Bee Busy Wellness Center in Houston, Texas, like other health centers across the country, struggled with efforts to offer telehealth services to patients when the COVID-19 pandemic hit.

THE PROBLEM

As a way to be creative and to extend its healthcare program to those seeking services via telehealth, Bee Busy purchased mobile phones for clinical staff and iPads for providers to engage with patients who had iOS or Android systems, but failed in attempts at expanding its EHR to be compatible to offer telehealth.

So providers engaged with patients via mobile phones, on iPads and on laptop computers to address their healthcare issues. Patients engaged with their providers from the comfort of their own homes, while waiting for the opportunity to have face-to-face visits. Patients did visit the health center to access labs; however, they did not visit their provider in person in an effort to ensure their safety.

"Bee Busy Wellness Center provides services to patients who are immunocompromised," said Norman Mitchell, CEO of Bee Busy Wellness Center. "The telehealth services were not sufficient as they didn't allow communication with the company's EHR, and were not adequate to offer as much continuity of care."

Bee Busy targets the following areas: Southwest and Southeast Houston, Prairie View, Waller County, Montgomery County and the Clear Lake Area. The targeted population includes individuals living at or below 200% of the federal poverty line, homeless people, and those with limited or no access to the Internet.

PROPOSAL

Bee Busy Wellness Center developed a proposal to address the dilemma. The proposal sought to purchase telehealth equipment to outfit the health center's complete network of locations and services to all patients accessing healthcare.

"The proposal was designed to address the HL7 compliance by offering the telehealth services via a closed-circuit system, complete with two-way broadcasting, protected health solutions and client safety," Mitchell explained. "The system would have multiple access points and allow ease of use by providers and patients alike. The system would offer patients access to translation services, and alleviate connection issues."

Further, the system would be offered on a Zoom medical platform, have access points in each exam room, give patients access via Android and iOS systems and provide secure licenses for capturing signatures via Docusign, he added. The proposal included adding training for staff to use the system and offering access to send secure data to patients via hightail, he said.

MARKETPLACE

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MEETING THE CHALLENGE

Bee Busy, with its makeshift telehealth setup, offers telehealth services, including remote patient monitoring, patient education, support services and provider visits. The provider visits include a review of systems, a diagnosis, treatment regimen, health literacy assessment and a discharge summary. Prior to COVID-19, Bee Busy performed minimal telehealth services; however, the pandemic encouraged the health center to increase capacity to offer telehealth services to a broader audience.

"Bee Busy Wellness Center has used our current makeshift telemedicine program to address the needs of the patients," Mitchell said. "Providers used mobile phones and iPads, staff used mobile phones and laptops, and patients used their personal mobile phones. The system has not been integrated into the health center's EHR and efforts to bill have been a nightmare."

Mitchell said the center's EHR, from vendor Aprima, is seldom heard of and not an easy system to use, which presented its own set of challenges.

"The makeshift telehealth setup all seemed to work, though far from seamlessly, and far from the expected outcomes expected by the providers," Mitchell reported. "Patients were given glucose and blood pressure monitors to check their vitals and then document and deliver those to the providers. This made it difficult to manage some patients who couldn't adhere to the strict guidelines of our makeshift telemedicine program."

RESULTS

Some of the accomplishments of the current telehealth program include: increased capacity for telehealth services; expanded hours of operation; and increase in area and number of patients.

"Bee Busy Wellness Center struggled to reach even the simplest metrics: increase in number of patients who access telehealth services, for example," Mitchell admitted. "This was achieved by our rudimentary efforts at developing a telehealth platform to address our patient population. It was sticky at times, attempting to host a telehealth call and gather information from patients; however, the health center staff were aggressive as to … [managing] with the limited resources at their disposal."

Bee Busy wanted to increase patient access to telemedicine by offering a simple solution to patients, provide them with glucose and hypertensive screening devices, offer them remote case management and care coordination, and develop a stronger relationship with the patients involved in their own healthcare. These were met with the makeshift telehealth program.

"Further, we wanted to address managing healthcare issues of critically ill patients who accessed our brand of telemedicine," Mitchell said. "With the extreme stretch of our resources, deploying staff in areas where they needed additional training and supervision, the health center was successful in managing and improving health outcomes of patients who accessed our telehealth program."

USING FCC AWARD FUNDS

In the spring of 2020, the FCC's telehealth program awarded Bee Busy $182,854 to purchase video monitors and connected devices to provide primary and preventive medical services, including remote monitoring, diagnosis and treatment, to COVID-19 vulnerable populations in Houston and surrounding areas.

"With the funding received via the FCC award," Mitchell explained, "Bee Busy plans to purchase an actual telehealth platform, including the following: 27 PolyCom Studio systems and 27 32-inch Samsung LED Health monitors, one to be installed in each exam room, medical Zoom licenses to ensure patient confidentiality, four 72-inch training screens to be used by staff to offer remote training to current and future staff as well as training for students on campus remotely, all further expanding our telehealth program."

It further intends to upgrade the health center's IT infrastructure to include a fiber-optic system to improve communications between patients and providers, allowing ease of transmission of data and information between all parties involved.

"Purchasing these devices, the health center will be in a position to offer telehealth services not only to patients in and around the service area, but to [those] beyond our current service area," Mitchell noted. "Offering telehealth services will expand our healthcare program beyond the Houston area. One specific goal of Bee Busy's telehealth platform is to include access to 135 specialists to offer low-cost, ease-of-access availability to patients without regard to their ability to pay."

These services will greatly expand healthcare services and offer a great solution to patients needing access, he added.

With the new telehealth program it is building, Bee Busy hopes to accomplish the following:

1. Implement a certified telehealth program designed by providers and patients to increase access to healthcare services.
2. Offer a low-cost and efficient healthcare alternative to persons seeking healthcare services.
3.  Provide enhanced telehealth services, including remote patient monitoring, improved patient engagement and improved health outcomes.

"Bee Busy's governance and executive leadership is committed to the success of this project," Mitchell concluded.

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