Over the past few months the country is increasingly becoming aware of the term Telehealth, a phrase that just over two months ago might only have been used by medical professionals. Today, “video visits” are common and offer people interaction with their providers from the comfort and safety of their homes. COVID-19 redefined the typical doctor visit for many, but for some, Telehealth has been an integral part of healthcare practice for over a year.
Jim Racht is the Telehealth Program Manager for Care Compass Network (CCN) and has been leading the pilot program that includes six skilled nursing facilities (SNF) within CCN’s nine-county region. The Telehealth Consult Program was designed to help prevent unnecessary emergency room visits and hospital admissions as well as to reduce the number of readmissions. The results have also eased the burdens on hospitals and medical professionals.
“The second major piece of the program provides behavioral health services, something rarely available within a SNF,” explained Racht. “In a rural area such as Groton, New York it might take a provider up to one hour to make an in-person visit for a behavior healthcare need, or the patient may have to be transported as far as Syracuse to see a specialist.”
Dr. Nasar Khan has been a part of the CCN Steering Committee and is the President and CEO of Groton Community Health Care Center. “Any opportunity I get, I advocate for Telehealth,” Kahn emphasized. “When medical providers are able to manage the health of their patients well using Telehealth and Telepsych services while avoiding sending them to the emergency room unnecessarily – that’s huge.” Khan points out that for many elderly patients, an emergency room visit can put them at greater risk especially during the COVID-19 pandemic. The experience can be traumatic for someone with dementia. “For them, every day is a new day. When you send them for an avoidable emergency room visit, it causes further confusion, elevating their struggle to make sense of things. We need to always do right by our patients and avoid these situations whenever possible.”
Dr. Darshan Patel is the Medical Director for Groton Community Healthcare Center and is the physician responsible for all of the patients there. “With Telepsychiatry, we can engage the patient in a video evaluation and prescribe the best medicine when needed,” said Patel. “Telepsych has also helped patients ween off their medication and, consequently, we’ve seen a huge improvement.”
Over three and a half years, Patel has come to know his patients and families well, emphasizing that their safety and quality of care are his top priority. Being the sole physician responsible for 80 patients, 24 hours a day, seven days a week can take its toll. When the Consult Program became available for Groton Health, Patel and his patients benefited immediately. “Nothing will completely replace the in-person doctor-patient relationship, but for those unpredictable circumstances late at night or over the weekend, the technology we’ve employed has been a significant tool,” explained Patel.
Curavi Health, one of the Telehealth vendors vetted by the Telehealth Steering Committee, provides access to a team of providers during the hours of 6 PM until 7 AM on weekdays and throughout the weekends. Patel is no longer paged in the middle of the night. Instead, a staff member can initiate a video-visit using a mobile unit wheeled from room to room. “Patients with Chronic Obstructive Pulmonary Disease (COPD) or Congestive Heart Failure (CHF) have frequent, unpredictable flair-ups. If they go into respiratory distress at night, it helps to have the providers available through Telemedicine to get patients the help they need as soon as possible,” Patel shares.
The device is similar to an iPad and provides complete video interaction between the patient and a Curavi practitioner while the nurse is present. Following the video-visit, the doctor prepares notes that Patel receives first thing in the morning. Meanwhile, the patient’s immediate concerns are addressed, treatment is administered, and an unnecessary emergency room visit is often avoided.
Along with Groton, pilot participants include Absolut Care in Endicott, Bridgewater Center for Rehabilitation and Nursing in Binghamton, Vestal Park Rehabilitation and Nursing and Willow Point Nursing Home, both in Vestal and Elderwood at Waverly. As of the end of April 2020, Racht reported that all six organizations cumulatively facilitated 1,964 Telehealth consults with 1,182 addressing off-hours patient changes in condition. 323 visits or 27.3% of the total were determined to have directly avoided hospitalizations.
Gerould’s Professional Pharmacy, Inc. began their own Telehealth project last year, providing healthcare support to patients with COPD. Cheryl Henninger is the Director at Gerould’s and manages a team of five respiratory therapists along with several outreach support personnel, customer service representatives, and service technicians. They have 700 patients enrolled in their respiratory program, many using Tap Cloud technology. “We deployed our Telehealth program last fall and have been working on the strategic plan for the past 18 months,” Henninger shared. “The Tap Cloud device helps patients stay engaged and involved in their own health management.”
Typically, the respiratory therapist makes an initial visit with the patient, helps them install the app and completes an overall clinical, social, and home assessment. Moving forward, the patient has the ability to complete daily check-ins using word clouds to help describe how they are feeling. Different levels of self-assessment are color coded using green, yellow, and red, alerting the therapist when it might be time to reach out to the patient. If the assessment scores yellow or red, the Gerould’s respiratory team gets a real time alert so they can respond.
Prior to the COVID-19 pandemic, the team at Gerould’s had been working on networking other devices to help monitor patients using remote blood pressure cuffs, oximeter, scales, and spirometers. Presently, the providers are utilizing Tap Cloud’s video health technology to carry out the initial visits and follow-ups virtually. “Tap Cloud has a caregiver app for our patients’ family members. It allows them the ability to use their tablets or smart phones to respond on the patient’s behalf,” explained Henninger.
Monitoring results quarterly, Gerould’s reports that Telehealth has increased patient engagement significantly. The program has also been expanded to include patients with obstructive sleep apnea. Emergency room visits and readmission rates are between 7-11% compared to the national average of 21-27%. “Some patients are so connected with their therapists, they send i-messages just to say ‘hello’,” says Henninger. “Telehealth is the new normal for us and for our patients.”
For Julie Steele, Director of Practice Operations for Cayuga Medical Associates (CMA), COVID-19 required an immediate transition to telehealth. She worked with her colleagues in primary care and specialty practices to get video visits online in a matter of days. “I partnered with many of my colleagues within Cayuga Health Partners, Cayuga Medical Center and Cayuga Medical Associates. The practitioners were the driving force prioritizing which visits were most appropriate for utilizing the technology.” Steele noted that Dr. Elisabeth Cotton with the internal medicine practice was the first provider to use Telemedicine in the face of COVID-19. “Dr. Cotton is a phenomenal physician team leader who stays the course when something new is rolled out. She helped work out the kinks, trained others, and created solutions.”
“COVID propelled us into the middle of Telehealth ready-or-not,” explained Cotton. “All of a sudden clinics were empty and patients were staying home as directed. There were still medical issues that needed ongoing management and the only way to address them was to use telemedicine.” In the span of two weeks, Cotton and her team were online “seeing” patients. Cotton described the transition as a group effort, fast and furious in the beginning, but now in retrospect, the practices are looking at how telehealth will be used going forward.
“Some organizations have been doing this for a while already,” shared Cotton. She sought examples from other organizations and used their tested protocols as a guide for her teams. “We did some role-playing with different patient scenarios, experimented to figure out the technical side of it and then jumped right in.” The providers learned quickly that most visits beyond physicals, imaging, and emergent conditions can be completed via telehealth.
Dr. Cotton and others believe that Telehealth is here to stay. During the pandemic, payer reimbursements have been covering video-visits at the same rate as in-person visits and this has helped move telemedicine forward. Providers and patients alike are seeing the long-term benefits and are hopeful that Telehealth will continue in a post-COVID world as well.