The COVID-19 pandemic has widened acceptance of telehealth, for both healthcare providers and patients. Many healthcare organizations scrambled to implement telehealth as lockdowns occurred throughout the country, while others already had systems in place and needed to scale them up – in a big way. Some were new to the technology, adopting a trial-by-fire approach by necessity. While the pandemic continues, healthcare organizations are opening back up, but realizing that telehealth is here to stay to some degree. It’s now possible, though, to get some distance to evaluate wins, continued challenges and lessons learned from the past year.
Maven Wave’s senior principal consultant in healthcare, Paul Nelis, held a roundtable discussion in August to discuss this issue with healthcare leaders. The roundtable included Brian Herrick, a family physician and chief information officer at Cambridge Health Alliance (CHA) in Massachusetts; Iris Berman, vice president for telehealth services for Northwell Health; Caleb Soileau, director of technology strategy at Amedisys, a home health and hospice company in Louisiana; and Kalyan Pamarthy, product manager for Telehealth at Google Cloud Healthcare and Life Sciences
Telehealth in early pandemic days
The leaders shared insights from their organizations’ use of telehealth during the lockdown.
Cambridge Health Alliance
CHA is a safety net public health system academically affiliated with Tufts and Harvard. Their work focuses on primary care and behavioral health, serving 125,000 primary care continuity patients at two hospitals and 15 outpatient clinics. Three-quarters of their patients are in underserved populations, and 50% speak a different language at home. Given their patients’ multigenerational living arrangements, this group was hit hardest and earliest by COVID-19. “We had to figure out pretty quickly how we were going to transition from population health outpatient work to critical care, and expand our critical care capacity really quickly,” Herrick said.
That meant adopting wide-scale virtual visits. Within a week, about 30% of their ambulatory visits, 50% of primary care visits, and 95% of behavioral health visits became virtual. “It was a pretty dramatic change for us,” he said.
CHA used Google Meet for telehealth visits, which had the added advantage of being able to include family members, especially helpful for family members who were isolated. “We could have these video conferences with patients and their families and give them a connection they otherwise would not have.” CHA relied on Google products for five years prior to the pandemic, making the clinical and operational adoption of telehealth fairly seamless, Herrick said. Maven Wave integrated Google Meet into the CHA workflow so the provider could directly connect from the EHR, while the patient connected from the patient portal. CHA knew it was a secure connection, also preventing patient access to provider data. “Those enhancements were turned around really quickly with Maven Wave and Google.”
CHA is now working with Google on creative solutions for remote telemetry and pulse oximetry monitoring, including the potential use of Nest.
With 23 hospitals, Northwell Health is New York’s largest health system, covering a wide variety of populations. Northwell increased their ambulatory visits from a few hundred per year to as many as 8,000 per day. They’ve settled into around 1,500 per day, as the sites reopened and COVID-19 numbers decreased in New York. Northwell Health already offered tele-ICU in several units, covering 175 critical care beds, but they had not clinically rolled out the program when COVID-19 hit.
The biggest barriers they experienced to telehealth prior to the pandemic were licensing and regulatory measures, and reimbursement. The federal government relaxed these regulations and offered payment, with private payers also agreeing to reimburse these visits. “ROI has always been the bane of our existence prior to this,” Berman said. “The ability to have reimbursement was big and assisted with accelerated adoption, but our home care did thousands of visits using telemedicine and found it was highly efficient and saved lives despite not receiving reimbursement.”
Amedisys, a leading national home health, hospice, and personal care company, serves a population that is majority federally funded. During the pandemic, their hospice care service line was able to leverage telehealth as a method for multiple visit types. They have completed thousands of telehealth visits for those with in-home care. “We’re able to do [telehealth] pretty rapidly through our current teleconferencing system,” Soileau said.
Telehealth for home health poses more complexity, and they are still working on a model there. Clinicians treat specific conditions and need data from patients, like blood pressure, weight, temperature, and pulse oximeter readings, that many patients are not adept in obtaining. An in-home caregiver is often needed to help with these challenges.
Amedisys sees engaging with an elderly, health-compromised population that is sometimes living alone as an upcoming challenge. Social isolation is difficult and the one potential social interaction the patient may be looking forward to is now in front of a video screen instead of in person. “That’s further distancing and isolating them,” Soileau said, and that needs to be considered long term.
Google Cloud Platform (GCP)
The Google Cloud Healthcare and Life Sciences team has been exploring solutions for telehealth for a few years, to determine how to add value in the telehealth ecosystem with its scalable video infrastructure and AI/ML capabilities. “Due to the impact of Covid-19, we went from telehealth being an exploration activity to needing to deliver a solution pretty quickly,” said Pamarthy. Google Cloud has various healthcare offerings helping provider systems securely manage data in the cloud, and it extended these offerings to include video-visits for telehealth. Google Cloud customers started reaching out for an easy-to-use, scalable telehealth solution utilizing various Google Cloud assets like G Suite, Google Meet, and Cloud Healthcare API to address healthcare needs during the pandemic. As a response to this need, Google and Maven Wave teamed up with CHA to provide a secure telehealth system with a custom interface and workflow. Additionally, Nest, a Google company, recently launched a solution using smart cameras for remote patient monitoring in the hospital setting, in the broader healthcare system.
The pandemic approach to telehealth, and future directions
While technology is important, the workflow took more focus. “We spent the majority of our time working with our project team on workflow,” Berman said. The technology is the first step, but the majority of time was spent determining how to make the process work while caring for patients safely. Language interpretation is one example. Northwell Health had interpretation built into the audio portion of their ambulatory software; they could use that software in mobile carts in the EICU, often avoiding the need for a third-party translator. “The ability to have multi-party conferencing during an event or end-of-life discussion was very, very critical, and it brought a highlight to specialty care that I don’t think people thought about before,” Berman said.
Berman also found that telemedicine increased efficiency in some cases. A surgeon told Berman that he’s been more efficient using telehealth for follow-up and consult visits, as he can see patients in the morning at home while his kids are sleeping. He increased his caseload without affecting his lifestyle and converted non-productive time to be productive.
That efficiency can also translate to home health. Soileau said Amedisys can’t afford to wait for reimbursement rates to drastically change before they start implementing a telehealth system. They need to construct their process now. A nurse may drive several hours a day to visit five patients. A nurse that doesn’t have to drive can see seven or eight patients a day. Physical therapists who can do the initial visit by telehealth and demonstrate how to do an exercise that way can also save time and see more patients. Or the patient can watch a prerecorded video before the visit and then ask questions during a virtual or in-person visit. “That’s the sort of thing we’re looking for next steps; expansion and understanding what changes in our business process and our use of it,” he said. That includes possible expansions beyond just a video call and determining what expenses are involved.
Northwell continues to consider lessons from their scale-up. They had growing pains with the scheduling system, getting everyone to talk to each other. That’s especially difficult in a large health system. Documentation is key, as is crafting a cohesive experience for the patient and the provider. “We can’t forget that the provider is also our customer in telehealth, so it has to be good for them too,” Berman said.
Google continues to imagine their roadmap for enhancing GCP integrations to improve the telehealth user experience. That includes bringing together all the Google assets, across remote patient monitoring, email, video and consumer services, and partner services to deliver a consistent telehealth experience, and including AI services such as medical translation and transcription data management and analytics through the Cloud Healthcare API is already widely deployed in healthcare.
“We’re getting strong signals from our conversations that telehealth is here to stay, and many health systems are starting to plan for the next phase of telehealth,” Pamarthy said.
Healthcare organizations looking to implement telehealth can partner with Maven Wave to deliver HIPAA compliant solutions that work for both their doctors and patients alike. As the first Google partner to create an Epic connector to Google Meet for telehealth, our experts can show you how easy it is to adopt and get your healthcare system on board. Contact us to learn more.
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