Telehealth Made EASY: Understanding Provider Perceptions of Telehealth Appropriateness in Outpatient Rheumatology Encounters

Abstract

Objective The purpose of this study was to evaluate a novel scoring system, the Encounter Appropriateness Score for You (EASY), to assess provider perceptions of telehealth appropriateness in rheumatology encounters. Methods The EASY scoring system prompts providers to rate their own encounters as follows: in‐person or telehealth acceptable, EASY = 1; in‐person preferred, EASY = 2; or telehealth preferred, EASY = 3. Assessment of the EASY scoring system occurred at a single academic institution from January 1, 2021, to August 31, 2021. Data were collected in three rounds: 1) initial survey (31 providers) assessing EASY responsiveness to five hypothetical scenarios, 2) follow‐up survey (34 providers) exploring EASY responsiveness to 11 scenario modifications, and 3) assessment of EASYs documented in clinic care. Results The initial and follow‐up surveys demonstrated responsiveness of EASYs to different clinical and nonclinical factors. For instance, less than 20% of providers accepted telehealth when starting a biologic for active rheumatoid arthritis, although more than 35% accepted telehealth in the same scenario if the patient lived far away or was well known to the provider. Regarding EASY documentation, 27 providers provided EASYs for 12,381 encounters. According to these scores, telehealth was acceptable or preferred for 29.7% of all encounters, including 21.4% of in‐person encounters. Conversely, 24.4% of telehealth encounters were scored as in‐person preferred. Conclusion EASY is simple, understandable, and responsive to changes in the clinical scenario. We have successfully accumulated 12,381 EASYs that can be studied in future work to better understand telehealth utility and optimize telehealth triage.

Encounter Appropriateness Score for You Model: Development and Pilot Implementation of a Predictive Model to Identify Visits Appropriate for Telehealth in Rheumatology

“…Model covariates include the following groups: 1) encounter characteristics, 2) patient sociodemographics, 3) patient clinical characteristics, and 4) provider characteristics (Supplementary Table 3). These covariates were chosen based on literature review, an earlier pilot analysis of variables associated with telehealth utility, and provider surveys during EASY score development 15 . The encounter characteristics include covariates such as scheduled appointment length, time since prior visit (in months), and the upcoming scheduled visit modality (in person or telehealth).…”

“…These covariates were chosen based on literature review, an earlier pilot analysis of variables associated with telehealth utility, and provider surveys during EASY score development. 15 The encounter characteristics include covariates such as scheduled appointment length, time since prior visit 16 Medications were grouped according to individual disease-modifying antirheumatic drugs (DMARDs), classes of DMARDs (ie, conventional synthetic, biologic, or targeted synthetic DMARDs), and the total number of DMARDs prescribed over the preceding 18 months (unique drug count). RAPID3 scores were analyzed in three ways: the RAPID3 score from the prior visit (prior RAPID3), the average RAPID3 score over the preceding 18 months (average RAPID3), and variance in RAPID3.…”

“…13,14 To improve our understanding of telehealth appropriateness in rheumatology, we developed a novel scoring system called the Encounter Appropriateness Score for You (EASY), in which providers document their perceptions of the appropriateness of telehealth or in-person care after every patient encounter. 15 An analysis of more than 12,000 EASY scores in our rheumatology practice at Duke University Medical Center demonstrated that approximately 30% of follow-up visits could be done by telehealth, although less than half of the visits that could have been done by telehealth actually occurred by this modality, indicating that telehealth is still underused. To address this problem, we sought to develop a predictive model that could identify future visits appropriate for telehealth rather than in-person care.…”

The Impact of COVID‐19 on Education and Training in Rheumatology: A Narrative Review

“…As data continue to emerge regarding the quality of telehealth visits in comparison to traditional face-to-face care, as well as identification of disease and patient-specific factors associated with improved quality of telehealth visits, we will be able to develop more robust curriculum for our fellows. [22][23][24][25] The COVID-19 pandemic also brought about swift changes in our clinical training, as knowledge regarding the virus and its potential impact on our vulnerable patients often took center stage during clinical encounters. Faculty had to balance time spent on the traditional core curriculum with data on antiviral regimens, emerging vaccines, and monoclonal antibody therapies.…”

“…Although this may represent a minority of clinical care encounters, it is no less important that our trainees have the requisite knowledge and skills to carry out effective, high‐quality telehealth services when called upon. As data continue to emerge regarding the quality of telehealth visits in comparison to traditional face‐to‐face care, as well as identification of disease and patient‐specific factors associated with improved quality of telehealth visits, we will be able to develop more robust curriculum for our fellows 22–25 …”