannot “educate our way” out of the disparities, nor will improved access to health insurance under the Affordable Care Act solve the persistent, structural racial disparities.

Now, in 2020, the traditional “house call” has been re-imagined as a series of texting prompts, asking questions, as a way to check in regularly with patients who may have tested positive for COVID-19 and been placed in quarantine.

And, given that there are many mothers who have proven to be the source of this innovation, often from the ground-up, not the top-down, there are a number of new texting software platforms that have been introduced into the Rhode Island marketplace in order to amplify the communication between patients and nurses and doctors.

Last month, ConvergenceRI wrote about the introduction of a new texting software platform by Healthcentric Advisors. [See link to ConvergenceRI story below, “From a novelty to a necessity.”]

The use of a texting software platform was also discussed in a story about the work being done by the Providence Community Health Centers to combat the spread of the coronavirus pandemic in vulnerable neighborhoods, deploying “Care Message.” [See link below to ConvergenceRI story, “Connecting primary care to emergency care in a pandemic.”

Last week, Gov. Gina Raimondo announced at one of her daily news briefings that that R.I. Department of Health was using a new texting platform created by Survey Monkey to track patients who had tested positive for COVID-19 and others who were in quarantine.

Like many “occurrences” described during the Governor’s news briefings, the introduction of the texting software platforms to track patients who have tested positive for the virus has been “ignored” by most of the news media, falling far under the radar screen of coverage.

The fact that there are at least three competing testing platforms in use in Rhode Island also went unreported. But, it is, in ConvergenceRI’s opinion, an important development that speaks to a changing dynamic in health care: how the office visit will be redefined in the future, not just as a function of adapting telehealth, but the way in which patients and providers communicate, creating a virtual “home visit” conducted on frequent, daily basis.

Translated, the patients’ voices can now be heard, changing the dynamics of the conversation.

Here is an interview with Susan Rohwer, the Senior Communications Coordinator at Healthcentric Advisors, talking about how the adaptation of new texting software platforms are changing the delivery of health care in Rhode Island.

ConvergenceRI: Do you know how many “different” texting platforms have been introduced in the Rhode Island market to track patients with COVID-19? I know of three – yours, Survey Monkey with the R.I. Department of Health, and one being used by Providence Community Health Centers, Care Message.
We’re excited to be assisting practices and patients across New England with our tools. In addition to the texting platform offered by Healthcentric Advisors, we are aware of the other two you mention, however each of these services may offer unique value to their audience.

Many consumer apps currently available for COVID-19 are designed for patients to assess their risk of coronavirus and where to go to seek help or support services. However, they do not incorporate a provider-facing portal that’s used in conjunction with that patient’s clinical care team.

Healthcentric Advisors developed a remote patient engagement application to monitor patient needs and help protect frontline health workers from exposure while still addressing emerging symptoms of patients during this health care crisis.

ConvergenceRI: What is the value of these texting platforms? Feel free to speak only about your own texting platform; what was been the response from providers, such as Coastal Medical, and their patients?
We created our texting platform to primarily meet the needs of physician practices, accountable entities, and community health centers and clinics.

It is a lifeline for patients and providers while our society copes with unprecedented disconnection. It automatically communicates with patients on a daily basis, requesting numerical responses to questions regarding breathing, cough, and temperature. The tool immediately alerts a practice if a patient indicates their condition has worsened.

We have physician practices, community clinics, and health centers in Rhode Island and throughout New England using our texting platform. Physicians, like those at Coastal Medical, report our tool is a highly effective mechanism for population health. And the state of Maine will soon be offering the platform to community health centers to monitor those who experience homelessness.

Hundreds of patients are receiving COVID-19 text messages daily from our tool. They not only appreciate the connection they feel with their providers, but are extremely responsive to the service. Our results show that when patients are sent reminders, compliance and activation increases significantly.

ConvergenceRI: What degree of interoperability exists between data from the texting systems and other data platforms, which track patient data? Is there interoperability between the different texting platforms?
Our texting platforms like many software products are developed with unique programming code. Formal cooperation and agreement between organizations would be necessary to create any sort of interoperability between multiple platforms.

ConvergenceRI: How does your texting system address social and health disparities?
It’s no surprise underserved communities are unfortunately bearing the brunt of the pandemic. Our focus has always been to support the most vulnerable patients across all their clinical and social health needs outside of their doctor’s visit.

Healthcentric Advisors was finalizing a care management texting platform addressing social and health disparities for organizations such as group practices and accountable entities, prior to COVID-19. Coastal Medical, serving as our beta test site, requested we modify it to respond to the increasing number of patients with flu-like symptoms in their practice during the COVID-19 pandemic.

Soon, our platform will enable providers to text their vulnerable patients about critical social health needs like food, housing, meds, etc. This pandemic has upended the lives of those infected and those participating in social isolation [in order to] protect the health of all.

But being able to reach and support someone in a socio-economic crisis is equally important to keeping [patients] well. We plan on finalizing the care management texting platform this summer.

ConvergenceRI: Do patients need to opt-in to your system?
The first text message a patient receives asks them agree to participate; and, patients can easily opt-out at any time. When patients contact their physician or clinic they are offered the opportunity to participate in our texting platform. If they verbally concur, their initial text asks for their confirmation that they wish to continue participating.

ConvergenceRI: Moving forward, is there a need to create a “council” to agree to standards for texting platforms in Rhode Island? Who should play the convening role?
One size may not fit all. Health care providers have different populations and needs and thus may need different types of texting platforms.

From a statewide public health perspective, it may be appropriate for the R.I. Department of Health to evaluate all texting platforms, post-COVID-19 pandemic, in order have one on “hot standby” for future statewide health emergencies.

ConvergenceRI: What questions haven’t I asked, should I have asked, that you would like to talk about?
While we’re unfamiliar with the specific functionality of the Survey Monkey texting service, it appears to have some functionality similar to ours.

Since we collaborate closely with providers in a number of arenas, our service is directly geared towards meeting the needs of practices.

One thing is clear: using technology to bridge relationships and ease connection between patient and provider is here to stay. And we’re hopeful that using technology like ours to reach patients outside of the office visit will continue to be a positive outcome of the pandemic.


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