Before shifting gears to telemedicine, the technology infrastructure of Southwest Mississippi Mental Health Complex in McComb, Mississippi, was very old and extremely limited. The last computers purchased across the agency were acquired in 2008.

THE PROBLEM

Because of the age of the equipment, the provider organization was unable to upgrade it. Further, the older equipment did not make the best use of the broadband the organization was using through USAC funding.

"We had not been able to upgrade any software, some of which actually expired in 2019, and the network server and server software also needed to be upgraded," said Margo Brooks, director of administrative services and special projects at Southwest Mississippi Mental Health Complex. "In essence, all of our equipment was very old and the software even older.

"Aside from the equipment issues, we were only able to offer limited telemedicine services," she continued. "At best, services were offered telephonically.

"We serve a very rural, poverty-stricken area – Southwest Mississippi Mental Health Complex is one of 14 state-sanctioned mental health regions in the state. It is the largest of the designated geographic regions – more than 150,000 individuals, encompassing more than 5,000 square miles – most impoverished with an average of 27.5%, and the most rural with an average of 38 persons per square mile," she went on.

At the onset of the pandemic, the organization was losing dozens of clients per week, resulting in a 50% decrease in the number of clients served in the first three quarters of 2020. Even to offer services by telephone alone was a challenge for the client population, in that many of the clients' cell phones had very limited data plans and patients refused to use their plans to access services.

"Our region serves nine counties in southwest Mississippi, operating out of 14 offices. Our two largest – most served and most clients – are in Pike and Adams counties. All of the other seven smaller counties only have services for two or a maximum of three days a week from a therapist, and often only twice a month from a nurse practitioner for medical evaluation services," Brooks noted.

"Perhaps a more underlying benefit of this FCC award is the effect on staff morale."

Margo Brooks, Southwest Mississippi Mental Health Complex

"Prior to telehealth services, this has constantly created problems for maintaining a substantive caseload in each of these seven counties and to adequately provide services," Brooks added. "Another problem we have encountered over the years is our ability to work with law enforcement to provide services in a safe manner to detainees."

Many of the area police and sheriff's departments had difficulty transporting clients from the jail or other places within the community where they picked up clients to one of the provider organization's facilities. Additionally, there is always a safety risk in transporting these clients to facilities.

"Within every facility, we serve both adults and children," she explained. "We have seen instances where children are traumatized when they bring someone in in cuffs, aside from the trauma of an armed officer entering the building. Our preference has always been that these clients would be seen through telehealth services."

PROPOSAL

Last year, Southwest Mississippi Mental Health Complex applied to the Federal Communications Commission for one of the agency's special telehealth grants.

"The focus of our proposal to the FCC was to broaden the availability of services to clients, better enable staff to provide services and ensure we always are available to clients through a broad range of service options," Brooks explained.

Using the $659,092 FCC grant the organization received, it was able to make substantive changes in its provision of services:

• More than 80% of staff received new computer equipment, including upgraded desktops, tablets and laptops. It is important to note, Brooks said, that none of the "field staff" had tablets prior to this funding and were always challenged with having to return to an office to capture notes from their visits with clients in the community.
• The organization purchased 14 telemedicine carts, placing one in each of the 14 sites throughout the region.
• The organization purchased three telemedicine kiosks that were placed in the largest sheriff's departments served by the region.
• With an upgraded server, the organization was able to establish the appropriate back-up system, expand broadband usage and allow for expansion of services across the region to new sites.
• It upgraded the software within several areas to improve staff productivity.
• The organization purchased a "Mist" system that enabled a client to access a "guest" service login from the parking lots of facilities or within a reasonable proximity of a building that allowed them to access services without entering facilities, if so desired, and not using their data plans for service.

"With these enhancements: 1) We were actually able to provide telehealth services; 2) field staff could access our EHR from their tablets or laptops; 3) even when staff could not come to the office, they were able to provide telehealth services; and 4) services are now being offered more frequently in our smaller offices without the need for staff to travel to those offices, substantially reducing the travel costs to the organization," said Brooks.

MARKETPLACE

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MEETING THE CHALLENGE

The telehealth technology is used by all clinicians – nurse practitioners, therapists, nurses and community support specialists. Because of the area spanned by the region, clients may show up at one office and a staff person from another is able to provide services. This has helped the organization's ability to offer services whenever and wherever they are needed.

"For telemedicine services, we are using a software service called Agnes Connect," Brooks reported. "Agnes Connect is an encrypted, cloud-based telemedicine platform that lets healthcare providers become remote workers. The ability to meet with patients via video conference is the primary focus, but the software also lets you capture and share medical data and exchange documents and medical images in real time.

"The telemedicine carts that we are using were purchased through a Mississippi-based company called BCI Answers," she continued. "BCI Answers provides the convenience of having a single source technology partner for the configuration, procurement, implementation, management and maintenance of IT and networking solutions."

The actual carts are a product of another Mississippi-based company, Howard Technology Solutions. These partnerships helped guide the development and implementation of a successful telehealth process, she added.

RESULTS

The ability to upgrade the network, the agency and staff equipment, and software has significantly aided Southwest Mississippi Mental Health Complex in regaining and increasing services across the region.

"From July 1, 2020, to June 30, 2021, we have experienced a 30% increase in clients served, compared with the loss of 50% of clients over the six-month period from Jan. 1, 2020, to June 30, 2020," Brooks reported. "Prior to June 2020, only one nurse practitioner was using a service online to provide telehealth services. Currently, the telehealth services are used by three nurse practitioners and 44 clinical staff.

"The availability of functioning, up-to-date computers and software has significantly aided the agency in sustaining itself through this pandemic," she continued. "Currently, approximately 15% of daily services are provided through telehealth."

USING FCC AWARD FUNDS

Southwest Mississippi Mental Health Complex was awarded $659,092 by the FCC's telehealth funding program for telehealth carts, computers, tablets, telehealth software licenses, network upgrades and remote monitoring equipment to increase the availability of telehealth services for treatment of substance abuse and mental health services across an eight-county region, with an emphasis on COVID-19 patients and families, as well as frontline workers caring for COVID-19 patients.

"Perhaps a more underlying benefit of this FCC award is the effect on staff morale," Brooks observed. "The equipment and services the agency had been using was older than most of the staff currently employed. The new equipment has created such a sense of enthusiasm among the staff to have the opportunity to use better equipment and move to this type of technology. Clients may or may not see the intrinsic value, but it has greatly aided us in providing a higher quality of services."

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