Population health and digital health endeavors are heating up across the country, but many good lessons can be learned from projects that began early and grew along with technology. One of the biggest lessons? It’s not all about IT.
Healthcare Informatics spoke with Lauren Faison, service line administrator over regional development, population health and telemedicine at Tallahassee Memorial Hospital, about the evolving world of digital health, personalized medicine and population health management. Tallahassee’s telehealth initiative began in 2012 and is still evolving today—as Faison believes it must.
What’s the difference between digital health and telehealth?
Digital health is about pulling together all the pieces of somebody’s health story. Thanks to the genomic revolution, we can look at our genetic makeup and family histories to try to determine what things we might be at risk for. So, digital health is really about pulling all of these pieces together, doing some predictive health analytics to figure out somebody might be at risk for, and informing people how to maximize their health by being aware of these things.
Telehealth is just a modality for delivering healthcare. And I actually hope that the “tele” part of the word will go away. Healthcare is healthcare. Telehealth is just one tool that enables practitioners to reach patients in a different way, so that the notion of geography, transportation and other barriers that impact flexibility of care aren’t in the way.
What has today’s data analytics done to evolve the way we look at patient treatment plans?
At first, we had to figure out how to capture the information and get it in one accessible place. Now, we can look at all the pieces of the puzzle, including health patterns, reactions to medications, genetic testing results and what illnesses are involved. Precision medicine is one evolution of this, where we can predict how a person will react to certain treatments or drugs, and then clinicians can formulate treatment plans that are best suited to that patient.
What are some of the big lessons you learned on telehealth integration?
The main thing is to look hard at how physicians need to interact with a patient virtually versus in the office. You can’t just set up a telehealth system and expect clinicians to use a whole different workflow for virtual visits.
What impacts has the program had on population health?
We started with discharge patients who have high-risk conditions, but now we also have partnerships with homeless shelters and have telehealth connections to them. We also connect to pharmacists and social workers. If a patient that has a question about medication, we can do a 15-minute virtual triage with them just to see what's going on, rather than having them dial 911 or show up at the emergency room. We’re trying to provide the connections we need to keep people out of the hospital and help patients through the communication gaps that often happen after discharge.
The acute care line focus is on the treatment, but some of our patients are just barely getting by and worried about where their next meal is coming from or when they can go back to work after being hospitalized. For some, treatment compliance is the last thing on their mind. So, we do a lot of listening and try to break down the complicated socioeconomic situations so patients can begin to understand their health and can tackle one thing at a time. Probably 80 percent of what we do is social work.
It all has an impact on reducing readmissions. We’ve learned that one of our biggest metrics is getting them connected to ongoing primary care. So, we focus on getting them in with a primary care provider or a free clinic even if we need to get them a bus pass—whatever we have to do to get them there. But the end results show us the opportunities we have to improve what we do in acute care as well.
How has the program impacted equal access to quality care?
It seems even lowest income patients have a smartphone, or live with someone that does, or have the neighbor, somebody like that. Everybody’s got access to this now, so we can use smart phone technology to do outpatient interventions. It saves everybody time and money. It reduces needless trips to the ER and panic or worry for patients while we can catch issues early on that could become acute episodes later.
What’s the next feature on your wish list?
One of the big problems is that nurses end up managing phone calls instead of caring for patients. I actually dream of a call center with a bank of dedicated nurses who have access to the actual patient record and are available 24/7 to answer questions from patients. Whether a patient says, “I can't find my prescription pills, what do I do?” or “I’m caring for my mother with COPD, what do I do?,” it would be a customer service-driven service that makes patients feel comfortable and gives them meaningful answers instead of generic advice.
Hear more about TMH’s telehealth implementation at the Health IT Summit in St. Petersburg, Florida, July 24-25, 2018.