For 13 years, Banner MD Anderson Cancer Center has established itself as a national leader in providing personalized integrated care for its oncology patients. No period has been more transformative than the last four years in terms of developing its virtual care delivery model.
Our recent webinar featured a dynamic conversation between:
Amanda Dean Martin, DNP, ACNP-BC (Chief, Division of Advanced Practice & Clinical Integration at Banner Health)
And
Andrew Watson, MD MLitt., FACS FATA (Senior Medical Director, UPMC Health Plan, Senior Medical Advisor, UPMC Enterprises, Past-President American Telemedicine Association, Consultant, FDA digital advisory committee).
The two discussed the remarkable strides Banner MD Anderson has made in virtually integrated cancer care, along with key challenges and strategies involved in scaling virtual care programs.
Background
Amanda Dean Martin has over 15 years of Nurse Practitioner experience, primarily in surgical oncology. During the COVID-19 pandemic, she spearheaded the development of Banner MD Anderson’s telehealth program for oncology in partnership with eVisit. Banner’s robust pre-existing eICU and e-hospitalist programs before the pandemic laid the groundwork for an agile and adaptive digital-first response to the onset of the pandemic.
Recognizing the hidden costs – the “toxicity” – associated with traditional in-clinic cancer care, Banner MD Anderson implemented a virtually integrated solution to create a more personal and improved patient and provider experience.
Reducing Toxicity to the Patient
While the initial focus was on maintaining patient safety during the pandemic, it’s become clear that virtual care offers a multifaceted approach to improving patient care, especially for reducing various forms of “toxicity” associated with traditional cancer treatment. Amanda Dean Martin and Andrew Watson discussed three types of toxicity to the patient.
- Financial toxicity: Virtual Care reduces travel costs, parking fees, and missed workdays, making high-quality cancer care more accessible. Martin cited a study from Sanford Health in South Dakota, highlighting that virtual care saved patients approximately 2.5 million miles of driving in one year.
- Physical Toxicity: Virtual care offers a safer and more comfortable alternative to long commutes and waiting rooms, especially for patients with compromised immune systems or those undergoing chemotherapy. Watson emphasized the additional benefit of avoiding difficult driving conditions and extreme weather, which can make travel unsafe or impractical.
“When you don’t feel well, what do you do? You don’t get in a car and look for potholes, you want to stay at home and lie on your couch,” Andrew Watson said. “I did five telemedicine appointments this morning and they were all at home. They loved it, didn’t have to drive.” - Psychological & Emotional Toxicity: Virtual care reduces the stress of navigating healthcare settings, and allows patients to receive care in familiar and comforting surroundings, often with loved ones by their side.
“People feel more comfortable at home and seem to receive the information better as well and have a better sense of what’s going on,” Amanda Dean Martin explained. “They seem to receive the consent better at home and it’s much more humane.”
By addressing these forms of toxicity, virtual care enhances patient outcomes and satisfaction, ensuring that high-quality oncology care is more accessible, comfortable, and less stressful. As providers continue to embrace and optimize virtual care, it will be crucial in delivering comprehensive and compassionate care.
Remote Patient Monitoring (RPM) and Reducing Readmission
Amanda Dean Martin explained that the definition of telemedicine is ever-evolving. In 2020, it primarily meant audio-visual (AV) and audio-only visits, but it is gradually expanding into other areas. Banner MD Anderson is exploring remote patient monitoring (RPM) and discussing how to deliver some aspects of oncology care at home using AV technology. Additionally, there are conversations about integrating AI into programs to support patients remotely.
In their initial phases of implementing RPM, Banner MD Anderson is sending patients home with devices such as tablets, pulse oximeters, blood pressure cuffs, scales, and thermometers. This is especially for patients undergoing high-risk chemotherapy, focusing on breast, lung, and gastrointestinal cancers. The primary goal is to monitor vital signs and patient-reported outcomes, such as vomiting, fatigue, and urine output. This data helps in making decisions about follow-up care, like scheduling AV visits or arranging for IV fluids in person, particularly for high-risk patients with later stages of cancer.
Amanda Dean Martin emphasized, “This is where we really think we’re going to reduce admissions, reduce hospital days, and push our program forward here.”
Collaborating with eVisit
The agility of the eVisit platform has been key to the success of Banner MD Anderson’s virtually integrated oncology program. Amanda Dean Martin described the value of a straightforward and streamlined process.
“We’re using the eVisit Express platform, which is really nice, it is not app-based, and this has been one of the keys to our success. What we found early on the pandemic is that having the patients require an app was a big hindrance.”
eVisit’s hardware-agnostic technology and user-friendly interface seamlessly integrate with leading EHRs—prioritizing swift communication, efficient patient data management, and adaptable clinical workflows rather than overly embedded experiences. Amanda Dean Martin shared the ease of patient registration, seamless provider handoffs, and enhanced team-based care coordination.
Learn More – eVisit awarded 2024 Best in KLAS for Virtual Care Platforms (non-EHR)
Relationship-Building and Establishing Multidisciplinary Care in a Virtual Setting
Amanda Dean Martin and Andrew Watson discussed how virtual care offers unique opportunities for relationship-building with patients. Through virtual visits, clinicians can gain insights into patients’ lives that are often missed in a clinical setting.
Virtual appointments allow clinicians to see patients’ home environments, assess their social support systems, evaluate nutrition, and identify fall risks and other stressors. This holistic view enables clinicians to respond more effectively to patient needs and engage more comprehensively with patients and their support systems.
Amanda Dean Martin emphasized, “You can deepen that relationship pretty significantly by having the patient in their home where they’re more comfortable, they’re feeling less vulnerable and they’re more willing to share.”
Addressing concerns from providers about telemedicine potentially limiting multidisciplinary care, Amanda Dean Martin pointed out that platforms like eVisit enable the visit to move around multidisciplinary providers and a holistic care team that can address aspects such as patients’ lack of social support.
“You’re gonna see these things that you would not have seen before, so you’re actually enhancing the multidisciplinary care from where it probably would have been in your traditional model.”
At-home teleoncology visits can facilitate the inclusion of additional resources such as nutritionists, physical therapists, and home health services, making it easier to provide comprehensive care.
How to Increase Provider Adoption of Virtual Care
Amanda Dean Martin and Andrew Watson agreed that the providers respond well to three main categories:
- Patient testimonials
- Robust academic research
- Making the platform easy to use, non-disruptive to the normal workweek
Amanda Dean Martin described how patient testimonials — such as saving time and reducing mental, financial, and physical toxicity associated with frequent in-clinic visits — can be powerful arguments for illustrating the benefits of virtual care.
Backing the adoption of virtual oncology with robust research can also alleviate clinicians’ concerns about its efficacy and safety. Amanda Dean Martin highlighted key studies such as rural patients saving 25.3 million miles of travel with virtual care options at Sanford Health, telemedicine visits not being associated with perceived adverse outcomes, and oncologists’ estimates that 46% of cancer care could be performed via telemedicine.
Amanda Dean Martin also emphasized the importance of communication and making it easy and seamless for providers to do telemedicine visits.
Including:
- Providing convenient telemedicine set-ups in multiple work areas and equipping clinicians with the same resources and support available for in-person visits allow them to manage virtual encounters confidently
- Having tele-hosts, medical assistants for troubleshooting and intake, and nurses aligned with the same workflows (i.e. intake, outtake, patient education, etc) helps to maintain the same quality of support and streamline encounters.
“Their nurses are still aligned to them as far as support and going through intake and outtake the education, everything that they would normally have is still available to them while they’re doing telemedicine versus in person.”
Few additional strategies:
- Highlight successful transitions in other specialties, like surgery, where minimally invasive procedures and electronic health records have become widely adopted.
- Recruit experienced nurses, advanced practice providers, and physician assistants to champion telehealth within their teams.
- Demonstrate – the benefits of telehealth, including improved patient engagement, reduced no-shows, and the potential to expand access to high-quality care.
Addressing Patient Leakage and Expanding Reach
Virtual care combats patient leakage by expanding access to those who struggle with travel or lack the means to visit a cancer center regularly.
Amanda Dean Martin notes that “one of the biggest benefits in cancer care is the ability to do extended second opinions.” After an initial consultation with their community provider, patients may seek a second opinion from Banner MD Anderson’s comprehensive cancer centers, potentially leading to more informed treatment decisions and smoother care transitions.
Telehealth facilitates collaboration between distant teams, allowing patients to begin or continue cancer care in different locations. This seamlessly ensures continuity of care without leakage.
Patient Age is Not a Barrier to Using Virtual Care Technology
Amanda Dean Martin and Andrew Watson challenged the misconception that older adults are incapable of using telehealth platforms.
Many seniors are “aging into technology” and are increasingly comfortable with digital tools, such as FaceTiming grandchildren and using smartwatches with fall alerts. Amanda said it perfectly, “If they know how to Facetime, they can do a virtual visit.”
Andrew Watson discussed patients sending pictures via the portal, highlighting the importance of an integrated digital experience. Amanda Dean Martin shared examples of patients finding telehealth visits easier than expected, such as being able to show their incisions during appointments rather than uploading pictures to a portal. She stressed the importance of simplicity and ease of use in oncology care platforms.
If you enjoyed this recap from our Virtually Integrated Care series, let’s keep the conversation going. Here are a few ways to stay connected:
- Access the full webinar discussion here
- Request a Demo – Learn how large innovative health systems like Banner Health, Texas Health Resources, MedStar Health, and NYC Health + Hospitals are using the eVisit platform to unlock the potential of virtual care across the care continuum.
- Live Use Cases including ED tele-triage, virtual nursing, telestroke, urgent care, specialty care, and primary care.
- Follow us on LinkedIn for updates, virtual care resources, and new videos from our Virtually Integrated Care series
