What does it take to build a successful telehealth program that harnesses the technology capabilities for digital health while gaining the outcomes the local population truly need? Hospital systems keen on reducing chronic care costs and unnecessary readmissions might want to take a look at what’s going on in Tallahassee, Florida.
Over the past five years, Tallahassee Memorial Hospital (TMH) has become one of the few healthcare organizations that has broken down healthcare delivery silos between acute care delivery and community wellness programs. TMH’s approach began at the hospital and branched out into transitional care, rehabilitation and a community wellness center.
The project is being led by Lauren Faison, TMH’s service line administrator over regional development, population health and telemedicine. Of interest, Faison isn’t an IT professional. She isn’t a clinician, either. But, she does know how to take a bull by the horns. “My role is merging all of the piece of the project,” she tells Healthcare Informatics. “What does the operational piece look like? What information would be most valuable for the clinicians to have at their fingertips? How can we deliver the information they need so they can spend their time providing clinical care instead of searching for data? I help bridge the gap between all these different institutions.”
She says her current job role at TMH could be an emerging one in the industry, as more health organizations seek ways to reach across the organizational barriers and implement digital health as a mainstay for improved outcomes long after a hospital discharge—much like the emergence of the CMIO role. “Telemedicine isn’t just an IT project, and it’s a mistake to think of it that way,” she insists.
The Local Mission
In part, the telehealth initiative stemmed from the facts of the Tallahassee region, which includes sizeable populations of homeless and under-insured patients, Faison noted. “If you look at our demographics in Florida, we're surrounded by very poor, very rural communities with little public transportation and very few health services. Once discharged from the hospital, patients couldn't get the follow-up services they needed. Or, they couldn’t get any specialty services at their local rural hospital. We needed to find a way to increase access to care while also being able to monitor them from their homes. We wanted to be able to talk with them about their medication, hear how they're feeling and watch their blood pressure without making them travel.”
The telehealth program began in earnest in 2012, with the acquisition of telehealth equipment to provide a link for high-specialty services between Level-2 trauma center and outlying areas. Like most successful implementations, it started with a lot of homework. “We spent a lot of time in Georgia where they have wonderful telehealth legislation and seeing how their networks are set up and how their technology works.” The team also spent months assessing available technologies and getting input from IT and the clinical side.
Once the specialty trauma services were set up, Faison developed a program to extend telehealth services to high-risk patients upon discharge, tackling the success rate of the crucial 90-day post-discharge window. Early focus was on patients with chronic heart failure, pneumonia and cardio-pulmonary issues—classic conditions whose outcomes benefit from close monitoring 30 days post-discharge.
While many of TMH’s patients have socioeconomic challenges, nearly all of them had a cell phone, Faison explains. “Sometimes it’s just about a voice call to say, “How are you feeling right now?” And, we can touch base to remind them about appointments and see if they’re taking their medications correctly. When people leave the hospital, they’re given a lot of instructions, but they’re still not feeling well and can be overwhelmed easily, especially when they don’t have a solid support system.” One of the biggest fail points in healthcare deliver, she says, is the follow-up stage.
Digging Deep into Population Health
Successful telehealth programs need to dive deep into the needs of the local community, focusing on the barriers to healthcare access and the reasons why patients are at high risk. “We look at things like patients who visit the hospital three or more times in the past year. Do they report not having a primary care provider? Do they not have insurance? Within our hospital EMR [electronic medical record], we have a button that case managers, nurses and physicians can push to indicate if this person is at high-risk for readmission and whatever their barriers are. If we can't see them physically because they can't get to us, we'll see them virtually through telemedicine.”
Reducing readmissions means delivering quality follow-up services as they’re needed, and that means offering access via telemedicine to much more than a case manager or ask-a-nurse service. “We have a pharmacist, we have a social worker, we have the clinicians, and we have this multidisciplinary team that all meets with the patient to see what their barriers to care may be,” she says. Faison even got the homeless shelters involved, including the community social workers.