COVID-19 spurred Houston-based AccessHealth to rapidly scale up its telemedicine offerings, simply as it made with most other health systems across the country. And similar to those other health systems, AccessHealth dealt with many challenges in the beginning, in attempting to adjust to this new regular.
THE PROBLEM
The health system dealt with client, staff education, infrastructure and reimbursement obstacles.
Staff also had to decide how they were going to inform patients on the platform. Within that training, staff members discovered that they needed to provide their clients comfort along with convenience. Doing this made it possible for patients to understand that a telehealth visit did not mean less quality.
Patients experienced a lack of resources in the locations of having information protection for video transmission and living in rural areas where there was not a significant signal, which affected how e-consents would be signed.
” When it comes to staff education, training the personnel in multi-departmental transitions was needed for our patient-centered medical home status,” said Jared M. Williams, CFO and senior vice president at AccessHealth. “Then we needed to ensure the right coding and paperwork was satisfying for insurance billing purposes.”
They also had to make sure that all personnel understood the types of telehealth gos to that were helpful to patients. This help in avoiding misdiagnosis throughout a telehealth visit and in decreasing the variety of possible symptomatic clients exposing healthcare employees.
” Utilizing the functions of the telehealth platform, the counselors had the choice to still see the client from their workplace through laptop to carry out the required screening and counseling.”
Jared M. Williams, AccessHealth
” On the infrastructure front, operating at an increased capacity, we needed to ensure that we had area for a seclusion space,” Williams explained. “With an increased capability, internet bandwidth was a concern in the areas of workflow and client gain access to. Buying gadgets and platforms due to rates was an issue, and HIPAA-compliant platforms and cybersecurity [were concerns] for PHI/patient security.”
Finally, prior to CMS loosening telemedicine policy for the pandemic, reimbursement was an issue. Team member were unsure if Medicare and Medicaid would honor the prospective payment-system rate. Choices were not made yet on the level of payment.
PROPOSAL
NextGen and Zoom for Healthcare both were proposed as telemedicine vendors. Considering time restraints for implementation, Zoom made the most sense for a fast application.
Personnel would provide Zoom telehealth abilities for medical and mental health patients. DocuSign, NextGen and Care Message were also utilized in order to have actually required documents signed, co-payments collected and consultation suggestions sent.
MARKETPLACE
There are numerous suppliers of telemedicine technology and services on the health IT market today.
FULFILLING THE CHALLENGE
Concerning psychological health, Zoom was the easier platform to execute, given that there were multiple licensure capabilities. The platform was user-friendly and its prices budget-friendly, Williams said.
” Execution with Zoom started with our psychological health department,” he stated. “Prior to the instant switch, we checked the platform with each company and asked each client if they want to have a telehealth see.
” To our surprise, patients elected to have phone and video consults,” he included. “Using a patient service planner to schedule and contact patients to get required documents and payments showed to be an effective workflow. Standard treatment through telehealth is the popular option.”
Screening, short intervention and recommendation to deal with, or SBIRT, is a program that falls within the mental health world. AccessHealth’s licensed chemical dependence therapists are incorporated within the medical adult centers. These counselors provide chances for early intervention with at-risk compound users before more severe effects occur.
” It is essential to note that this model is various than standard therapy,” William explained.
In addition, this process equaled for the mental health therapists (therapists and psychotherapists) who are integrated within the scientific setting, he included.
” Medical clients likewise were steered to telehealth visits using the exact same procedure,” he said. “Client education within adult and pediatric centers were doing not have enormously. A big part of our patients preferred to still come in, and need the ‘company’s touch.’ The older population transitioned much easier than patients under the age of50 While Zoom did whatever that was required in the telehealth world, we acknowledged a need for gadgets that could enable safer client care.”
RESULTS
The hard results AccessHealth so far has accomplished are an increase in visits and a boost in clinical-quality procedures. A couple of metrics staff determines that can be measured are:
- Portion of clients with HbA1C blood glucose level of 9%or listed below. In 2019, AccessHealth was able to reach a compliance rate of 71%by incorporating multidisciplinary departments with medical concerns, such as psychological health, nutrition, care coordination and social determinants of health. To date, AccessHealth has been able to maintain that rate of compliance utilizing the telehealth platform to gauge patients in the areas of medical visits/follow-ups, mental health, nutrition, care coordination and social determinants of health.
- Portion of clients evaluated for depression with treatment strategy documented. Clients screened for depression with a treatment strategy documented increased 5%year over year. Using the technology platform enabled all celebrations involved to get in touch with patients for check outs, evaluations and follow-ups.
USING FCC AWARD FUNDS
AccessHealth was granted $439,286 for telehealth carts and network upgrades to increase clinical capacity and avoid more neighborhood spread of COVID-19 by dealing with primary care clients remotely for COVID-19, diabetes, high blood pressure, asthma, and other illness and health problems.
” The overarching goal for the FCC grant is to supply quality, inexpensive healthcare for low-income, underserved, uninsured children and adults in Fort Bend, Harris and Waller Counties whose household earnings are less than 200%of the federal poverty level,” Williams noted.
Recognized health needs include:
- Growing uninsured population in requirement of access to main healthcare.
- High occurrence of chronic illness: weight problems, diabetes, depression and anxiety.
- COVID-19 testing, treatment and avoidance procedures to stop community spread.
Factors that will be tracked to measure impact include:
- Percent of patients with HbA1C blood glucose level of 9%or below.
- Percent of clients with blood pressure at or listed below 140/90
- Percent of clients recommended appropriate treatment for asthma.
- Percent of clients screened for anxiety with a treatment strategy recorded.
- Percent of patients evaluated for BMI with a treatment plan documented.
- Number and percent of client care encounters offered via telehealth.
” Telehealth is required now more than ever to continue securely providing necessary healthcare services to locals of Fort Bend, Waller and Harris Counties,” Williams said. “Connected care services to be supplied by AccessHealth with the grant include medical care for adults, pediatrics, prenatal care, behavioral health and nutrition services.
” New telehealth equipment will increase AccessHealth’s clinical capacity to prevent more neighborhood spread of COVID-19, as well as gain access to main and specialty care.”
Conditions to be dealt with include COVID-19, diabetes, high blood pressure, asthma, COPD, HIV, cold, sinus infections and other physical health conditions, along with anxiety and stress and anxiety, he included.
As the community’s safety-net doctor, AccessHealth will maximize hospitals to concentrate on COVID-19 patients. The new telehealth equipment will permit AccessHealth to care for 20,000 patients who otherwise would have extremely few choices for quality preventive or main healthcare, he stated.
Telecommunications services and gadgets required to allow the provision of telehealth services include:
- Telecoms services and broadband connectivity services, consisting of voice services and Web connection services for doctor or their patients.
- Info services, including remote patient tracking platforms and services; client reported outcome platforms; shop and forward services, such as asynchronous transfer of patient images and data for analysis by a doctor; and platforms and services to provide concurrent video assessment.
- Internet-connected devices/equipment, including tablets, mobile phones or connected gadgets to receive linked care services at home (for instance, broadband-enabled high blood pressure displays and pulse-oximeters) for client or healthcare provider usage; telemedicine kiosks/carts for healthcare provider website.
The proposed gadgets to be utilized are Medpods by Henry Schein. Medpods make it possible for providers to break down the barriers of standard care shipment and produce new care pathways, all while complying with federal and regional law, FDA, HIPAA, and CMS mandates and guidelines, Williams said. A few of the highlights of this device include:
- Live video speaks with telehealth diagnostics.
- Intense care, sub-acute care, immediate care or ambulatory care.
- Expanded service offerings, including specialized care and practice reach.
- Hub-and-spoke operations.
- Health care microsites, consisting of schools and worksites.
- Resource load balancing.
” Medpod telehealth will enable top quality, remote physician-patient encounters on par with an in person check out,” Williams concluded. “It consists of integrated, professional medical gadgets that make it possible for improved medical evaluation abilities; live video, audio, clinical and laboratory data-streaming, and remote tele-diagnostic device control; supplier access through web internet browser, no software to set up; EHR integration; and the Medpod platform [that] makes it possible for both fee-for-service and value-based models.”
Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
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