St. Luke's University Health Network realized it needed technology that could help expand care across its 14 hospitals throughout Eastern Pennsylvania and Western New Jersey spanning both urban and rural areas.

THE PROBLEM

The organization was looking for a way not only to expand network coverage but also to reduce time to consult. It also wanted to expand access to care whenever patients needed it, which St. Luke's knew would require additional clinical coverage. The provider organization realized through virtual care it could enable its clinicians to see patients much faster.

"Another problem we had was with the number of solutions we were using," noted Jody McCloud Missmer, behavioral health network administrator, St. Luke's University Health Network. 

"We had multiple platforms in place so it was important that we could find a solution that worked within our EHR, to make the process simpler for our care team members and would be sustainable for the long term.

"We also needed to make sure the solution could accommodate language preferences to meet the needs of our diverse patient population," she added.

As St. Luke's, like many other healthcare organizations, saw an uptick in mental health patients during the pandemic, it knew it needed to act fast to meet their needs and be able to ensure continuity of care for patients – even for those who contracted COVID-19 – while keeping the organization's providers and employees safe.

"Further on the employee side, we saw an opportunity to leverage technology to help with the self-care of our employees and their families," said Amie Allanson-Dundon, network director of clinical therapy services, St. Luke's University Health Network. "We know healthcare workers have higher rates of stress and anxiety, and in looking at how much our employees leveraged our St. Luke's services, we saw a need to improve their access to quality mental healthcare."

PROPOSAL

The biggest challenge was finding a platform that would fit St. Luke's needs and help the organization combat the aforementioned challenges. The organization needed a platform that had high privacy standards and could take into account any needs for face-to-face consults. St. Luke's decided on telehealth vendor Amwell and the digital health subsidiary of Amwell, SilverCloud Health.

"We currently are partnering with Amwell to power virtual care solutions across our enterprise, including both software and hardware solutions, as well as Amwell Psychiatric Care," McCloud Missmer said. "We felt the company offered a consistent solution that could support the various virtual care needs across St. Luke's, with strong results promised through effective and sustainable usage.

"Furthermore, using Amwell Psychiatric Care, we could offer psychiatric care services to our patients at all times of the day, allowing us to expand our network coverage while reducing the time to consult and increasing our scope," she added.

For the employee program, St. Luke's studied 12 different platforms and was impressed with how SilverCloud could meet its needs.

"They are clinically proven and evidence-based," Allanson-Dundon said. "They offer self-guided and coached interventions and are available 24/7 – all of which was attractive to us."

MARKETPLACE

There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News published a special report highlighting many of these vendors with detailed descriptions of their products. Click here to read the special report.

MEETING THE CHALLENGE

St. Luke's always had wanted to leverage virtual care for psychiatric services but was restricted by regulatory and reimbursement issues. When the pandemic hit, it opened regulatory and reimbursement doors, allowing the organization to take virtual care to the next level.

It started to use virtual care technology in the inpatient unit, emergency department, outpatient unit, integrated care and school-based care – across the board.

"We created a Virtual Remote Monitoring Center (VRC) at the beginning of the pandemic that was connected to multiple systems and included predictive analytics so we could have a 24/7 registered nurse available to monitor patients with COVID symptoms from home and not keep them in a hospital setting," McCloud Missmer explained.

"Through the VRC, we were able to monitor more than 6,000 patients," she continued. "The VRC still exists today and probably will be a central enterprise for other virtual monitoring and virtual nursing needs for the foreseeable future."

To ensure patient privacy, St. Luke's conducted at-home tests with every practitioner to make sure privacy requirements were met. Because it anticipated issues with WiFi reliability and technology resistance, St. Luke's formalized a Virtual Care Operations and IT Team that was available to provide support to patients and answer questions 24/7.

"To support employees, we collaborated with SilverCloud and did a custom build," Allanson-Dundon noted. "We offered a self-paced program across stress, anxiety and depression, providing self-guided support from a social worker and coaching interventions that were accessible 24/7 via an app on their phones, tablets or computers.

"If patient acuity exceeded the program's capability, the patient was referred to an Employee Assistance Program or a St. Luke's therapist or otherwise, as necessary," she continued. "Employees also now can benefit from programs focused on insomnia, resilience and alcohol use."

The provider organization also started a program called "Supporting #StLukesStrong," which features weekly virtual sessions for employees led by either a psychotherapist, a psychiatrist or a chaplain trained in critical incident briefing.

RESULTS

By implementing the telehealth model, one of St. Luke's biggest questions was how to ensure the program would work while meeting unique needs, both from a staff and patient perspective.

"We used the PHQ-9, a reliable tool for measuring mental health outcomes, to look at the difference in results between in-person and virtual visits from July 2021 to March 2022," McCloud Missmer said. "We found that, of those patients seen in person, 90% reduced their score by at least 6 points. Meanwhile, 96% of patients seen virtually reduced their score by at least 6 points.

"Of the 92% of in-person patients who started with a score higher than 10, 76% ended with a score less than 10," she continued. "And of the 96% of virtual patients who started with a score higher than 10, 88% saw an end score less than 10."

The results show that patients got better in a virtual setting as effectively as they did in an in-person setting. Perhaps most important, telehealth provided the flexibility to pivot along the way and maintain a consistent care continuum for patients from wherever they were.

"When we look at virtual care across the board, comparing pre-pandemic to now, we see tremendous patient adoption," she said. "Over 205,000 unique patients received telehealth care at least once between March 2021 and March 2022. In the peak month of April 2020, St. Luke's provided 82,000 virtual services across our network."

Another area of remarkable improvement was in the organization's outpatient no-show rate. In 2020, St. Luke's already prided itself in having a low outpatient no-show rate of approximately 14%. Through the use of telehealth, it has reduced that no-show rate to just 6%, highlighting the tremendous impact that the flexibility of telehealth had on patient attendance.

The "#StLukeStrong" program provided consistent, valuable mental health support to St. Luke's frontline workers throughout every stage of the pandemic, Allanson-Dundon reported.

"Our first series, from April to May 2020, consisted of 12 weekly virtual sessions and benefited 1,276 employees," she noted. "Our second session, from December 2020 through February 2021, featured weekly sessions with an average of 48 attendees per session. A total of 576 employees benefited.

"Our most recent series offers weekly virtual sessions and continues to draw attendance with an average of 100 weekly attendees," she added.

ADVICE FOR OTHERS

Think holistically and comprehensively, McCloud Missmer advised.

"For us at St. Luke's, it was important that we not only took care of the mental health of our patients but also our employees," she said. "Look for a partner that can provide a solution that will be sustainable for the long run – one that supports future needs.

"This may require you to think a few years down the road, but it will be worth it to have a platform that can evolve with you and the needs of your patients and care teams," she continued. "Careful planning is important. Know the success metrics that matter to you and how you want to measure results. Success can be achieved through assessment, planning, implementation, process and outcome evaluation."

Having a dedicated IT team also is important to help facilitate streamlined services, as well as overcome any technology resistance that may exist and help educate on proper technology use across the enterprise, she added.

"On the employee side, offer a digital solution that is easily accessible and clinically proven," she concluded. "Throughout the process, it is paramount to understand and listen to your employees while encouraging ongoing conversations around mental health and well-being. Finally, make sure to get leadership buy-in from the start."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.