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Jackie Gerhart is aiming to change some misconceptions around 

Jackie Gerhart, Epic's vice president of clinical informatics

Despite concerns that telehealth visits typically lead to in-person visits, Gerhart, vice president of clinical informatics at Epic, said that’s not exactly the case.

An Epic study of a host of specialties indicated that in most cases, no in-person appointment was needed for a follow-up visit within the next three months.

“Less than half of the time people actually needed a follow up in person,” Gerhart says. And she tells 

“I expected to find it. But I think it's surprising to most people,” she says.

The results were especially noteworthy in mental health and psychiatry, where only 15% of patients required an in-person visit after a telehealth visit.

“Telehealth has been amazing throughout the pandemic in being able to provide access to care, but also in being able to give the care that otherwise may have otherwise been done in the exam room setting, and actually give that care in a way that's not only more convenient, but maybe even gets to a diagnosis or a plan of care faster than it might have taken if you had to wait for an in-person visit,” Gerhart said.

 about telehealth, its growing use in some specialties, and how providers can use telehealth access to healthcare. 

(See part of our conversation in this video. The story continues below.)

Telehealth finds receptive ear in Congress

More doctors are using telehealth, at least on an occasional basis. 

Four out of five doctors (80%) used telehealth or virtual visits

 in 2022, according to a survey by the American Medical Association.

Some health leaders have questioned if telehealth will reduce in-person visits or simply be duplicative, with patients needing to go see a doctor shortly after a virtual visit.

But in 33 specialty areas reviewed in the Epic analysis, most didn’t need a follow-up visit within 90 days. Only three specialties saw more than half of patients require an in-person visit afterwards. Epic examined more than 35 million telehealth visits between March 1, 2020 and May 31, 2022.

“We've been surprised at how many different conditions we can take care of through telemedicine that we hadn't thought of doing before,” Gerhart said.

“if the evaluation and treatment that you can have for a given disease could be done without seeing the person face to face, then telemedicine seems to be an effective way to do it.”

Telehealth diagnosis shows high degree of accuracy, study finds

Mental health professionals have touted telemedicine as a vital tool to expand access to more patients, partly due to the shortage of mental health professionals. Over half of all U.S. counties are without a practicing psychiatrist, according to the 

There are promising indicators that telehealth is effective in behavioral health. Researchers with the Centers for Disease Control and Prevention and the National Institutes of Health found 

patients struggling with substance abuse had a lower risk of overdose if they had a telehealth appointment

Many patients struggling with mental health issues welcome telehealth appointments for a variety of reasons, Gerhart says.

“If you happen to be in a depressed state or you, for whatever reason, have transportation troubles, it is just easier to get to a telemedicine visit via your mobile device,” she says.

Some patients also are extremely private and don’t want to be seen going inside the office of a mental health services provider.

“Telehealth can often be more discreet where you can just go into a private room and quickly join in and then go back with the rest of your day,” Gerhart says.

A patient disclosing a difficult subject may also feel more comfortable talking inside their own home. And telehealth visits offer advantages for both the patient and the practitioner.

“There are benefits from the home for a few different reasons,” Gerhart says. “One, it might be more comfortable. You might feel more at ease. You have other people and other signs in your room that help the practitioner know what else is going on in your life even if you didn't bring it up.” The provider could see a child or a pet for instance, or even gain some insights from photos on the wall.

Group appointments can also be easier via telehealth, Gerhart says.

“Two people could just sit together from their home as well,” she says. “So I think the comfort of being able to explore even more detail into a person's life via telehealth is really neat.”

Telehealth appointments can offer more comfort for kids, who sometimes find going to a sterile physician’s office - the place they get shots - to be a scary proposition. And some children enjoy talking via video on a mobile phone or tablet.

“It almost attracts them to be more engaged,” she said.

Kids can enjoy another perk of seeing a doctor from home. “You don’t have to get out of your princess pajamas,” Gerhart says.

In the Epic analysis, some areas saw very few patients go to a follow-up appointment. In genetics, only 4% of patients required an in-person appointment (the lowest in the analysis), while only 10% of those in nutrition needed to see a doctor afterwards within 90 days.

Other specialties with a low-level of patients who needed an in-person visit following a telehealth appointment include endocrinology (14%), neurology (16%), GI (20%), infectious diseases (21%), and rheumatology (21%).

"It's clear that there's certain specialties that can rely upon telemedicine a little bit more heavily than others,” Gerhart says.

Some patients are going to need in-person visits. Perhaps not surprisingly, the highest rate of in-person visits following a telehealth appointment came in obstetrics (90%).

Other specialties regularly needing an in-person appointment following use of telehealth include fertility (54%), geriatrics (50%), surgery (43%), sports medicine (43%), and cardiology (42%).

But telehealth has proven to be especially useful for older patients, even though some skeptics have thought seniors wouldn't be tech savvy enough to engage in virtual appointments.

“That's another myth that we have been trying to bust, that people over a certain age can’t use technology,” Gerhart says.

Seniors are using technology to have video chats with grandchildren and use apps to board airplanes. “It’s already ingrained in them,” she says.

Telehealth appointments are also appealing to seniors with mobility issues or those who don’t relish long drives to a provider.

“Quite frankly, it's pretty frustrating if you can't get the same level of autonomy and access to service in a field that is so important and relevant, like health care, especially as you age,” Gerhart says.

Since only a small number of patients needed follow-up in some specialties, will there be a shift in some areas of medicine where telehealth replaces face-to-face care?

Gerhart says it depends on several factors, including the physicians having the right data to make an accurate diagnosis virtually.

But she also said it depends on the comfort level of the clinician in using telehealth.

“It is not just about what preferences the patient has,” Gerhart says. “It's also about how a provider can provide the best care.”

“There are physicians and clinicians that feel more comfortable having the person come into the exam room, just like there's patients that feel more comfortable being seen in the exam room,” she adds.

For doctors to succeed with telehealth, they need to be comfortable guiding a patient and explaining medical information in a virtual visit.

“If you're able to communicate better with the patient, they will have a better outcome,” Gerhart says. “Depending on your communication skills, if you feel like in your specialty, you can communicate those via telehealth, then it may be effective. But if you don't feel you're comfortable doing that, then it may be less effective.”

For doctors who don’t relish telehealth appointments, health systems and practices should view it as “a learning opportunity,” she says.

“It seems more like an opportunity to help people grow in their own practice, and hopefully help serve their patients better,” Gerhart says.

Healthcare leaders should embrace and expand the use of telehealth, Gerhart says.

“As we've seen from the data, especially as supported in this study, it is something that patients enjoy,” Gerhart says. “But more importantly, that they don't need another follow up afterwards. And I think that was the big question going into this was, is this something that can kind of stand on its own, that is able to provide care without needing to do duplicative care? And I feel like this study shows that.”

Articles

Many patients who had a virtual appointment didn’t need to go to a doctor’s office, an Epic study found. Jackie Gerhart of Epic talks about the ways telehealth can expand access. 

Where telehealth can help patients, and providers, avoid in-person care

Several top medical schools have now indicated they won’t be participating in the popular U.S. News and World Report rankings.

Harvard Medical School first made the announcement

 earlier in January, and several other schools have made similar decisions.

The medical schools at Columbia University, Stanford University, and the University of Pennsylvania, among others, all said in recent days they are no longer taking part in the U.S. News rankings. Duke University and the University of Chicago joined the ranks Friday.

Many students and families use the reports in making decisions on medical colleges, law schools and four-year colleges and universities. U.S. News has defended its rankings as a valuable tool in helping readers decide where to pursue their education. Plenty of medical schools and hospitals tout their lofty places in U.S. News reports.

But the rankings have gained growing scrutiny in recent years, with critics saying the focus on standardized tests favors affluent students and doesn’t reward schools for seeking diverse enrollment and promising students from disadvantaged groups.

Medical schools see dip in enrollment, but more diversity

The Vagelos College of Physicians and Surgeons at Columbia University made the announcement Jan. 20, three days after Harvard Medical School. Katrina Armstrong, dean of the college, said in a 

 that the “rankings perpetuate a narrow and elitist perspective on medical education.”

“Their emphasis is on self-reinforcing criteria such as reputation and institutional wealth, rather than measuring a school’s success in educating a diverse and well-trained cohort of doctors able to change medicine for the better and meet society’s needs,” Armstrong said. 

J. Larry Jameson, dean of the University of Pennsylvania’s Perelman School of Medicine, said in a 

 to the school community that the institution had been contemplating the move for some time.

“We reached the decision to end our participation not because of concerns that these rankings are sometimes based on data that can be inaccurate or misleading, but because the rankings measure the wrong things,” Jameson said.

 announced its decision to pull out of the U.S. News rankings Jan. 24, saying “the medical school rankings have a harmful impact on medical education.”

“The rankings provide a flawed and misleading assessment of medical schools; lack accuracy, validity, and relevance; and undermine the school’s core commitments to compassionate care, unrivaled education, cutting-edge research, a commitment to anti-racism, and outreach to diverse communities,” the school said.

Lloyd Minor, dean of the Stanford School of Medicine, said in a 

 Jan. 23 that is withdrawing from the U.S. News rankings after “extensive deliberation.” U.S. News can continue to rank the school using publicly available data, Minor said. And Stanford said it would independently report data on the medical school’s performance.

“We believe that our decision, along with those of a growing number of peer institutions, is necessary to lead a long-overdue examination of how medical education quality is evaluated and presented to aspiring students,” Minor stated.

 said Jan. 26 it would no longer participate in the U.S. News rankings. David H. Perlmutter, the school’s executive vice chancellor for medical affairs, said “it is time to stop participating in a system that does not serve our students or their future patients.”

Even though Washington University School of Medicine has fared well, Perlmutter said, “There comes a point at which participating in such a system can stand in the way of achieving our most important goals. The information upon which these rankings are based is too easily subject to manipulation and misrepresentation.”

While it already submitted data this year, the 

 said Jan. 26 that it would stop contributing to the U.S. News rankings. Timothy H. Dellit, interim CEO of UW Medicine and interim dean of the UW School of Medicine, said “it is important to join other medical schools” in ending participation.

“The emphasis on prestige and reputation without any objective evaluation of the quality of education is discordant with our vision for the future of medicine,” Dellit said in the statement. “Similarly, the sole focus on standardized scores and grades does not reflect our holistic admission process and the importance of diverse life experiences. Instead, this emphasis perpetuates inherent bias.”

The Duke University School of Medicine said Friday it would no longer submit data to the U.S. News rankings. In a 

, the medical school’s leaders said they “long had reservations” about the rankings.

“While the ranking system may have been intended to provide students with useful information to help them determine whether a school is a good match for them, it is now apparent that the metrics used have little connection to the values or the quality of the school’s educational program,” the school said.

 announced its move to stop participating in the rankings, citing “the impact the ratings system has on an equitable medical education.” The school announced its decision Friday, Jan. 27.

Vineet Arora, dean for medical education of the Pritzker School, said many the chief concern in the decision is reducing inequities in medical education. “This is essential as our nation continues to suffer from extreme health disparities and would greatly benefit from a more diverse physician workforce,” Arora said in a statement.

Eric Gertler, U.S. News executive chairman & CEO, said earlier this month that the rankings offer valuable guidance to students and families in making decisions on where to go to school.

“We know that comparing diverse academic institutions across a common data set is challenging, and that is why we have consistently stated that the rankings should be one component in a prospective student’s decision-making process,” Gertler said in a 

“The fact is, millions of prospective students annually visit U.S. News medical school rankings because we provide students with valuable data and solutions to help with that process."

In recent months, several top law schools, including 

, said they are withdrawing from the U.S. News rankings.

After Harvard Medical School announced it would no longer participate, other institutions are following suit. 

Not banking on rankings: More medical schools withdraw from U.S. News listing

Americans living in rural areas have a significantly higher risk of developing heart failure than those living in cities, according to a large study supported by the National Institutes of Health.

Black men living in rural areas face an especially high risk of heart failure, the study found.

The National Heart, Lung, and Blood Institute, a division within the NIH, collaborated with Vanderbilt University Medical Center on the study. The 

Rural Americans had a 19% higher risk of heart failure than those living in urban areas, the study found. However, Black men living in rural communities had a 34% higher risk of heart failure than Black men living in urban areas, the highest risk of all those studied, researchers said.

When rural hospitals close, surrounding hospitals feel the pain

Women in rural areas also faced greater likelihood of developing heart failure, according to the study.

White women in rural areas had a 22% increased risk of heart failure, compared to white women in metropolitan areas. Black women had an 18% higher risk of heart failure than Black women in urban communities.

Men are more likely to be given drugs to prevent heart disease, women are told to diet and exercise

Even the researchers were surprised by the disparities, said Véronique L. Roger, a co-author of the study and a senior investigator within the National Heart, Lung, and Blood institute.

“We did not expect to find a difference of this magnitude in heart failure among rural communities compared to urban communities, especially among rural-dwelling Black men,” Roger said in a 

 accompanying the study. “This study makes it clear that we need tools or interventions specifically designed to prevent heart failure in rural populations, particularly among Black men living in these areas.”

The authors said the precise reasons for the greater risk of heart failure in rural communities aren’t entirely understood. 

However, researchers said a lack of access to healthcare, structural racism, and a paucity of grocery stores offering healthy foods are all likely contributing factors.

The study found that white men living in rural areas did not indicate a higher likelihood of heart failure than white men in urban areas.

Researchers tracked 27,115 people over a 13-year period. The study examined participants in 12 states: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia.

, a long-running study of major diseases in the Southeast.

David Goff, director of NHLBI’s Division of Cardiovascular Sciences, said finding a link between living in rural areas and a greater chance of heart failure is “an important advance.”

“We look forward to future studies testing interventions to prevent heart failure in rural populations as we continue to fight heart disease, the leading cause of death in the U.S.,” Goff said in a statement.

Other studies have shown disparities in care between Black and white Americans in treating heart failure. 

White patients are much more likely than Black patients to receive heart transplants and devices that help the heart function properly

, researchers found in a study that was also supported by the NIH.

Black and Latinx patients also experienced greater delays in cancer care

 during the COVID-19 pandemic, according to a 

President Biden’s administration has focused on 

closing disparities in health outcomes among disadvantaged groups

The disparity surprised even the authors of the NIH-supported study. The researchers suggested a lack of access to healthcare and structural racism are likely contributors.

Rural Americans, especially Black men, have greater risk of heart failure

Hundreds of cyberattacks have been reported against healthcare systems, but federal authorities say a “21st century cyber stakeout” thwarted a notorious group targeting hospitals and other critical infrastructure.

 announced Thursday that the FBI managed to break into the networks of Hive, a ransomware group that has threatened health systems, financial companies, and schools around the world.

The FBI managed to penetrate Hive’s systems, recover decryption keys and offered those tools to victims. The FBI’s success prevented victims from having to pay $130 million in ransom payments, the justice department said. 

John Riggi, the American Hospital Association’s national advisor for cybersecurity and risk, hailed the FBI’s success in disrupting the HIVE group. 

Scores of hospitals have been hit by ransomware attacks

“The disruption and dismantlement of the Hive ransomware by the FBI, the U.S. Department of Justice and international partners is welcome news and will help make hospitals safer against high-impact ransomware attacks, which have disrupted health care delivery and jeopardized patient safety,” Riggi said in a statement.

The federal government reported hundreds of breaches of private health information in 2022, affecting millions of Americans.

The 11 biggest breaches of health data in 2022

In a survey of healthcare IT professionals released earlier this month, 

nearly half said their organizations experienced a ransomware attack in the past two years

. Among those who said they had been hit with a ransomware attack, 45% said the attacks led to patient complications, according to the survey by the Ponemon Institute.

The Justice Department said the FBI distributed over 1,000 additional decryption keys to previous Hive victims. And the department said it coordinated with law enforcement agencies in Germany and the Netherlands to hamper Hive’s ability to communicate with its members by seizing servers and websites Hive has used.

Deputy Attorney General Lisa O. Monaco said in a statement that the success of federal authorities should send a reassuring message to victims and a warning to other cybercriminals.

“In a 21st century cyber stakeout, our investigative team turned the tables on Hive, swiping their decryption keys, passing them to victims, and ultimately averting more than $130 million dollars in ransomware payments,” Monaco said. “We will continue to strike back against cybercrime using any means possible and place victims at the center of our efforts to mitigate the cyber threat.”

The Hive group has been all too successful. Since June 2021, the Hive group has targeted more than 1,500 victims around the world and received more than $100 million in ransom payments.

“Cybercrime is a constantly evolving threat," Attorney General Merrick Garland said in a statement. "But as I have said before, the Justice Department will spare no resource to identify and bring to justice, anyone, anywhere, who targets the United States with a ransomware attack.

The Department of Health & Human Services sent an 

 in April 2022 warning hospitals and healthcare providers about the Hive group.  

Hive “has been very aggressive in targeting the US health sector,” the HHS Cybersecurity Program advisory said.

Ransomware gangs have demanded payments to restore systems, or have threatened to release private health information from patients unless they are paid, experts say.

Hospitals have been hampered by ransomware payments all too frequently, said Lee Kim, the senior principal, cybersecurity and privacy at the Healthcare Information and Management Systems Society (HIMSS).

“The threat of ransomware hasn't gone away,” Kim told 

“Certainly the extortion techniques that are used to try to force hospital systems to pay ransom, that’s certainly in vogue at the current time," she said. "I think as we look at the past incidents in this past year, obviously, ransomware is among them.”

Health systems are making progress in defending against cyberattacks, but too many are vulnerable, Kim said.

“We do see some organizations that essentially are probably applying a wait-and-see approach because they haven't been breached yet,” Kim said.

(See excerpts of our December interview with Lee Kim of HIMSS on cybersecurity in healthcare.)

Victims of Hive ransomware should contact their local FBI field office for more information, the justice department said.


Federal authorities had warned health systems about the Hive group, which targeted more than 1,500 victims worldwide.

FBI disrupts ransomware group targeting hospitals, thwarting $130M in payment demands

Susan Garfield has been working on health equity issues for 25 years.

Nonetheless, Garfield, the U.S. chief public health officer at Ernst & Young (EY), says she is glad health equity issues are gaining more attention from healthcare leaders. Many of those issues have been vividly illustrated in the COVID-19 pandemic.

“COVID has brought the challenges of health equity and health disparities to the forefront,” she says. “It has shown the impact persistent health disparities and health inequities have.”

“It has always been a topic that is real and prevalent,” she says. “It has emerged as a priority for healthcare organizations.”

Moving health equity from goals to reality

EY recently surveyed 500 healthcare leaders representing providers, payers, and life sciences on health equity. Nearly all of those leaders (98%) said their organizations had health equity strategies in place, and roughly four out of five (82%) said they had organization-wide strategies. EY noted participants in the survey had to have a role in health equity efforts, so it’s more likely participants are coming from organizations with established strategies.

Garfield talked about health equity efforts and measures healthcare leaders can take to close disparities. Many health systems have different ideas on strategies for health equity, and that’s a positive, she says.

“We are in a period of opportunity, learning and creating the foundation for additional and future collaborations,” Garfield says. “It’s not something we are going to reach by doing one single thing.”

Hospitals and health systems may be focused on issues such as transportation and connectivity, she says, while payers may be looking at affordability and access to care.

CMS leader says health innovation must be accessible to everyone

Healthcare leaders who are interested in improving equity in their communities must recognize that it should be an organization-wide effort.

“This is an issue that should be at the center of your strategy,” she says. “When you put it at the center, you can start to win on every front.”

Health systems that can move the needle on closing disparities can build deeper and more sustainable ties with their community. They will also improve their own reputation in their communities.

“Health equity at its utmost is an aspirational goal. But closing health disparities  and addressing the root causes along that continuum …… it is a meaningful way healthcare executives can change patient lives and improve their communities,” Garfield says.

In the EY survey, health leaders most commonly pointed to the lack of understanding of what health equity actually entails as the biggest barrier they are facing.

More organizations are appointing a chief health equity officer to lead efforts in closing disparities. More than half (58%) of the leaders surveyed by EY said their organizations have a chief health equity officer.

Some organizations have given those responsibilities to members of their executive team. But Garfield said she was “thrilled” to see many organizations investing in health equity officers.

“It is certainly helpful in any big transformation like a health equity activation to have someone in charge … It’s not necessary but it’s really an accelerator and can help organizations reach their goals more effectively,” Garfield says.

Healthcare leaders can empower health equity officers by working with other senior leaders to be aligned around key goals. Leaders should be in agreement on what equity efforts are going to entail, and organizations need to develop data analytics infrastructure to support those initiatives.

While a majority of organizations say they have strategies to close disparities, 

many health systems don’t have specific budgets for health equity programs

, according to a study by Accenture and HIMSS Market Research released last year.

Garfield suggests that organizations who aim to make progress must budget for those equity initiatives.

“Budgets and investments are really critical to support these leaders,” she says.

“Investment needs to be tied to those efforts, so organizations can see ROI, communities see the value, and there’s an incentive to continue the investment,” Garfield says.

Healthcare organizations must engage with their communities to understand key issues that are driving disparities. Virtually all of those surveyed (99%) said they recognized the need to work with members of the community and secure their involvement in health equity efforts.

“No one should think in isolation from the people that they are trying to serve,” Garfield says.

Healthcare organizations need data to close disparities. While hospitals and health systems have enormous amounts of information on their patients, many don’t have the ability to analyze that data to see where disparities are emerging, such as procedures where members of minority groups may have worse outcomes, Garfield says.

“Most organizations don’t have the analytic infrastructure to take that data and address the root causes of healthcare disparities,” she says.

A hospital may know that the Hispanic community lags other groups in cancer treatments, but the organization may not know what to do with that information, she says. Getting more data can help with interventions.

Less than half (47%) of healthcare organizations say they have reliable health equity data, according to the EY survey. Systems that don’t have the capacity to analyze their data could consider finding partners “to build out capabilities they don’t have internally,” Garfield says.

The EY survey also found 10% of payers said they aren’t collecting and examining data to track disparities in their populations.

Systems that are aiming to close disparities in minority groups must make every effort to improve the diversity of their own organizations, Garfield says.

“Embedding diversity, equity and inclusion efforts is critical on many levels,” she says.

“It also supports your health equity initiatives.”

A diverse clinician workforce can help improve interactions with communities, Garfield says.

Garfield notes the lack of diversity in the physician workforce. 

Only 6.9% of doctors identified as Hispanic, while 5.7% identified as Black or African American

, according to data from the Association of American Medical Colleges. Much of the challenge is a pipeline issue.

Still, healthcare organizations must make every effort to improve diversity in order to make gains on closing disparities, Garfield says.

Healthcare organizations must recognize that the effort to improve health equity is a long road.

“This is a big challenge that's going to take a long time, a lot of commitment, a lot of collaboration,” Garfield says.

More health systems say they are aiming to close disparities in healthcare. Susan Garfield of EY outlines steps to help move the needle.

To improve health equity, leaders must make it ‘the center of your strategy’

Employers aren’t giving health plans top marks.

The Leapfrog Group, a healthcare watchdog group founded by large employers, surveyed 114 companies about their satisfaction with their health insurance plans. Employers were asked to evaluate their plans with a GPA, similar to the grading scale used in school.

Health plans fared worse than they did in a similar survey in 2020. Employers assessed health plans with a 2.29 GPA in 2022, down from 2.57 two years earlier. The Leapfrog Group released the 

Leah Binder, president and CEO of the Leapfrog Group, said the “C” grade “is a somewhat depressing result if you’re a health plan.”

“Employers remain disappointed in many aspects of healthcare performance,” Binder said during a webinar outlining the survey’s findings.

The Leapfrog Group surveyed employers and found disappointing results for insurers. Employers say they’re most concerned with improving care, even more than managing costs.

Ron Southwick

Articles

Where telehealth can help patients, and providers, avoid in-person care

Not banking on rankings: More medical schools withdraw from U.S. News listing

Rural Americans, especially Black men, have greater risk of heart failure

FBI disrupts ransomware group targeting hospitals, thwarting $130M in payment demands

To improve health equity, leaders must make it ‘the center of your strategy’

Health plans slip in employers’ report card

Better communication can curb anger and violence in hospitals

Hospital trauma fees vary by tens of thousands of dollars: Study

Digital health funding plunges to 5-year low in Q4

How hospitals can reduce the risks of violence