Section 718 (Telemedicine): Virtual Health Outcomes From Regional Health Command Europe.

BACKGROUND: Section 718 of the Fiscal Year 2017 (FY17) National Defense Authorization Act (NDAA) outlines many reportable telemedicine outcomes. While the Military Health System Data Repository (MDR) and the Management and Reporting Tool M2 provide some telemedicine analyses, there are many outcomes that neither the MDR nor M2 provide. Understanding patient and provider attitudes towards telehealth and specialty-specific usage may assist initial or ongoing telehealth lines of effort within Defense Health Agency Medical Treatment Facilities (DHA MTFs). METHODS: A retrospective descriptive analysis of synchronous virtual health (VH) encounters and results from three internally developed telehealth surveys for calendar year (CY) 2016 was conducted. RESULTS: Three thousand seven hundred and seventy-eight synchronous VH visits for 2,962 unique patients were completed by 142 providers located within 27 distinct specialty clinics. 89.8% of patients were adults and 75.9% were Active Duty. Skill type I and II medical providers conducted 1,827 new consultations, 1,187 follow-up visits, and 371 readiness exams. Overall, specialty-specific VH use ranged from less than 1% to 39.9%. Patient satisfaction was 98% while provider satisfaction ranged from 91% to 93%. Additionally, significant intangible savings were recognized. CONCLUSION: Regional medical centers conducting synchronous VH will require both internal and external data sources to report Section 718 outcomes required by Congress. As the anticipated demand for direct provider-to-patient telehealth increases, understanding these outcomes may aid initial and ongoing efforts in other military treatment facilities conducting synchronous VH.

Multispecialty Synchronous Telehealth Utilization and Patient Satisfaction Within Regional Health Command Europe: A Readiness and Recapture System for Health.

BACKGROUND: Telehealth implementation within the Military Healthcare System continues to advance toward the goal of a mature regional health platform; however, specialty-specific usage or patient satisfaction regarding synchronous or "real-time" telehealth at the regional military hospital level has not been described. METHODS: A retrospective review of synchronous telehealth encounters and patient satisfaction surveys from Landstuhl Regional Medical Center (LRMC) specialty clinics engaging in synchronous telehealth to regional Army Health Clinics (AHCs) during 2015 was conducted. RESULTS: 2,354 synchronous telehealth encounters were conducted for 1,886 unique patients. The majority of patients were adults (88.4%), male (71.1%), and active duty (75%). Twelve distinct distant locations were engaged in synchronous telehealth with 31 distinct specialties. 1,552 (62.5%) patients had a single telehealth visit with a median (range) of 1 (1-7) visit. Median (range) visits per specialty was 25 (1-582) with sleep medicine (24.7%), general surgery (13.1%), nutrition (9.7%), orthopedics (9.0%), and ENT (6.0%) representing 62.5% of all encounters. Median (range) number of encounters per location was 146 (13-685). Surgical specialties preferentially evaluated patients at locations with a specialty-trained presenter (p < 0.001), whereas nonsurgical specialties did not (p > 0.05). Fifteen percent (372/2,354) of patients completed an anonymous survey at the time of their telehealth visit. Mean responses on a 5-point Likert scale ranging from "strongly disagree" (1) to "strongly agree" (5) was 4.8 ± 0.5 for both recommending and being satisfied with their telehealth visit. The 2,354 telehealth visits represented 2.4% (2,354/100,094) of all visits to LRMC during 2015 for 25 of 31 specialties whose total outpatient visits could be determined. CONCLUSION: Clinic utilization varied between specialties as well as whether a specialty-trained patient presenter was preferred. This robust multispecialty synchronous telehealth experience provides insight into both specialty-specific utilization and patient satisfaction which may aid regional medical centers recognizing avenues for specialty-specific telehealth initiatives.