At Central Maine Healthcare in Lewiston, Maine, the pandemic created an acute need to adopt novel tools to deliver on its commitment and ability to ensure that patients were able to receive the care they needed without increasing their risk of exposure to COVID-19.
The health system quickly experienced patient volume declines as it postponed elective procedures and surgeries. Simultaneously, patients were hesitant to seek in-person care for many of their health concerns.
“The loosening of the telehealth requirements by CMS, specifically mandating that telehealth visits be reimbursed on par with office visits, was essential to successfully navigate through the early days of the pandemic,” said Dr. Steve Martel, chief medical information officer at Central Maine Healthcare. “Our organization quickly identified a solution that would allow us to extend telehealth opportunities to patients where clinically appropriate.”
Central Maine Healthcare looked to telehealth vendor Innovaccer, which allowed it to quickly stand up a platform that could easily be used by team members and patients, he added.
In addition to having the ability to electronically offer patients the COVID-19 screening questions, Innovaccer’s telehealth platform offered the opportunity to craft a tool that would allow the health system to easily schedule patients and conduct video visits.
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MEETING THE CHALLENGE
The strategy for deployment of the Innovaccer telehealth platform focused on primary care. The platform is used by physicians, nurses, medical assistants, patient service representatives (PSRs), mid-level providers and social workers throughout the organization. Staff chose to go with a standalone solution rather than an integrated solution in order to become operational as quickly as possible because of the pandemic.
“When patient environmental factors are considered, we have been able to achieve more than 90% successful video-visit completion.”
Dr. Steve Martel, Central Maine Healthcare
“We have modeled the telehealth workflow after our clinic workflows,” Martel explained. “PSRs schedule the patient visit, which then sends the patient a text message and/or e-mail link to the visit. Fifteen minutes prior to the visit, the patient receives a reminder text and/or e-mail. Once the patient initiates the visit and appears in the clinic’s virtual waiting room, the PSR will begin the call to collect any registration information that is needed.”
Once they have concluded their part, the PSR returns the patient to the virtual waiting room. At this time, the medical assistant will perform their role before returning the patient to the virtual waiting room with a status of ‘Ready for Provider.’ The provider sees only those patients in the waiting room that are scheduled to them and is easily able to connect the call.
Once the call is complete, the provider has the ability to end the call or return the patient to the waiting room for a PSR to complete the checkout process.
“In order to ensure the telehealth solution would meet the needs of our patients and team members, our project team, led by me in partnership with our medical group leadership, met many times a week to troubleshoot issues and offer ideas for enhancements,” Martel explained. “One of the most satisfying experiences working with Innovaccer was how quickly they incorporated our suggestions into the platform.”
The vendor’s willingness to work quickly to add features – including inviting loved ones to a visit, adding additional statuses to the waiting room workflow and sending appointment reminders – have had positive impacts on adoption and patient satisfaction, he added.
To date, Central Maine Healthcare has conducted more than 25,000 telehealth visits since the beginning of the pandemic lockdown in March. The health system established ease of use and successful completion of a call as two of the primary telemedicine metrics.
“We conducted surveys of our team members where more than 90% of them reported that the platform was easy to use,” Martel reported. “They commented that scheduling appointments was straightforward and establishing the start of a visit with a patient was intuitive. They also appreciate the continuing evolution of the platform to bring additional enhancements that expand upon the existing functionality of the technology.”
The health system has targeted a 90% successful completion rate for telehealth calls. As a predominantly rural state without widespread high-speed internet access and/or strong cellular phone reception in many of the areas it serves, the health system has had to be selective about which patients have the tools to have a successful video visit.
“The majority of incomplete video visits is largely due to lack of high-speed Internet or strong cellular phone reception,” he explained. “When patient environmental factors are considered, we have been able to achieve more than 90% successful video-visit completion.”
USING FCC AWARD FUNDS
Earlier this year, Central Maine Healthcare was awarded $270,172 for computers, tablets, network upgrades and a telehealth platform to design, implement and support an integrated telemedicine application across three sites for the use of video telehealth, including specialty consultations between a provider in a distant facility and a patient, typically in a rural community, in a different facility.
“We are using the FCC award funds to expand our telehealth offerings to our specialty and surgical service lines as well as our hospitals,” Martel said. “The funds are used for necessary hardware purchases for cameras, telehealth carts, iPads and other infrastructure needed to ensure a successful program.”
Moreover, he concluded, the health system will use the opportunity to expand its ability to conduct inter-hospital consultations so patients can have access to immediate specialty care wherever they may be hospitalized in the health system.