At Philadelphia's Albert Einstein Medical Center, whose health system serves a large geographical area and offers complex quaternary care, telehealth has been an innovative solution to several care delivery problems. These can be categorized in three areas: patient/staff safety, communication and logistics.

THE PROBLEM

Patient and staff safety, which are primary concerns, were especially critical after the COVID-19 outbreak and subsequent mandatory shut-downs nationally.

In the state of Pennsylvania, only urgent medical care was permitted for several months, which created an instant barrier to receiving routine, follow-up and preventive care.

"We were almost immediately able to overcome that challenge and deliver care to our patients using a telehealth solution when patients were unable to come to us face-to-face," said Reshma Patel Stone, associate vice president of planning and business development at Albert Einstein Medical Center. 

"Although the statewide mandates have been lifted for care delivery, we still use telehealth as a solution for our patients who feel safer at home.

"To protect our staff and patients who are in the hospital or in our clinics, we use telehealth to care for those suspected to have COVID-19 or who have COVID-19 symptoms without bringing them into the office and unnecessarily exposing others to the virus," she added.

The second challenge that telehealth has helped the health system overcome is that of communication with patient family members and loved ones for decision-making. It often is challenging to organize a meeting date and time with family members and a care team.

Telehealth has been an elegant solution to this and has allowed staff to hold family meetings where care providers can show their face via video and provide time to answer questions, she said. This also has been highly effective in coordinating multiple physicians caring for the same patient on one video call, she added.

"The most important result we have achieved is we have been able to meaningfully and effectively remain connected to our patients since March 2020 using telehealth solutions."

Reshma Patel Stone, Albert Einstein Medical Center

"The pandemic did not take away the need for support groups and education sessions, and our telehealth technologies allowed us to transition these group meetings to virtual events where our community can see each other, ask questions and meet care team members," Stone said.

"This has been such a successful transition and due to the significant number of patients and community members participating, we expect to continue to hold virtual support groups, education sessions and seminars well into the future.

"Additionally, we were able to use telehealth for various other providers, including, but not limited to, genetic counselors, social workers and dieticians," she continued. "Dieticians found this extremely useful, as they were able to work with patients on reading labels and seeing what is in their fridge and pantry if the patient was comfortable enough to share."

Finally, a tremendous challenge that telehealth continues to allow the health system to overcome is that of getting patients safely to the provider for care.

"Many of our patients struggle with transportation issues, whether it is available or accessible public transportation or physical disabilities that make a trip to the doctor's office difficult," Stone said. "Telehealth has helped us work around this, and we have given our patients with these concerns a direct connection to a doctor's visit from the comfort of their home.

"We have additionally implemented a process wherein our nurses who conduct home visits for our most high-risk patients bring tablet technology to their bedside in their home and help them navigate through their telehealth visit," she noted.

"In some of our primary care locations, we have implemented the ability to connect with a specialist via a telehealth visit while the patient is already at the primary care office to avoid having to make multiple trips."

PROPOSAL

The virtual care technology vendors Albert Einstein Medical Center currently uses include Teladoc, Doximity, EMOpti and Zoom.

"Focusing primarily on Doximity and Zoom, given that the majority of our virtual care occurs using these platforms, the proposals were very similar," Stone explained. "Both offered a video platform through which our users can send appointment links to patients and connect to them in order to conduct a video visit.

"Some differences with each vendor exist in terms of how the links are sent and the availability or need for a smartphone app to conduct the visit," she continued. "Both vendors are HIPAA-compliant and work with healthcare providers nationally. They have both been recognized as trusted consultation platforms and have stable, secure video quality for our patients and providers."

Both vendors pitched the ability to seamlessly connect and stay connected. They also proposed their products would allow the health system to maximize resources available by having seamless access and maintaining patient satisfaction due to the availability of a video call versus an audio-only call.

MARKETPLACE

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MEETING THE CHALLENGE

Most Albert Einstein Medical Center providers converted their face-to-face visits to virtual ones during the height of the pandemic. This has leveled off, with approximately 10% to 25% of all visits remaining virtual, depending on the specialty.

"Our physicians, advanced practice providers, nurses, therapists, techs and other care team members connect with and care for the patient in a virtual space via telehealth technology," Stone said.

Some examples include:

A physical medicine and rehabilitation physician may ask a patient to sit, stand, lay down or move their body to determine range of motion, pain levels and other assessments through careful observation via camera, in the same way they would in person.

A behavioral health provider can discreetly conduct a counseling session with the patient at a time and place most convenient for them via video visit.

A patient recently discharged from the hospital can follow up with their primary care provider effectively through a video visit and avoid another trip.

A transplant social worker can perform a virtual check-in with a patient on the waiting list for an organ.

RESULTS

"The most important result we have achieved is we have been able to meaningfully and effectively remain connected to our patients since March 2020 using telehealth solutions," Stone stated. "We did not have to turn patients away and we provided them extended days and times with which to connect to us.

"It was important to us that we measured success with this new care modality," she continued. "We set a goal for all providers, with minimal exceptions, to have telehealth hours carved out in their schedule, for practices to provide telehealth blocked time during the week, and for every specialty to have telehealth super users. All of these goals were achieved and continue to be in place."

Because the health system cares for a population that might not have accessibility to smartphones and/or may struggle with smartphone technology, it was critical that it provide resources and education along with this effort.

"To that end, we implemented some tactics to achieve this and measured our telehealth success in terms of the percent of audio-only phone calls versus video and audio visits," she said. "We exceeded all our goals, and more than 82% of our telehealth visits are video and audio visits at this time."

USING FCC AWARD FUNDS

Albert Einstein Medical Center in 2020 was awarded $315,357 by the FCC telehealth funding program for a triage software license, a telehealth platform, laptop computers, tablets, videoconferencing equipment and software licenses, and a remote patient monitoring platform to serve a patient population at increased risk for adverse outcomes from COVID-19 infection and to help triage the busiest emergency department in the city.

"The funding allowed us to immediately offer telehealth capabilities to more than 300 physicians and other providers that accept scheduled appointments," Stone said. "We implemented Zoom for Healthcare and Doximity Video Dialer to immediately begin to connect with our patients virtually. We continue to use this technology to offer this convenient option for patients.

"We also were able to use the funding to set up the infrastructure to provide a virtual urgent care solution for low-acuity visits for our employee population," she concluded. "Lastly, the funding allowed us to implement a tele-triage system in our three emergency departments across our network. Our providers were able to serve multiple facilities simultaneously using this platform."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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