Hawaii Health System Meets Island Community, COVID-19 Needs With Telehealth

Due to Hawaii’s island geography and relative isolation, it faces unique challenges in delivering healthcare services – a fact that staff at Queen’s Health Systems in Honolulu, Hawaii, know all too well. good.

This was true even before the COVID-19 pandemic, when the primary focus was the provision of tertiary specialist services to patients living in rural Oahu communities and those on neighboring islands.

Over the past decade, Queen’s Health Systems has established telehealth services to meet patient needs, starting with hospital-based telemedicine and expanding to direct-to-patient telehealth services.

More than 10 years of manufacturing

“Like many organizations, we started our telehealth journey over ten years ago with telestroke and telepsychiatry,” said Dr. Matthew Koenig, medical director of telehealth. “Over the past five years, we have developed clinic-to-clinic telemedicine and programmed direct-to-patient telehealth. Prior to the COVID-19 pandemic, we built an integrated telehealth platform within our EHR EHR using a third-party provider, Extended Care.

“During the pandemic, using part of the FCC COVID-19 telehealth funds, we standardized the technology to allow video calls to be made from Epic through the ExtendedCare virtual care room to connect with patients. at any location, whether it’s a home, clinic, emergency department, intensive care unit, or brick-and-mortar clinic on nearby islands. “

This technological improvement has also enabled staff to better care for patients with COVID-19 who are hospitalized in the new emerging infectious diseases unit.

The FCC Telehealth Fund has awarded nearly $ 1 million to Queen’s Health Systems.

A massive increase in telehealth visits

Prior to the COVID-19 pandemic, staff planned to make about 2,500 telehealth visits in 2020, about half of which were likely direct-to-patient telehealth. Like most healthcare organizations, Queen’s Health Systems saw a massive surge in telehealth adoption during the early days of the pandemic in the spring of 2020.

Unlike many healthcare organizations on the continent, which have seen a rapid rise and fall in telehealth, Queen’s has seen continued and growing interest throughout 2021.

“From a provider perspective, whether the patient is in a COVID-19 isolation room, at home on a personal device, or in a physical clinic on nearby islands, the technology workflow and the whole functionality is exactly the same. “

Dr Matthew Koenig, Queen’s Health Systems

“We plan to make approximately 165,000 telehealth visits this year and we had the highest number of telehealth visits on record in October,” Koenig reported. “While the return to ‘normality’ will likely lead to some downward trend in telehealth as patients return to more in-person care, we expect telehealth volumes to continue to grow over the years. coming years.”

From a technological standpoint, Queen’s Health Systems uses the Epic EHR and network infrastructure supported by Cisco. For mobile and wall-mounted telemedicine equipment, it has standardized on Iron Bow Health CLINiC and Medview units using Cisco CODECs and, more recently, WebEx room kits.

Recent technology upgrades this summer

The organization previously used Cisco Jabber and DX80 videophones for point-to-point connections with Iron Bow telemedicine devices to support telestroke, tele-ICU and clinic-to-clinic telemedicine services. Recent upgrades completed this summer removed all devices from Cisco Unified Call Manager and registered all devices to the WebEx Cloud.

“This allowed us to use ExtendedCare to make multi-party video calls to devices stored in the cloud to allow us to use the same set of features for our direct-to-patient telehealth visits, while maintaining control of the remote camera and access to peripherals. like digital stethoscopes, ”explained Koenig.

“This enhancement has allowed us to achieve the holy trinity of features: 1) Epic Telemedicine Platform Integration, 2) Multi-party calling to enable remote family presence and video translation services, and 3) Access to remote camera control and peripherals during a multi-party video call. “

In the summer of 2020, Queen’s Health Systems invested more than $ 12 million to rapidly build a new 24 bed department for emerging infectious diseases with state-of-the-art sterilization, isolation and negative pressure rooms. , and telehealth services.

COVID-19 isolation rooms

From a telehealth perspective, staff needed a way to enable video recordings and telemedicine consultations for patients in COVID-19 isolation rooms to reduce the need for staff and providers to ” enter the patient’s room and use personal protective equipment, while ensuring that patients are safe and their medical needs are met.

“We also needed a mechanism to allow patients to see their family and friends while they were hospitalized in the isolation rooms,” noted Koenig. “Using COVID-19 telehealth funds from the FCC, we purchased Iron Bow Medview telemedicine units for all 24 rooms to allow staff and providers to make video calls with patients using remote camera control, high definition video and high quality external microphone. and speaker.

“After the technology upgrade this summer, when we registered Medview devices in the WebEx cloud and integrated ExtendedCare into Epic, staff and vendors can now call Medview directly from Epic. “

Based on the patient’s room number, Epic is able to correctly route video calls to the appropriate device associated with the patient. This allows any provider to access the patient outside of Epic without a connection or separate app and without having to know which device to call.

Telemedicine via Epic

The provider also has access to the full set of ExtendedCare features, including multi-party video, virtual family presence, video interpretation services, split screen and media capture in Epic while maintaining control over the remote camera. Additionally, the staff enables fast video and audio recordings with the patient directly from Epic with ExtendedCare integration.

“We are using the FCC’s COVID-19 telehealth funds to meet three important needs: 1) telemedicine equipment for COVID-19 patients in our new emerging infectious disease department, 2) telemedicine equipment for clinic telemedicine to clinic for patients on the Island of Kauai, and 3) the telehealth license fee to support scheduled and on-demand telehealth directly to patients for patients on their own devices, ”noted Koenig.

“Crucially, these three disparate use cases now follow exactly the same technology since we standardized the ExtendedCare telehealth platform now integrated with Epic,” he continued. “From a provider perspective, whether the patient is in a COVID-19 isolation room, at home on a personal device, or in a physical clinic on nearby islands, the technology workflow and the whole functionality is exactly the same. “

Providers can now access the ExtendedCare virtual care room directly from Epic and connect with the patient either by video call to a telemedicine device associated with the patient based on their location, or by video call with the patient on a smartphone or a computer. .

“While COVID-19 has dramatically increased the adoption of telehealth by patients and providers over the past 18 months, we are now using telemedicine equipment and licenses supported by the COVID-19 telehealth funds. of the FCC across the care spectrum, ”observed Koenig.

“These technologies are also used by a full range of provider types, including primary and advanced practice providers, emergency care providers, hospital and specialist physicians, to care for inpatients with the disease. COVID-19 and also provide routine patient care. at home and in brick-and-mortar clinics on neighboring islands. “

During the pandemic, Queen’s saw widespread adoption across all specialties, but the largest increase in telehealth adoption was in comprehensive neurology, psychiatry and weight management programs which continued to perform the majority of telehealth visits rather than in person.

When telehealth is particularly useful

Telehealth services are particularly useful for patients with significant mobility issues related to movement disorders, stroke, epilepsy or morbid obesity, or for patients with behavioral health needs who feel stigmatized by going to a psychiatric clinic.

“We still have important work ahead of us to better use data and analytics to understand the patient experience, why telehealth visits succeed or fail, the medical relevance of telehealth and in-person visits, and to determine valuable measures of success, ”said Koenig. . “Even determining an appropriate metric for a successful visit is a bit of a moving target.

“We have data in WebEx Control Hub, ExtendedCare, and Epic to determine that the video connection has taken place, and we have patient and provider survey data to gauge their satisfaction with the visit,” he continued. “For direct-to-patient telehealth visits, we are currently seeing that approximately 85% of patients are satisfied or very satisfied with the telehealth visit and we are seeing a technical success rate of approximately 85% as determined by the patient and the provider connecting by video for at least five minutes. “

None of these measures really answer the staff question about the value of telehealth, however, in terms of providing timely, impactful, and less expensive care than in-person care.

Measuring the impact of virtual care

“We are still in the early stages of creating reports and dashboards to measure the impact of telehealth visits on the total cost of care, emergency room visits and hospitalizations, patient satisfaction, patient care. duplicate or fragmented and other important metrics, ”Koenig said. “We are also in the first phase of using the technical data we have from the platform to determine the factors associated with failed telehealth visits.

“Identifying these factors – such as network strength, devices, geography, patient characteristics, previously unsuccessful visits – will help us develop an algorithm to predict which scheduled visits are likely to fail in order to that we can proactively connect with the targeted patients to resolve the issue. technology or move to another type of in-person or clinic-to-clinic visit. “

Twitter: @SiwickiHealthIT
Email the author: [email protected]
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