In March 2020, the number of new COVID-19 infections was rapidly increasing in Washington. With no vaccination or specific treatment on the horizon, Howard University Hospital, an academic medical center in the district, prepared for a major surge of COVID-19 patients.

Soon after the onset of the pandemic a racial disparity became clear. African Americans were disproportionately taking the toll of the infections and developed more serious and often fatal illness. With a large Black community in Washington, Howard University Hospital prepared for disproportionately more patients and more severely ill patients.

The hospital set up a tent to expand the emergency department and invested in major construction works to expand existing departments in preparation for a surge of up to 125% of its prior capacity.

Staffing new departments

"We had to deploy not only new beds, nurse call systems, oxygen lines and infection control solutions, we also had to prepare for staffing the new departments," said Dr. Kevin Dawson, CIO at Howard University Hospital. "Many physicians were interested in returning from retirement. However, they were afraid of the risk of COVID-19 exposure while being onsite.

"Considering the advanced age of retired physicians, they face higher risk of developing more serious illness," he continued. "Inpatient telemedicine seemed to be the perfect solution for solving this problem. By deploying telemedicine carts in the hospital, physicians could provide care remotely, irrespective of their location."

Early in the pandemic, to minimize infection risk in the hospital, staff implemented a no visitation policy. Without access to their loved ones, patients felt alone and isolated. To solve this challenge and improve patient satisfaction the hospital purchased hospital-grade washable tablets for patients to communicate when in isolation rooms or when the hospital is closed to visitors.

"A third component of our plan was to improve our wireless network," Dawson noted. "The opening of new departments and the deployment of telemedicine carts and tablets demanded better wireless connectivity."

$882,000 from the FCC

At this time Howard University Hospital applied for and received a $881,958 grant from the FCC telehealth fund to purchase telemedicine carts and associated software licenses, tablets and network upgrades to deploy in-patient telemedicine services in the emergency department, intensive care units, and medical/surgical departments treating patients with and without COVID-19 symptoms, including remote video and voice consultation and treatment of all patients to reduce the possibility of transmission.

"During the search for vendors, their ability to ship and deploy their products and services fast was important, as we had to spend all funds by September," Dawson explained. "Although the deadline was later extended, we were able to select the vendors and make all purchases by the earlier deadline.

"Cerner, our EHR vendor, helped us with the process," he continued. "We purchased 20 telemedicine carts with high-resolution cameras and software from Amwell, 90 tablets from CyberNet, and relied on our IT infrastructure partner Advanced Computer Concepts to deploy new wireless network equipment."

Parallel with deploying the technology, the hospital also evaluated the clinical and business processes of delivering inpatient telemedicine services. Staff addressed questions related to documentation of the visits, informed consent, government regulations, physician licensing and supervision of residents, and developed forms in the EHR.

Multi-way communication

"The telemedicine system currently is not integrated with other systems," Dawson said. "Clinical documentation is performed within the same systems that would be used during in-person consultation. The telemedicine system allows for multi-way communication. If consented by the patient, a resident in training, interpreter or the patient's family member can be part of a telemedicine visit.

"With the help of Amwell, we developed training programs for physicians and nurses," he added. "These trainings are delivered weekly upon request. Labor and delivery and psychiatry were two departments with much interest. Telepsychiatry visits are offered at all locations, with the highest interest in the emergency department."

One of the key goals with the program is to improve patient satisfaction. Between November and March, staff observed patient satisfaction scores increasing by 22-32%. Patients were surveyed by Press Ganey. One question asked patients to rate the hospital on a scale of one to 10. Patients were also asked whether they would recommend the hospital to others.

While the observed improvement is influenced by many other factors besides the deployment of the telemedicine program, staff believe that having access to a telemedicine solution and tablets contributed to the improved patient satisfaction scores.

Further improvements

"We currently are collecting satisfaction data with the telemedicine visits from patients and physicians," Dawson said. "We'd like to use this data to further improve the program. Moreover, we are working on better penetration of the program in clinical areas where it is still underutilized.

"We believe that making specialist visits more accessible could further improve patient satisfaction and may accelerate the clinical process by shortening the time between specialist consultations requested and delivered," he concluded. "Faster and streamlined clinical process may shorten length of stay and improve clinical outcome."

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