The population served by St. Thomas Community Health Center in New Orleans, Louisiana, was particularly hard hit by COVID-19. In fact, during the first few months of the pandemic, New Orleans was second only to New York City in the intensity of impact.

THE PROBLEM

The health center tried to use its existing telehealth platform, doxy.me, to reach patients. But for much of its population – largely older, African American and Medicaid-eligible – the technology was extremely challenging and added more anxiety to an already stressful situation. Staff realized that many of their patients had little or no Internet access and also lacked experience using mobile technology.

"Although clinicians attempted to conduct telehealth visits using doxy.me, patients had difficulty, often because they lacked broadband access or telehealth-adequate devices, or were unable to enable the camera or microphone properly," explained Dr. Don Erwin, CEO of St. Thomas Community Health Center. 

"Even those with smartphones had mixed results," he said. "Sessions that needed to be audiovisual were often completed by telephone only or not at all."

This caused a great deal of frustration and confusion. Staff simply were not getting the results they needed to address patients' needs in a crisis situation, where immediate access to healthcare can make a difference between life and death.

PROPOSAL

St. Thomas Community Health Center turned to telemedicine technology vendor Sano Health to tackle the challenge.

"The first thing Sano Health did was to listen in order to gain insights, to better understand the specific needs of our patients," Erwin recalled. "Their expertise in both healthcare and telehealth really shined through; they were extremely diligent in pulling back the curtain on underlying issues, both on our side and on the patient's end."

The vendor also was extremely flexible and customer-focused – if the health center asked for a tweak to the standard platform or feature, the vendor team always strove to address the needs, he added. Ultimately, the vendor provided a customized solution that would be both turnkey and intuitive, something that would work for the specific patient population, he said.

"This was an iterative process. The Sano Health team provided guidance on how to make telehealth accessible and easy to use," he explained. "Their team worked hand in hand with our patient liaison to understand the issues she was experiencing, and addressed her challenges in the solution that was deployed to our patients."

Once the devices were in the hands of patients, the vendor continued to work with the health center to refine the solution, develop how-to videos that guided patients every step of the way, and alleviate the burden on practitioners. 

Telehealth use is in its infancy, Erwin contended, and the health center's continued partnership with the vendor is essential as the provider continues to evolve its solution based on an ever-better understanding of how it is being used by patients.

MARKETPLACE

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MEETING THE CHALLENGE

Sano Health worked closely with St. Thomas Community Health Center to develop a custom telehealth solution that struck the right balance between simplicity and functionality.

For example, health center staff knew a cluttered home screen would be confusing for the population they were trying to serve. They settled on a solution that includes access to doxy.me telehealth, texting, MyHealthRecord EHR, limited voice calling and the St. Thomas website.

"With their easy-to-hold, easy-to-use Sano devices, patients can now access our EHR without having to figure out how to download the app," Erwin said. "They can start a doxy.me telehealth session without answering confusing questions about enabling the camera and microphone, since permissions are preconfigured."

The health center also ensured the device primarily is a healthcare tool to be used by patients to connect with their healthcare providers and provide them access to important information.

"With the Sano platform, we are able to restrict and relax access to additional information and functionality as it makes sense over time," he said. "We also have monitoring capability to see how the devices are being used. We can use this information to refine and improve the product for our patients and to monitor the success of the program."

The customized video presentation and FAQs loaded onto each device provide tremendous support and help patients gain confidence in using telehealth technology, he added. By giving patients a dedicated and simplified device with detailed and customized usage instructions, the health center is enabling them to get comfortable using digital services, he said.

RESULTS

Erwin said that the health center has been successful in identifying patients who absolutely needed these devices. The health center alerted its staff of more than 30 clinicians of the availability of the Sano devices and told them to request a device for older patients with chronic medical conditions who had been unable to conduct an audiovisual visit.

"Our staff were able to act on these requests and distribute the devices, including by using our connections with church pastors in the community," he explained. "And the devices are being used. Within a few months of distributing the first 400 devices, we were able to conduct approximately 900 audio/visual visits that would otherwise not have happened due to technical limitations."

In addition, these devices have been an important tool in addressing social isolation among seniors.

"We distributed to the Mercy Endeavors Senior Daycare Center 30 customized devices that included Zoom, in addition to the more medically oriented applications," Erwin said. "Due to the fact that the devices were so easy to use, our seniors have gravitated toward them with enthusiasm on a daily basis, with many using video conferencing for the first time, including seniors in their late 90s!"

ADVICE FOR OTHERS

It is paramount to consider the user experience from the onset, Erwin said. He offered plenty of telehealth advice to his peers, including:

• Make sure the cellular coverage is adequate in the areas where patients live. To that end, the vendor may have to work with a number of wireless providers to get the optimal coverage.
• Accept that this is not a one-time thing, but an iterative process. It is important to work with a vendor that has experience providing solutions and services to the type of patient population being served. Select a vendor that is flexible and has the wherewithal and patience to be thorough in product development to define the right menu and patient experience.
• Deciding which patients will receive the telehealth devices is very important. It should be addressed early in the process. Equally important is determining how to distribute the devices and how to track which patients received a device, and when.
• Defining the right metrics to measure success, and to tweak as needed, is essential and should be done early in the process.
• Training and education are paramount. Will there be members on the team who need to be trained to provide patient hand-holding when needed? Although the vendor selected must have customer service resources, issues that pertain to the telehealth solution will arise that only the internal team can manage. Empowering those individuals with the right tools and information will make all the difference in developing a trusting relationship with patients.

"I strongly recommend doing interviews of patients and staff, as these provide a window into what the ultimate solution should look like," said Erwin. "This brought us much closer to our users and we learned so much in the process that will help them to see us as a partner in their healthcare."

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