Reducing the time to diagnosis and initiation of appropriate treatment is paramount to intercept inflammatory damage in patients at the onset of rheumatic disease. But those targets can be delayed by provider shortages and other barriers to care. Since last June, Remission Medical, a virtual rheumatology clinic, has been partnering with Mayo Clinic to find ways to address those barriers.
Their agreement aims to further develop earlier time-to-treatment initiation in rheumatology and to increase predictive patient care. Now in its pilot study phase, the Remission Medical/Mayo Clinic collaboration will leverage patient-reported outcomes and clinic metrics with remission status, employing artificial intelligence (AI) and machine learning, to develop algorithms and predictive software to triage patients with telehealth and facilitate timely interception when symptoms are exacerbated, potentially avoiding urgent care and emergency department visits.
John Davis III, MD, vice chair and practice chair for the Division of Rheumatology at Mayo Clinic, says, “We are facing a critical shortage of rheumatologists, leading to gaps in access to care. It is paramount to provide access to care for people with rheumatic and musculoskeletal diseases living in underserved communities in the U.S., especially in rural areas.”
A Personal Investment
Closing the gaps in care and sustaining continuity in care during remission are issues that compelled Blake Wehman, MHA, to found Remission Medical. In fact, the genesis of Remission Medical was personal for him. Mr. Wehman’s experience with what he calls “navigating the labyrinth of rheumatology” pushed him to question whether it was possible to develop a better model to maintain remission for those with rheumatic conditions.
Mr. Wehman
At age 20, Mr. Wehman developed symptoms that were attributed nearly a year-and-a-half later to adult-onset, undifferentiated inflammatory arthritis. Finding his way to diagnosis through initial bouts of high fevers and pain, and then to remission, has been nearly a 10-year process.
After college—where he pursued a degree in healthcare management—he also moved several times, experiencing what are typical wait times for finding a new rheumatologist. He cycled through many treatments—etanercept (Enbrel), abatacept (Orencia), infliximab (Remicade), adalimumab (Humira)—before finally being prescribed the interleukin-6 inhibitor tocilizumab (Actemra). Although that medication worked for him, prior inflammation had already rendered his left hip damaged, requiring a total hip replacement. In Mr. Wehman’s mind, the need to go beyond the model of reactive response (i.e., using pain, inflammation levels and lab reports to direct care) led to a vision of building a novel composite picture of each patient’s true remission status.
Looking for the Fit
According to Mr. Wehman, Remission Medical’s propriety technology platform is intended to be “frictionlessly embedded” within electronic medical records (EMRs), such as EPIC. Remission Medical uses a machine learning program to filter patient data from its EMR and industry-accepted and approved patient-reported outcome tools, such as PROMIS (Patient-Reported Outcome Measurement Information System), RAPID3 (Routine Assessment of Patient Index Data 3) and PASS (Patient Acceptable Symptom State), and yield a remission score without adding additional workload to providers.
What Mr. Wehman envisions is a way for providers to press a button, ideally within the patient’s EMR, that would move patients into a virtual care pathway because of their remission status—“or automate them out of that pathway into a different pathway because their inflammatory markers are elevating.”
Next steps in this collaboration, he says, will hopefully lead to a way for providers to quickly see in their preexisting tool who’s doing well and who isn’t, and how that might align with practice management.
“We’re starting with just one small ripple in the pond,” he says, “which is, to ask, ‘What would you do if you could quickly organize and run your practice based on that stratification of remission?’”
A Multidisciplinary Approach
Once Mr. Wehman started Remission Medical, he sought to round out the services offered. Kyle C. Harner, MD, based in Greenville, N.C., and a partner in a private practice there, joined Remission Medical as chief medical officer in 2022. In addition to Dr. Harner, the company includes rheumatologist Emily Gilbert, MD, who completed her residency in rheumatology with the Mayo Clinic in Jacksonville, Fla. Completing the executive team are counselor Marie Celano, LCPC, Chief Clinical Officer Bhavika Amin, NP, and Chief Growth Officer Pete Celano, MBA.
State-by-state licensing is required for any provider conducting telehealth, an ongoing requirement. Dr. Harner, for example, has obtained licensing in 20 states. Concurrent with the Mayo Clinic work, Remission Medical is using EPIC for initial visits with patients, some of whom are self-referring thanks to Remission Medical’s partnership with KeyCare.
Dr. Harner
In addition to its partnership with the Mayo Clinic, Remission Medical has announced partnerships with Ortho Virginia, a large, independent orthopedic practice; Sentara Health, a major health system in Virginia; and Sterling Medical, a prominent multi-specialty, urgent care clinic in Idaho.
“Through these partnerships, Remission Medical is able to envelop our technology-enabled services to improve access to care for these partners’ preexisting patient populations and medical groups,” Mr. Wehman says.
In addition to consults, Remission Medical works with patients to help find nearby services for treatments, such as infusion suites, as well as generating lab imaging study orders for patients’ locales. “The big drivers [to enroll with Remission Medical] have been convenience for some people, and then just trying to get answers because patients cannot get in anywhere else,” notes Dr. Harner.
Benefits of the COVID-19 Pivot
Many rheumatology practices have begun incorporating telehealth, especially after the pandemic, which acted as a catalyst for expanding virtual patient visits. Dr. Davis says: “It makes sense for telerheumatology platform companies to work with academic rheumatology centers, so patients with more serious or complex conditions have access when necessary to in-person examination, diagnostic testing and other consultations for evaluation of the diagnosis and plan of care.
“To track health outcomes, monitor population health, and predict disease relapses and complications, it is important that we develop digital tools for remote monitoring and predictive analytics,” Dr. Davis continues. “Lacking physical examination is a barrier in telemedicine but also an opportunity to leverage digital sources of data, including patient-reported outcome measures and data from wearable technologies, to devise intelligent tools that assist and inform longitudinal management.”
These tools could go a long way to help others fare better than Mr. Wehman initially did and to help transform the experience of “navigating the labyrinth of rheumatology.”
Gretchen Henkel is a health and medical journalist based in California.
