Background: When a patient with cancer or terminal illness is hospitalized, they may benefit from the input of their outpatient, primary oncologist or palliative care provider to inform key decisions. As most oncologists’ and ambulatory palliative care clinics are based outside the hospital, these conversations often happen via unreimbursed phone conversations, making it difficult to engage the primary team and/or family members in the discussion. Telehealth presents an opportunity for patients’ primary oncologists and palliative care providers to virtually join patients at the bedside via a billable telehealth encounter.
Purpose: To improve continuity and communication between (1) admitted patients and their families, (2) their primary oncologists or palliative care providers, and (3) primary medicine teams, we proposed using telehealth infrastructure to facilitate remote consultations between these three groups.
Description: The Remote Oncology/Palliative Care Video Encounter Program (or ROVE) was implemented in April 2018. An Epic Workbench report was developed that identified patients admitted to the hospital medicine service who had an outpatient oncologist or palliative care provider. A Telehealth Coordinator contacted patients’ oncologist/palliative care providers offering a ROVE visit and recorded subsequent encounter details. Scheduled ROVE consults were conducted using the Zoom ® video conferencing platform installed on mobile iPad tablets. After the visit, oncologists/palliative care providers were instructed on how to write a billable note for the visit.
The intervention was conducted over a period of 18 weeks for admitted patients with outpatient oncologists and 10 weeks for patients with outpatient palliative care providers, during which time 336 and 117 such patients respectively were admitted. Twenty-one patients with oncology providers and 10 patients with palliative care providers received ROVE consults, representing 10% and 9% of eligible patients in both groups, respectively (Figure 1). Barriers to conducting ROVE visits are noted in figure 2; lack of clinical necessity or lack of provider availability were the most frequent barriers in oncology, and lack of clinical need or a preference for in-person/phone/e-mail contact were the most frequent barriers in palliative care. In the oncology patient population, ROVE consults were used to discuss treatment options (n=11 patients or 52% of ROVE patients) or goals of care (n=10 patients or 48% of ROVE patients). Forty-eight percent of all oncology patients with ROVE visits (n=10 patients) transitioned to hospice during the hospitalization.
Conclusions: Telehealth can be used to provide remote consultation with outpatient oncology and palliative care providers in a hospital medicine patient population. In our patient population, though such telehealth encounters occurred in a relatively small percentage of eligible patients, the visits frequently discussed high-importance events such as a transition to hospice.
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