Article by Emma Penrod

Like many in behavioral health field, researcher John “Fred” Thomas was skeptical that telemedicine could deliver the same results as in-person care by a psychiatrist. Then a hurricane hit the town where he and his colleagues had received a grant to study telehealth outcomes.

While interviewing a young parent in the storm’s aftermath, Thomas said, she confessed that her child—an elementary age kid—had not been able to focus in school, which did not have the resources to help. “And she looked at me, and started crying and said, ‘this has changed our lives,’” Thomas said. 

Watching telehealth heal a community that had been evacuated, Thomas said, “sealed the deal” and convinced him of the need for a more flexible health system. Seventeen years later, he now leads telehealth initiatives in diverse disciplines as the executive director of the Extension for Community Health Outcomes (ECHO), a Colorado-based nonprofit dedicated to improving access to healthcare through technology.

It’s not just doctor’s minds that are changing—technology, health practitioners say, has also changed the way they operate, making healthcare more efficient and cost-effective by reorganizing medical teams while, perhaps surprisingly, increasing the amount of time specialists spend with patients.

Telehealth, Thomas said, is “not a lesser form of care,” as he once though, but “just a more convenient kind of care.”

Traditionally, he said, children with complex medical conditions such as diabetes or asthma would miss school, forcing their parents to take time off work as well, to travel for treatment. ECHO uses technology to do the reverse—bringing specialists to the students. Specially trained in-school nurses, in consultation with remote providers including pulmonologists and psychiatrists, provide in-person treatment at more than a dozen schools via ECHO-backed initiatives.

Utilizing school nurses—who have the capacity to administer care and who are already located where the patients are—“makes a whole lot of sense, if you’re thinking about how to do care that costs less, is as or more effective, and is satisfactory for both the patient and the provider.”

Using technology to reconsider how health teams are deployed is also far more efficient, according to Todd Allen, a PC Case Manager who oversees care for more than 150 patients at Four Seasons, a North Carolina-based palliative care nonprofit.

Initially, the Four Seasons team was structured much like any other home health operation, Allen said. He traveled from one home to the next, checking in on each patient and consulting with a physician about prescriptions and care decisions. But it wasn’t working—“there weren’t enough hours in the day to get it all done,” and things were falling through the cracks, Allen said.

So Four Seasons decided to try something different. Allen would work from his home office, deploying nurse practitioners and other professionals such as social workers for in-home appointments, while fielding communication with patients and ordering prescriptions and supplies.

The team committed to try the new structure for three months and never looked back. Although at first it seemed backwards to have more highly trained practitioners performing hands-on duties, it was far more efficient. Instead of waiting hours or days for approval from a doctor, if a patient needs medical care or a prescription, Allen files the order immediately, cutting out the back-and-forth. They saved additional time by shifting team communication from phone calls to encrypted SMS messaging, where they can share pictures and documents.

Although he spends less time talking with the other members of his team, Allen said, the SMS enabled rapid, more frequent communication that actually “brought the team very close together, and there is very little wait time.”

Four Seasons physicians now spend far more time one-on-one with their patients—anywhere from 45 minutes to 2.5 hours. And in spite of the lengthy appointments, Four Seasons has actually cut costs. The project initially required grants and outside funding to support its efforts, but now breaks even, Allen said.

But his role, Allen said, is a heavy lift for the RN. It may involve less hands-on work, but it requires far more tech and medical savvy than is typically required of an RN. Four Seasons specifically sought Allen for the job thanks to his background in information technology. Other team members, Allen said, have “quit because they could not handle the technology, and not all of them were old.”

Other providers have similarly recalibrated their teams while deploying telehealth programs. Utah-based Intermountain Healthcare plans to spend the better part of a year writing new guidance and retraining staff as it prepares for the 2020 rollout of new remote patient monitoring initiatives to manage conditions such as COPD and high blood pressure.

Technologies such as remote patient monitoring enable team members other than the primary care provider to interact more authoritatively with patients, said Brian Wayling, who oversees technology and development at Intermountain Healthcare. If, for example, the primary doctor is unavailable, another member of the care team may be able to step in and make recommendations based on the patient’s data and care history. As with Four Seasons, Intermountain has also discovered that remote care requires more centralized management. And that, Wayling said, necessitates a “re-imagining of how care could be performed.”

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