Telehealth Applications for Post-Pandemic Practice

In Part 2 of this Q&A, Elham Hatef, MD, health physician and clinical informatician, Johns Hopkins Center for Population Health IT, talked with Psych Congress Network about the results of her recent study “Outcomes of in-person and telehealth ambulatory encounters during COVID-19 within a large commercially insured cohort,” recently published in JAMA Network Open.

Following up on the study approach and results, Dr Hatef explains the research teams’ findings on telehealth care for patients with chronic versus acute conditions, the place that telehealth will have in healthcare moving forward, and the need for further studies on the specific application of telehealth to mental and behavioral healthcare.

Missed Part 1 of this Q&A? Find it here.

Brionna Mendoza, Associate Digital Editor, Psych Congress Network: Could you elaborate on the differences observed in the utilization of telehealth by patients with chronic conditions versus patients with acute ACS conditions? 

Elham Hatef, MD: Our results showed that the use of telehealth services for the management of chronic ACS conditions appeared to be comparable to in-person encounters concerning the need for follow-up. However, patients with an initial telehealth encounter for 1 of the acute ACS conditions appeared to require additional follow-up compared with patients with an initial in-person ambulatory encounter.

From our analysis of episodes of care for specific presenting conditions, we identified that follow-up encounters after an index telehealth encounter were substantially more common for acute respiratory infections. Such increased follow-up was not more likely for other types of acute conditions (eg, acute pyelonephritis), suggesting that this difference could reflect concerns associated with the ongoing pandemic. Given that symptoms of these respiratory infections may be similar to those of COVID-19, one explanation of the higher number of follow-up encounters after an initial telehealth encounter of these types could reflect follow-up linked to suspected COVID-19 (eg, testing or ensuring adequate patient recovery). In contrast, follow-up care was generally less frequent after an initial telehealth encounter for a chronic condition than for an in-person encounter for the same condition.

Mendoza, PCN: What do you think the study results indicate about the future of telehealth in the United States? 

Dr Hatef: Our study helps to plan for the use of telehealth after the pandemic. It helps to identify the patient populations and type of clinical conditions that the telehealth care is a better mode of care delivery for them. 

Mendoza, PCN: What are the practical applications of your findings for clinicians in the mental healthcare profession? 

Dr Hatef: Mental/behavioral health conditions were among the most common conditions that telehealth was used for, even after the drop in overall visits during the pandemic. However, we did not assess the outcomes of care specifically for mental/behavioral health conditions. 

Mendoza, PCN: What future areas of inquiry do these findings point towards?

Dr Hatef: Looking into specific subpopulations of patients and how their disease-related clinical outcomes changed, comparing telehealth vs. in-person in longer time frames (longer than 14 days after the initial visit as was the case with our analysis).

Elham Hatef, MD, earned her medical degree from Tehran University of Medical Sciences, in Tehran, Iran, and her Master in Public Health from Johns Hopkins Bloomberg School of Public Health (JHBSPH). Dr. Hatef completed a preliminary year in Internal Medicine at Yale-affiliated Griffin Hospital in Connecticut and the Preventive Medicine Residency and Chief Residency at JHBSPH. She then completed the Clinical Informatics Practice Pathway at JHBSPH. Dr. Hatef is board certified in Preventive Medicine-Public Health and Clinical Informatics.

As a preventive medicine-public health physician and clinical informatician, Dr Hatef focuses on population health, social and behavioral determinants of health, and health disparities using health IT and informatics. She is involved in several projects in this area; at the Johns Hopkins Center for Population Health IT (CPHIT) she led the development of population health framework and measurements for Maryland, a collaboration with Maryland Health Information Exchange (a.k.a, CRISP: Chesapeake Regional Information System for our Patients) supported through Maryland State Improvement Model and Centers for Medicare and Medicaid Services. She also led the project to evaluate the health outcomes such as hospitalization rate at the primary care level at the Veterans Health Administration while taking into account social and behavioral risk factors of veterans. Also, in collaboration with other faculty across Johns Hopkins University, she works on new methods of data mining and natural language processing to address social and behavioral determinants of health by using structured and unstructured data in electronic health records.