Even before COVID-19, Louisville, Kentucky-based Baptist Health was facing a variety of challenges: access to care, patient experience, the lack of specialists in its rural market and the lack of new patient acquisition strategies in the digital space.

THE PROBLEM

"For far too long, patients needed to follow the hospital's rules to seek care – must drive in, wait in a room, etc.," said Nick Sarantis, system director of digital health at Baptist Health. 

"The advancement of digital health helps to put some of the control back into the patients' hands. We have seen this change in every other aspect of life – banking, retail, insurance, entertainment, etc. – and consumer expectations had been evolving for quite some time."

Another problem Baptist Health was facing was nontraditional players such as Amazon, Walmart and Google entering the healthcare industry, along with dedicated national telemedicine companies such as Amwell, LiveHealth and others. 

With the billions of dollars invested into digital health companies in 2021 alone, these nontraditional players will serve as even greater competition in the future.

"The FCC funds were used to pay for the equipment to support nearly 1,000 providers' ability to provide video visit services to their patients."

Nick Sarantis, Baptist Health

"An additional problem was lowering readmission rates, in particular for COPD and CHF patients. But with COVID-19 the problem changed to 'How do we safely get patients out of the hospital quicker, but still safely, to free up beds?'" Sarantis noted. 

"Remote patient monitoring was something we had just begun to implement with a system strategy supporting it at the end of 2019 with Current Health."

PROPOSAL

Because of this work, Baptist Health was able to quickly pivot to supporting COVID-19 patients with remote patient monitoring technology with Current Health. Its work in the remote patient monitoring space is just beginning as it pivots back to its original clinical use-cases: to support COPD and CHF patients, along with looks at various levels of monitoring using Epic's MyChart care companion.

"We use Epic with Zoom as the video solutions," Sarantis said. "As part of Epic, we leveraged a wide array of MyChart tools and functionality to support the new virtual world we were forced to be in. Due to this we needed to add MyChart functionality to support these new functions, such as a dedicated MyChart support desk, the ability for net new patients to sign up for MyChart online, and advanced eCheckin functionality.

"Our specially designed carts were a homegrown solution built by our infrastructure and telecom teams leveraging Epic and Zoom workflows," he continued. "Designing a cart ourselves without relying on a vendor has allowed us to use the carts in tele-stroke, tele-ICU and other workflows, depending on the emergent need."

But the technology solutions are only as good as the operations that support them. Organizations can invest in the newest, greatest and most expensive technology. However, without the operations and workflows to support it, then it becomes an expensive cup-holder, Sarantis said.

"However, moving to video visits and other virtual solutions, including eVisits and telephone visits, allowed for patients to remain at home to seek care, and allowed for immunocompromised providers to treat patients from home," he explained. 

"The remote patient monitoring technology allowed for us to discharge COVID-19 patients while still being able to monitor in real time. This is essential."

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MEETING THE CHALLENGE

In the ambulatory setting, Baptist Health uses scheduled video visits for patients to see their primary care physician or specialist as they would have in the office. The health system uses urgent care video visits and eVisits to allow 24/7 virtual access to a pool of providers that treat common urgent care issues. These visits are also the first entrance point with regard to COVID-19 testing and isolation protocols.

"We use our Patient Connection Hub to proactively reach out to patients to see if they want to be seen virtually rather than in-person, or canceling their visit," Sarantis said. "We use our nurse triage call center to recommend virtual options whenever clinically appropriate. Again, we use Epic with Zoom integrated with a MyChart functionality."

RESULTS

Baptist Health notes two success metrics over the past 18 months.

In terms of outpatient visits performed digitally, at the start of the pandemic the figure was .005%. During the peak of the pandemic it was 58%. It has since averaged around 10%.

And a big-win success metric has been the ability to scale up quickly depending on the need: For example, 1,483 patients had an emergent tele-stroke consult at their hospital without the need to be transferred.

Other success metrics Baptist Health currently is tracking include the percentage of outpatient visits conducted digitally and the number of tele-stroke consults performed virtually that otherwise would have needed a transfer to another hospital.

USING FCC AWARD FUNDS

In 2020, Baptist Health was awarded $873,982 by the FCC telehealth fund for a remote telehealth platform, telemedicine carts, computers, tablets, remote monitoring equipment and videoconferencing equipment to expand the telehealth program at eight Kentucky hospitals and treat COVID-19 patients entirely with specially designed carts that connect critical care physicians remotely to patients without risking further virus spread.

"The funds were used to support issues related to the COVID-19 pandemic," Sarantis explained. "During the early months of the pandemic, when patients were either not allowed to come to the office or did not feel comfortable coming to the office, we needed to implement a wide variety of technology solutions.

"The FCC funds were used to pay for the equipment to support nearly 1,000 providers' ability to provide video visit services to their patients," he continued. "Some of the equipment needed included web cameras, echo-free microphones and speakers, iPads and Zoom licenses."

In the hospital setting, with patients in isolation rooms and visitation limited, the health system also needed technology solutions to provide both providers and patients a virtual alternative.

"Due to the pandemic, when every provider all of the sudden needed access to virtual solutions, the FCC grant allowed us to support all of these providers at once with the appropriate camera and microphone set-up," Sarantis concluded. "Without the pandemic's demands and the FCC grant, our approach would have been much more conservative, outfitting just a few practices over the course of the year, as opposed to all of them."

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