Telehealth-Based Infectious Diseases Consulting: One Organization’s Experience

March 15, 2021
As with other specialist medical care, it turns out that infectious diseases medicine lends itself well to telehealth-based consultative services contracted by community hospitals, as a UPMC spinoff firm has found

The vast, 40-plus-hospital UPMC health system based in Pittsburgh continues to innovate along numerous dimensions. Numerous innovations continue to be sponsored inside UPMC itself that then eventually become commercialized as separate entities, once it’s been determined that those innovations might be capable of surviving and thriving as entities on their own.

One of those has been Infectious Disease Connect Inc. (ID Connect), a UPMC-backed company offering solutions to improve treatment of infectious diseases and antimicrobial stewardship. Serving more than 30 facilities in nine states, ID Connect estimates that it has helped its customers reduce patient transfers by up to 40 percent, cut antibiotic use by 30 percent, and reduce days of treatment per 1,000 patients by 40 percent. Merck Global Health Innovation Fund also is an investor.

March 1, 2021 marked the second anniversary of Infectious Disease Connect Inc., which began as a service provided by UPMC at the corporate level to its own health system facilities. One of the organization’s core services has been providing the expertise of board-certified infectious diseases physician specialists to hospital facilities, in order to fill gaps in infectious diseases expertise. From the very beginning, the senior clinicians and administrative leaders of community hospitals lacking in infectious diseases specialist presence have been eager for the consultative service; and the demand has only grown since March 2019. As might be expected during the COVID-19 pandemic, the organization has been seeing rapidly growing demand for its telemedicine-enabled services, including consultations with ID specialists and infection prevention and control. In the last 6 months, ID Connect has added 5 new customers in 3 states; seen 30-percent growth in consults at existing customers in 2020, and is supporting a pilot to provide COVID-19 care to nursing home patients in Western Pa. It’s recently signed an exclusive agreement with McKesson Pharmacy Optimization to provide ID decision support and antimicrobial stewardship products to McKesson’s hospital customers, who are seeking to meet new CMS rules and reduce unnecessary use of antibiotics.

As the company notes on its website, “Founders Rima Abdel-Massih, M.D., and John Mellors, M.D. partnered to create Infectious Disease Connect to address the growing demand for ID expertise and expand its accessibility. Since then, ID Connect has become a leader in telemedicine care of infectious diseases, antimicrobial stewardship, and infection control and prevention.”

In December, ID Connect received top scores from the Orem, Utah-based KLAS Research both for its services and for its software platform. According to a KLAS report published last month, ID Connect earned an overall score of 96.9 for service, with 80 percent of its customers reporting that they were “highly satisfied,” and 20 percent reporting that they were “satisfied.” Also, its ILÚM Insight clinical decision support platform had an overall score of 96, with 80 percent of respondents “highly satisfied” and 20 percent “satisfied.” Responding to the publication of the KLAS report, ID Connect president and CEO Dave Zynn stated in a press release on the subject that, "In the face of a global pandemic and a growing shortage of infectious disease experts nationwide, ID Connect has never been a more important partner to the hospitals and patients we serve. We are pleased that KLAS Research has validated the quality of the tools and services we provide.” Zynn recently spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding the organization’s origins, mission and its future prospects. Below are excerpts from that interview.

Could you share with us the story of your organization’s being launched by UPMC Enterprises?

UPMC’s Infectious Diseases Division had been providing tele-infectious diseases services for years, beginning in 2016. One of UPMC’s community hospitals lost its infectious diseases physician, and the Infectious Diseases Division started serving that hospital remotely.  The hospital was very pleased and word got around. Organically, they started servicing other UPMC hospitals; and then they landed their first non-UPMC hospital. The leaders of Infectious Diseases went to UPMC Enterprises, and they agreed there was a broader opportunity and on March 1, 2019, they spun ID Connect off officially.

How did you personally become involved in the creation of the organization?

I am a finance person, grew up in the public accounting sphere, worked as a CFO, and moved into operational roles. For the past ten years, I have been the CEO of telemedicine companies, including a tele-dermatology company, before joining Infectious Disease Connect.

I ended up being an operational CFO and loved that. I liked looking forward and planning and strategy, and so kind of morphed my career in that direction.

Since launching ID Connect, we’ve had great success. We continue to service the UPMC hospitals, but have added about eight new hospital customers that are not UPMC in four different states -- Virginia and New Jersey, and soon Illinois and Ohio.  It really proved the initial premise that there is a shortage of ID specialists.

Early on in our model, we thought we would be serving small to medium-sized hospitals. What we’re learning is that it’s just rural. For instance, the hospital system we serve in Virginia has 6 hospitals, including a 500-bed tertiary hospital.  There is a shortage of ID specialists in rural areas; specialists want to go to academic facilities to be with their peers and to teach and research. It’s really hard on rural hospitals to recruit and retain. I was talking to the CMO of a rural facility last year about ID care and he said, ‘We muddle through.’ What they ultimately do is they transfer a lot of patients. We invert that model. You don’t need to bring your patients to us. We’ll bring the experts to you.

And we get great reviews. We expected our results in KLAS to be good, but they were phenomenal. We really make our customers feel like partners. We do patient surveys as well, and those are glowing. A lot of people who have a telehealth visit find that it’s really high-quality, and the person on the other end of the phone is a top-notch physician.   We customize our service for our customers, bringing ID subspecialties to them in areas like orthopedics and pediatrics. We can right size the service so they don’t have to hire a full-time ID doctor.

How did the pandemic’s arrival affect your trajectory?

Before the pandemic hit, we wanted to provide more than services; we wanted to provide a software product as well. So we started to partner with ILÚM Health Solutions, a subsidiary of Merck, which had developed an infectious diseases clinical decision support tool that focused on antimicrobial stewardship. In March of last year, we purchased them and then integrated that company into our own, all during the pandemic. There are people in that company I haven’t yet met in person, just through Teams, but the integration has gone well.

And even though COVID-19 is an infection, it is  really something that your internists and intensivists are caring for. We were pulled in when people acquired secondary infections. But in March through June, hospitals were shutting down around elective procedures. And we weren’t marketing to hospitals during that timeframe. We had some customers we had signed that we continued to service and some  we had to wait to implement, which was understandable. July rolled around and hospitals started to look outward again and opened their doors. We started marketing again, and the pipeline filled up again. We felt like everybody just jumped right back in.

And in October through January, the second surge, we didn’t slow down. As we get to April and the second quarter, a lot more hospitals are going to look more into the future. A lot of hospitals are looking at how to manage their business post-COVID.

If there are positives to come out of this, one is that 2020 truly is the year that telemedicine gained acceptance. We kept saying for ten years, this is going to be the year. But finally, it really was ---consumers, doctors, everyone has accepted it.  So it’s here to stay, and so for us, that’s great. I’m talking to somebody now who said, a year ago, I wouldn’t have considered telehealth, but now, I’m in. And a lot of hospitals got caught flatfooted not being prepared for COVID. We are going to see more consulting for infection prevention and control. Do I have the right policies? Am I ready for the next pandemic, or the next antibiotic-resistant disease?

And then the other thing that got lost in this is that in March 2020, CMS had come out with some pretty strict rules around antimicrobial stewardship. It had been an area with rather loose rules. And CMS came in and said there are seven core principles you must follow, and it’s not by choice, and it has to be sustainable and evidence based. As we come out of this a lot of hospital leaders are beginning to realize that they need to focus on antimicrobial stewardship. And that’s been very important for us, after acquiring ILÚM.

Based on your organization’s experience as a consultative service in this area, what would you say are the critical success factors for making specialty-based telehealth programs work?

Great question. In many cases, we’re not coming in and replacing an existing service. We’re filling a huge void. I don’t have to sell executives on having to fill the void. As I said earlier and as the KLAS report noted, we’re bringing top-notch medical experts—the best of the best--to the bedside. And we are a part of their medical staff the moment we sign a contract with our partners. We round with them, we do educational seminars, we participate in grand rounds. We really do position ourselves as an extension of their hospital medical staff. We gain the confidence of the hospitalists and the intensivists. We make sure to document very rigorously.

So telehealth-based specialists cannot be seen as aliens who land in spaceships, they have to be seen as integral to the medical staff, correct?

That’s exactly right. We have very tight relationships with our customers, the CMOs and their staff. And once the pandemic is over, I look forward to getting back out and visiting clients. We’re also full-service infectious diseases. We bring patient care as well as consulting for antimicrobial stewardship. And we’re doing infection prevention and control consulting. I think hospitals love having the teams work together. It really becomes integral.

How do you see the future of specialty-based telehealth services?

If you look at the history of telemedicine, there was a lot of press about it, and you had publicly traded companies focused on the consumer-facing element in this area. But the better adoption has actually been in hospitals around patient care, but even there, there was minimal adoption. There was the idea that I’ve got to have doctors walking the halls. But that’s over now. This is just a natural fit. I think a lot of  hospitals in rural markets are going to say, here are my hospitalists and my surgeons, but I don’t need an infectious diseases specialist in the building; I don’t need a stroke specialist and other specialists in the building; I can bring in the best as I need them. I think you’ll see an increase in the use of companies like ours to extend care. And for infectious diseases especially, a lot of patients leave the hospital still on antibiotics; many are still on IV-delivered antibiotics.  We can make sure that they don’t get readmitted, and that antibiotics aren’t over-used. We will be focused strongly on the post-discharge phase with patients, as well.

Is there anything that you’d like to add?

The fact that we were able to grow during the pandemic says a lot about our model. I think there’s going to be an unmet need here. A lot of people put off their elective surgeries to post-COVID. So I think there’ll be an increased demand here in the next six to nine months, and we’re ready to help hospitals. I think people realize that you’ve got to be ready for something like this—another pandemic, or a drug-resistant disease—in the future. We’re lucky to be associated with UPMC, where you have a world-renowned infectious diseases group. And the shortage of ID expertise and the need for antimicrobial stewardship is not unique to the U.S. so there’s an opportunity to take this into an international marketplace in the future. Healthcare really is international, as COVID proved. We see a need for our services all over the world.

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